bluuebunny/crossref_metadata_2025 huggingface dataset:
923-P: Benefits of Electronic Consultations (E-Consults) in Improving Diabetes Care within a Safety-Net Health System
Authors: GUNAWAN FELONA , AJAZ SYED , MENEGHINI LUIGI , GUNASEKARAN UMA
Published: May 2022

Timely access to diabetes specialty care is often limited by resources, especially within a safety-net health system serving a large under/un-insured and ethnically diverse patient population. Implementation of a diabetes electronic consultation (e-consult) service offers several potential benefits, including timely access to diabetes specialists’ input, improvement in patients’ glycemic control, decreased need for in-person referral or visit (a potential benefit to patients and providers) , and an opportunity to support primary care providers with targeted education. We performed a retrospective electronic medical record review of completed diabetes e-consults within a 3-year period (2018-2021) at a large safety-net health system in Dallas, TX to determine the effectiveness of e-consult service. A total of 277 e-consult encounters were completed for 266 patients (age 52.8±12 years, 65% female, 46% Hispanic, 56% Caucasian, 39% Black, 91% with type 2 diabetes) . The average specialist response time following an e-consult request was 2 days, with recommendations fully or partially implemented for 78% of the e-consults. For the 145 patients with reliable hemoglobin A1c (HgbA1c) data at baseline and within 6 months, the HgbA1c improved from an average of 10.1±2.1% to 9.3±1.8% (paired t-test, p=<0.05) , with an average HgbA1c change of -0.7±1.8%. Only 51% of these patients were subsequently referred for in-person diabetes clinic visit. Moreover, review of the e-consults questions helped identify common knowledge gaps in diabetes care among the primary care providers, and led to the development of monthly educational webinar series for primary care providers.

In conclusion, implementation of diabetes e-consult service improved timely access to diabetes specialty care as well as patients’ glycemic control, and also created an educational opportunity to improve overall diabetes care within a large safety-net health system.

Disclosure

F.Gunawan: None. S.Ajaz: None. L.Meneghini: Employee; Sanofi. U.Gunasekaran: None.
929-P: Person-First Language in Diabetes and Obesity Scientific Publications: Are We Making Progress?
Authors: BIALONCZYK DAMIAN , DICKINSON JANE K , REECE JESSICA D. , KYLE THEODORE K. , NADGLOWSKI JOSEPH F. , JOHNSON KATIE , GARZA MATTHEW , PASH ELIZABETH , CHIQUETTE ELAINE , CLOSE KELLY L.
Published: May 2022

Several professional societies endorse the use of person-first language (PFL) in communication involving people with diabetes or obesity. The purpose of this analysis was to determine the extent to which scholarly articles focusing on diabetes or obesity use PFL.

We reviewed existing guidelines and constructed separate lists of PFL and condition-first language (CFL) terms for diabetes and obesity (e.g., diabetic, obese) . Exact phrase searches were conducted using PubMed from 2011-2020 and resultant articles were categorized as PFL, CFL, or both. Journal-specific factors (e.g., scope, PFL policy) were extracted from a manual review of author guidelines.

The searches yielded 56048 scholarly articles for diabetes and 45584 for obesity. Among diabetes articles, 42.8% used PFL, 40.1% used CFL, and 17.2% contained both (p<0.0PFL vs. CFL) . Among obesity articles, 0.5% used PFL, 99.3% used CFL, and 0.2% used both (p<0.0PFL vs. CFL) . Use of PFL increased by 3.1% per year for diabetes articles, compared to 117.0% for obesity articles (p=0.002) . The rate of adoption of PFL in diabetes articles was unchanged in 2018-2020 compared to years prior (p=0.970) . PFL was more likely to be used in diabetes articles published in a diabetes-focused journal (OR 1.66; p<0.001) and in journals with a PFL policy (OR 2.97; p<0.001) . Obesity articles were more likely to use PFL if published in a US journal (OR 2.34; p=0.002) and in journals after implementation of a PFL policy (OR 32.11; p<0.001) . Obesity-focused journals were not more likely to use PFL than non-specialized journals (p=0.12) .

Although the use of person-first language in diabetes articles has increased over the past years, progress has slowed despite the recent publication of PFL guidelines. Fewer than 1% of obesity articles used person-first language, suggesting a widespread lack of recognition of the importance of PFL in obesity. The strongest predictor of the use of person-first language was if the article was published in a journal with a PFL policy.

Disclosure

D.Bialonczyk: Employee; Gelesis. K.L.Close: Other Relationship; Abbott, ADOCIA, Amarin Corporation, American Association of Clinical Endocrinologists, American Diabetes Association, American Medical Association, Ascensia Diabetes Care, Astellas Pharma Inc., AstraZeneca. J.Dickinson: Consultant; DiaNavi, Vivify. J.D.Reece: None. T.K.Kyle: Advisory Panel; Nutrisystem, Inc., Consultant; Gelesis, Johnson & Johnson. J.F.Nadglowski: Employee; Obesity Action Coalition. K.Johnson: None. M.Garza: None. E.Pash: Employee; Gelesis. E.Chiquette: Employee; Gelesis.
930-P: Care Management Practices for Diabetes and Other Chronic Conditions during COVID
Authors: PETERSON KEVIN A. , SOLBERG LEIF , CARLIN CAROLINE
Published: May 2022

Background: Diabetes outcomes in primary care settings depend on specific care management processes (CMPs) provided by practices. CMPs have been tracked in Minnesota since 2017 using a practice survey that measures the presence of 1CMPs in primary care, including CMPs focused on patients with diabetes.

Method: Secondary data analysis of CMP data collected in 2017, 2019, and 2021, with a COVID supplement in 2021. The 2021 survey was conducted in February and March, between the peaks in COVID cases observed in Minnesota.

Results: Response rates for the three waves were 71%, 72% and 69%, respectively. Our analysis focuses on the 269/556 practices participating in all three waves. Overall prevalence of CMPs for this subset was not significantly different (p=0.069) than for practices that participated in only one or two waves. Among continuously participating practices, overall prevalence of CMPs increased significantly (p=0.005) in 2021. This increase was driven by CMPs focusing on chronic disease management (p=0.011) , patient self-management (p=0.013) , and development of care plans (p=0.004) . Diabetes-specific CMPs had the highest prevalence in all years relative to CMPs focused on cardiovascular disease, depression or asthma. Nearly 90% of respondent practices described moderate to extreme disruption in disease management practices during the pandemic peak. Prior to the pandemic in 2019, virtual visits (phone, video) comprised less than 20% of the total visits for almost all practices. During the 2020 peak, 29% of practices conducted 60% or more of their visits virtually, and an additional 50% of practices conducted 20%-59% of visits virtually. By early 2021, nearly all practices reported less than 40% of visits being conducted virtually.

Conclusions: Despite significant practice disruption due to the pandemic, primary care practices in Minnesota reported continued increase in CMPs supporting care for patients with diabetes and other chronic conditions.

Disclosure

K.A.Peterson: Board Member; Treatment. L.Solberg: None. C.Carlin: None.

Funding

National Institutes of Health R18DK110732
936-P: Improving Decision Making by Clinicians for Initiation of Insulin in Adults with Type 2 Diabetes Using Simple Python Program
Authors: LAKHANI OM J.
Published: May 2022

Introduction: The initiation of insulin is significantly delayed in patients with type 2 diabetes. To facilitate primary care doctors for decision making we have written a simple computer program using Python.

Methods: The program incorporates evidence based recommendations for insulin initiation in insulin naive, outpatient, non-pregnant, adult participants with type 2 diabetes. The program modules answer three questions: 'Does your patient need insulin?’, 'Which insulin should you initiate ?' & 'What dose of insulin to initiate ?'

Ten clinicians volunteered for the study. The program was retrospectively deployed on the Electronic health record (EHR) data of 500 patients treated by the clinicians. The decision making regarding insulin initiation by the computer was compared with the decision made by the clinicians. The clinicians were then asked to use the program in the subsequent 500 eligible patients.

Results: When the computer program was deployed on the EHR data, we found insulin was initiated in 112 of 500 patients by the clinicians, while the computer recommended insulin initiation in 163 patients. There were no cases in which the clinician initiated insulin, and the computer recommended against it.

When used prospectively, the clinicians initiated insulin in 159 patients while the computer recommended insulin initiation in 164 patients. The clinicians made a manual override of the decision only in 5 patients. There was a 28% improvement in insulin initiation when the clinicians used the program. The improvement in insulin initiation using the computer program compared to the same prior to using the program was statistically significant. (p=0.037)

Conclusion: A simple python program can potentially improve insulin initiation by clinicians.

Disclosure

O.J.Lakhani: Advisory Panel; FITTERFLY, Speaker's Bureau; Eli Lilly and Company, Novo Nordisk Global Business Services, Sanofi, Stock/Shareholder; Zydus Cadilla.
950-P: Point-of-Care Glucose Testing in the Preoperative Area prior to Surgery: Is It Useful?
Authors: AHMAD SUSHMA , EDMISTON KIRSTEN K. , GOOD BRITTANY , JEFFERY MICHELLE W. , CLOUGHERTY PATRICK W. , CLEMENT STEPHEN
Published: May 2022

Background: Maintaining perioperative glycemic control is important for patients undergoing a surgical procedure to prevent postoperative complications.

Methods: The authors conducted a pilot project designed to detect and manage perioperative hyperglycemia in a women’s hospital in Virginia. Point of Care (POC) fasting blood glucose tests were performed on the day of surgery in high risk patients. Criteria for screening were: known diabetes, BMI >30 and age > 45. Patients with hyperglycemia were treated according to a protocol using a bolus of intravenous insulin and/or insulin infusion.

Results: Of the 1478 patients undergoing surgery, 1187 (80%) met criteria for POC glucose testing during the 12 week pilot. Forty-eight percent had fasting blood glucose values of either impaired glucose/prediabetes (100 mg/dL-125mg/dl) or higher (see figure) . Seven patients had a fasting glucose of > 200 mg/dl and met criteria to receive insulin in the O.R. Six of these seven patients had known diabetes. A single patient with previously undiagnosed diabetes qualified for insulin therapy. In no circumstance was surgery delayed or cancelled due to hyperglycemia.

Conclusion: Screening for hyperglycemia in the preoperative area is a valuable tool for identifying patients who may benefit from intraoperative insulin therapy. The vast majority of patients who require rescue insulin therapy in the operating room have known diabetes.

Disclosure

S.Ahmad: None. K.K.Edmiston: None. B.Good: None. M.W.Jeffery: Other Relationship; Medtronic. P.W.Clougherty: None. S.Clement: Research Support; Novo Nordisk.

Funding

Division of Endocrinology, Medicine Service Line, Inova Health System
951-P: Racial and Ethnic Disparities in Diabetes Management, Hospitalization Risk, and Physical Health Status Associated with Cognitive Impairment among Older Adults with Diabetes
Authors: LI PIAOPIAO , ZHANG PING , TANG SHICHAO , GUO JINGCHUAN , BROWN JOSHUA D. , JIAO TIANZE , SHAO HUI
Published: May 2022

Cognitive impairment (CI) is associated with adverse health outcomes, but little is known about whether this varies across different racial and ethnic subgroups. We compared health outcomes associated with CI across racial and ethnic groups among adults aged ≥ 60 years old with diabetes in the US. Adults with diabetes were identified from the 2011-2014 National Health and Nutrition Examination Survey based on self-report and HbA1c labs. Those with the cognitive score (measured by Cognitive Functioning Assessment scale) in the lowest quartile were defined as having CI. We used regression models to compare diabetes management (HbA1c, SBP, and BMI) ; hospitalization; and poor physical health associated with CI across racial and ethnic subgroups, adjusting for age, sex, complications, insurance, income, and education. Of 1465 (357 with CI) adults ≥60 years with diabetes, CI was associated with a higher SBP (adjusted difference (aDifference) : 5.91, 95% CI: 3.25-8.57) in non-Hispanic White individuals and non-Hispanic Black individuals (aDifference: 12.07, 95% CI: 4.94-19.2) . CI was not associated with an increase in Hispanic individuals (aDifference: 3.16, 95% CI: 1.52-4.57) and decrease in non-Hispanic Black individuals (aDifference: -1.79, 95% CI: -0.72,-3.11) . For hospitalization, CI was associated with an increase risk in non-Hispanic Black individuals (adjusted odds ratio (aOR) : 1.78, 95% CI: 1.11-2.37) and a decrease risk in Hispanic individuals (aOR: 0.63, 95% CI: 0.36-0.95) . CI was associated with an increase in the risk among non-Hispanic Black individuals (aOR: 1.83, 95% CI: 1.03-2.14) and Hispanic individuals (aOR: 2.91, 95% CI: 1.45-3.8) . The impact of CI on older adults with diabetes varied across racial and ethnic subgroups, with non-Hispanic Black and Hispanic adults experiencing mostly adverse health outcomes compared to non-Hispanic White individuals.

Disclosure

P.Li: None. P.Zhang: None. S.Tang: None. J.Guo: None. J.D.Brown: None. T.Jiao: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.
954-P: Barriers to Enrollment in a Continuous Glucose Monitoring Pilot Program for Medicaid Patients
Authors: CHEN WENJING , BLANCHETTE JULIA E. , MACWILLIAMS JESSICA , HATIPOGLU BETUL
Published: May 2022

Background: CGM usage is associated with lower A1c and decreased diabetes-related hospitalizations and emergency room visits. However, there are still many barriers to accessing CGM, with the most prominent being cost and cumbersome insurance eligibility criteria. We aimed to explore and describe barriers to enrollment in a pilot CGM program for Ohio Medicaid patients.

Methods: Patients seen at a large academic medical center in the past year, a diabetes diagnosis and A1c >8.5% were identified by Medicaid. The pilot CGM program removed the need for the common CGM coverage requirements of prior authorizations, multiple daily injections, and glucose logs. Patients had to use a mobile CGM application to participate. Patients were contacted via phone and agreeable participants saw a diabetes care and education specialist for CGM education and initiation and an ambulatory care pharmacist for follow-up. Baseline characteristics were obtained via chart review and data were analyzed using descriptive analyses.

Results: N=43 were contacted for enrollment (mean age 43.4±10.8 years; 88.4% female; 93.0% African American; mean A1c 10.2±2.0%; 58.1% on multiple daily injections) . In total, n=16 (37.2%) agreed to participate, n=17 (39.5%) were unable to be contacted, n=8 (18.6%) were already actively using CGM and n=2 (4.7%) declined to participate. Older age predicted agreeance to participate (β=0.350, p=.022) . Those who agreed to participate were more likely to see primary care over endocrinology for diabetes care X 2 (1, N=43) = .62, p=0.018. At one-month post-program enrollment, only n=2 (4.7%) patients successfully started CGM.

Discussion: Although over one-third of participants agreed to enroll in the CGM pilot, there was low CGM initiation. Removal of cost and insurance coverage requirements alone did not result in high CGM adoption. Patients were difficult to reach via phone and offering CGM initiation and education during primary care appointments may improve CGM access and utilization.

Disclosure

W.Chen: None. J.E.Blanchette: Advisory Panel; Cardinal Health, Provention Bio, Inc., Board Member; JDRF, Consultant; WellDoc, Other Relationship; Insulet Corporation, Tandem Diabetes Care, Inc., Research Support; Association of Diabetes Care & Education Specialists. J.Macwilliams: None. B.Hatipoglu: None.
959-P: Improving Continuous Glucose Monitor Use: Success Strategies from the T1D Exchange Collaborative
Authors: MUNGMODE ANN , DEWIT EMILY L. , GREENFIELD MARGARET , ILKOWITZ JENIECE T. , ODUGBESAN ORI , DEI-TUTU SELORM A. , THOMAS SARAH , YEE CURTIS , EBEKOZIEN OSAGIE , MCNAMARA KIMBERLY , BYER-MENDOZA CHRISTINE , SCHMITT JESSICA
Published: May 2022

Background: Continuous glucose monitors (CGMs) support patients with type 1 diabetes to maintain optimal glycemic targets and health outcomes. The T1D Exchange Quality Improvement Collaborative (T1DX-QI) is a network of over forty endocrinology centers working to improve health outcomes by implementing QI science. We aim to demonstrate the use of QI methodology in expanding CGM use across seven T1DX-QI clinics.

Method: Clinics initiated iterative plan-do-study-act cycles to test changes and sustain improvements. Interventions included patient education and involvement through print or electronic materials, device troubleshooting, and data downloads. Sites enhanced clinic processes by optimizing paperwork requirements for new devices and standardizing a referral process for patients who faced body image challenges. Clinics shared monthly aggregate data with T1D Exchange coordinating center.

Results: All participating clinics were successful in improving CGM use. Cumulatively, CGM use increased from 66% to 71% over 14 months (Figure 1) . Clinic-level improvement ranged from 5% to 18%, with an average improvement of 9%.

Conclusion: Efficiently implemented QI science can support teams to improve patient health outcomes, including meaningful device access to support glycemic control in patients with type 1 diabetes.

Disclosure

A. Mungmode: None. E.L. DeWit: None. M. Greenfield: None. S.A. Dei-Tutu: None. S. Thomas: None. O. Ebekozien: None. K. McNamara: None. C. Byer-Mendoza: None. J. Schmitt: None.

Funding

Helmsley Charitable Trust
966-P: Reducing Patient No-Show Rates in a Diabetes Clinic
Authors: JAFRI FARZAN , GUNASEKARAN UMA
Published: May 2022

Background: Patients missing scheduled appointments, or no-shows, is a pervasive issue across outpatient clinics. The estimated no-show rate among primary care clinics ranges between 14% and 50%. No-shows are estimated to cost the US healthcare system $150 billion a year. At many clinics no-shows have necessitated overbooking clinic slots to maintain efficiency. Ultimately, patient no-shows and the overbooking they necessitate causes problems for both the patient and provider.

Methods: We used the PDSA (plan/do/study/act) cycle from quality improvement methodology. We determined the baseline no-show rate at the Parkland Diabetes Clinic, an endocrinology clinic with 16 providers (including specialists and advance practice providers) which sees ∼1200 visits a month. The baseline no-show rate from June 2018 to May 20was ∼31.9% ± 2.19. We then examined clinic processes to determine reasons for no-shows through process mapping and root cause analysis. Mapping of the scheduling process identified process inefficiencies. Phone call surveys were conducted with patients with high no-show rates. Using the process map and survey data, we brainstormed interventions to target root causes of no-shows. Our first intervention was ensuring that every patient received a phone call reminder for their appointment. Our second intervention was limiting the degree to which a third-party call center handled scheduling for the Diabetes clinic.

Results: Interventions were implemented in August 2020, and subsequent data collected from November 2020 to October 2021 was analyzed to see changes in the no-show rate. The average no-show rate during this post-intervention period was ∼22.2% ± 2.50 (t-test, p <0.05) , a significant decrease from the baseline rate of ∼31.9% ± 2.19. We predict this reduction will result in more consistent follow-up care, less risk of disease progression, and increased clinical efficiency. Our next step will be to transition our interventions into long-term sustainable solutions to maintain the lower no-show rate.

Disclosure

F.Jafri: None. U.Gunasekaran: None.
967-P: Decentralizing Diabetes Specialty Care Improves Glycemic Control
Authors: GUNASEKARAN UMA
Published: May 2022

Parkland Health and Hospital System (PHHS) is the Dallas County safety-net health system and serves indigent Dallas County residents. PHHS has primary care clinics (COPCs) located in underserved areas of the county to provide easier access to its residents. The Diabetes Specialty Clinic (DSC) is located next to the Parkland Hospital, but this location can be difficult to access for patients with limited means. We studied the effect of co-locating a diabetes specialty practice (H-DSC) at a community primary care practice (Hatcher Station COPC (HSC)) by comparing the A1c change between the patients managed by primary care providers at HSC alone or by specialists at H-DSC. Table 1 displays the results of this study. The data show that there was a significant reduction in A1c in the HSC patients seen by primary care and H-DSC patients of -0.2% and -0.5% respectively. There is also a significant difference in baseline and final A1cs between both groups that show that H-DSC patients had poorer baseline glycemic control but also greater improvement in glycemic control. H-DSC patients were also being seen by their primary care providers at HSC, and without the co-location of the DSC to H-DSC, many of these patients would not have accessed care at the DSC main location. This suggests that co-locating diabetes specialty services at local, easy-to-access primary care centers at a safety-net health system can improve the glycemic control of patients with diabetes.

Disclosure

U.Gunasekaran: None.
977-P: Utilization of Glucose Management Team–Conducted Remote Patient Visits Decreases Hospital Readmissions for Patients with Diabetes
Authors: JOHNS ALLISON , PRICE CATHERINE E. , ALOI JOSEPH A. , BURNS CYNTHIA
Published: May 2022

Introduction: Hospital readmissions are more common in persons admitted with diabetes as a primary diagnosis, accounting for approximately 20% of unplanned readmissions.1 Poor clinical outcomes and higher costs result.2 Helping people remain out of the hospital with improved diabetes self-management is both patient-centered and cost effective.1 Remote patient care improves access to care, removes transportation as a barrier and lessens the time required versus in person diabetes visits.3

Methods: The glucose management team (GMT) at Atrium Health Wake Forest Baptist Medical Center, comprised of advanced practice providers and an endocrinologist, offered post-discharge telehealth visits within 7 days to patients with insulin treated complex diabetes from 1/1 - 3/24/21. Patients’ diabetes regimens and glucose readings were reviewed and recommendations for treatment changes were offered.

Results: A total of 88 patients were scheduled for post-discharge visits, and 55.7% (n=49) participated in a scheduled telehealth visit, while 36.4% did not (n=32) . Of patients who no-showed, there were zero 30 day readmissions and fourteen 90 day readmissions (43.8%) . Of patients who had a telehealth visit, there were two 30 day readmissions (4%) and eleven 90 day readmissions (22.4%) . Odds ratio for 90 day readmission was 2.69 (p=0.042) in those who did not attend a post-discharge telehealth visit.

Conclusion: While 30-day readmissions were higher in the group that had a telehealth visit, this may be due to global struggles with nonadherence in the no-show group. An odds ratio of over 2.5 for 90 day readmission compared to patients who completed a post-discharge telehealth visit supports this view. Post-discharge telehealth visits decreased unplanned readmissions at 90 days by providing access to expert clinicians for support, instruction on self-directed glucose management and treatment regimen recommendations.

Disclosure

A.Johns: None. C.E.Price: None. J.A.Aloi: Research Support; Abbott Diabetes, Medtronic. C.Burns: None.
98-OR: Prediction of Cardiovascular Disease in People with Type 1 Diabetes with Novel Omics Biomarkers
Authors: PYLE LAURA , VIGERS TIMOTHY B. , JOHNSON RANDI K. , ZHANG QIBIN , SNELL-BERGEON JANET K.
Published: May 2022

Introduction: Type 1 diabetes (T1D) increases risk for cardiovascular disease (CVD) at least 2-4 fold, with only half the excess risk explained by known risk factors. We sought to identify novel proteomic, lipidomic, and metabolomic biomarkers of CVD in T1D.

Methods: We first built a predictive model of coronary artery calcium progression (CACp) using LASSO regression of clinical variables measured at baseline in 365 participants with T1D in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. The selected model was refit to a subgroup of 102 participants with complete clinical information and measured omics markers (targeted and untargeted metabolomics, global proteomics, glycated proteomics, and lipidomics) . Omics biomarkers were identified for inclusion in the final model by retaining the top markers that predicted CACp by moderated t-tests and sPLS-DA models.

Results: The table shows variables retained in the clinical model (AUC=0.91) and in the model with biomarkers added (AUC=0.94) . Higher age, urine albumin:creatinine, and insulin dose predicted CACp in both models. Longer duration of T1D predicted CACp in the clinical model. In the model with D-Glucosamine/D-galactosamine and glycated fibrinogen peptides, D-Glucosamine/D-Galactosamine predicted CACp.

Conclusion: Novel metabolites improved prediction of CACp in people with T1D.

Disclosure

L.Pyle: None. T.B.Vigers: None. R.K.Johnson: None. Q.Zhang: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc.

Funding

American Heart Association (17CSA33570025) , NIH (P30-DK116073)
983-P: Prediabetes A1C Is Associated with Metabolic Disease in Girls with PCOS and Obesity
Authors: FINN ERIN , REYES YESENIA GARCIA , TAYLOR ANYA E. , GARFIELD AMANDA L. , VIVAS CAMILO A. , FULLER KELLY , BERGMAN BRYAN C. , NADEAU KRISTEN J. , CREE-GREEN MELANIE
Published: May 2022

Polycystic Ovary Syndrome (PCOS) is associated with metabolic diseases, including diabetes, and metformin is indicated if a1c is ≥5.7 demonstrating prediabetes/diabetes. To determine when to prescribe metformin, 2018 PCOS guidelines advise only an OGTT to screen, whereas ADA guidelines also include A1c. We sought to determine patterns of dysglycemia and metabolic disease in youth with PCOS and obesity. Data from girls (age 12-21 yrs, n=110) with obesity and untreated PCOS were examined. Metabolic assessments included fasting labs, 4-hour oral sugar tolerance test (OSTT, 75 g glucose, 25 g fructose) with Oral Minimal Modeling, liver fat assessment by MRI, and endogenous glucose release (Ra) with isotope tracers (N=31) . Data were divided by A1c (<5.7 vs. ≥5.7%) and compared by t-test. Pearson’s correlations were used to compare A1c to metabolic variables across the cohort. Prediabetes A1c was found in 27% (n=30, A1c 5.8±0.2% vs. n=80, A1c 5.3±0.2%) . Glucose concentrations, insulin sensitivity (IS) , and obesity related measures were worse with a1c≥5.7% and correlated with increasing A1c. Lower IS and higher liver fat were most strongly correlated to a1c. There were no differences in clinical or laboratory hyperandrogenism by A1c category, nor correlation with A1c (Table) . A1c testing is less burdensome than OGTT and can identify girls with PCOS and obesity at increased metabolic disease risk who may benefit from metformin.

Disclosure

E.Finn: None. Y.Garcia reyes: None. A.E.Taylor: None. A.L.Garfield: None. C.A.Vivas: None. K.Fuller: None. B.C.Bergman: Research Support; Eli Lilly and Company. K.J.Nadeau: None. M.Cree-green: None.

Funding

National Institutes of Health (R01DK120612) , (K23DK107871) , (UL1 TR002535) , (P30 DK048520) , (K12HD057022) ;Doris Duke Foundation (CDSA) , (CDSA COVID extension) , (2015212) ; Childrens Hospital Colorado; Boettcher Web Waring Foundation
988-P: Higher Environmental Pollution Burden Scores Associate with Lower Insulin Sensitivity in Minority Children with Overweight and Obesity
Authors: BARRAGAN KARINA , WEIGENSBERG MARC , TOLEDO-CORRAL CLAUDIA M.
Published: May 2022

Background: Epidemiological evidence in children suggests that environmental pollution, such as ambient and traffic air pollution exposure, is associated with type 2 diabetes risk; however cumulative exposure to various environmental pollutants has not been well examined. The objective of this study was to determine if cumulative measures of environmental pollutants were associated with insulin sensitivity (SI) , acute insulin response (AIR) and disposition index (DI) in minority children.

Methods: Participants (N=135, Mage = 14.4 ± 2.9 years; 59% male; 57% Latinx and 43% Black) had a 13-time point frequently sampled intravenous glucose tolerance test. Glucose and insulin values were used in minimal modelling (MinMod Millennium) for determination of SI, AIR, and DI. Self-reported mailing addresses were geocoded to identify census tract number and associated pollution burden scores (1-10) derived by CalEnviroScreen 3.0 (CES 3.0) . Multivariable linear regression was used to test relationships while considering for age, ethnicity, sex, and total body fat percentage (by DEXA) . Due to positive skewness, SI, AIR and DI were natural log transformed.

Results: Higher pollution burden score was associated with lower lnSI, after adjusting for covariates (β= -0.150, 95%CI= -0.280, -0.020, p=0.024) . There was a positive, but non-significant association with pollution burden score and lnAIR (β= 0.114, 95%CI= -0.006, 2.35, p=0.063) . An inverse, but non-significant, association was observed between pollution burden scores and lnDI (β= -0.34, 95%CI= -.140, 0.71, p=0.518) .

Conclusion: Using a publicly available environmental pollution risk score, we show that high environmental pollution exposures associated with lower SI, but not AIR or DI. Our findings provide further evidence of the link between ambient environmental factors and type 2 diabetes risk.

Disclosure

K.Barragan: None. M.Weigensberg: None. C.M.Toledo-corral: None.

Funding

NIH P60MD00254
989-P: Impaired Coronary Arterial Dilation in Youth-Onset Type 2 Diabetes
Authors: VILLALOBOS-PEREZ ALFREDO , FEELEY JENNA , ABD-ELMONIEM KHALED Z. , DIETSCHE KATRINA B. , DIXON SYDNEY A. , MATTA JATIN R. , STAGLIANO MICHAEL S. , MABUNDO LILIAN , SHOUPPE EILEEN L. , GHARIB AHMED M. , WALTER MARY , CHUNG STEPHANIE T.
Published: May 2022

Young adults with type 2 diabetes (T2D-Y) have increased risk of subclinical atherosclerotic cardiovascular disease (ASCVD) . Cardiac magnetic resonance imaging (MRI) may guide risk stratification by noninvasively quantifying coronary wall thickness (CWT, an indicator of ASCVD) and endothelial function (arterial dilation during isometric hand grip exercise, IHE) . The utility of these novel MRI biomarkers in T2D-Y is unknown. We hypothesized that T2D-Y would be associated with increased CWT and impaired endothelial function. In T2D-Y (6 male, age 19.8±1.6y, BMI 37±7kg/m2) and 12 healthy controls (5 male, age 22.7±2.9 y, BMI 24±5 kg/m2) we measured CWT and coronary and brachial dilation during IHE with a 3.0 Tesla MRI. T2D-Y had higher HbA1c (6.5 ± 0.8 vs. 5.1 ± 0.6%, P<0.01) , C reactive protein (5.16 ± 5.35 vs. 1.25 ± 2.25 mg/L) , systolic blood pressure (129±13 vs. 116±14 mmHg) , heart rate (84±13 vs. 72±9 beats/min (all P<0.05) . T2D-Y had lower HDL cholesterol (40±vs. 66±15 mg/dL, P=0.002) but similar LDL-cholesterol and triglycerides. CWT was not different (1.26±0.12 vs. 1.34±0.14 mm, P=0.18) but coronary and brachial arterial dilation was impaired in T2D-Y (Figure) . Overall, compared to health peers, T2D-Y had comparable CWT but impaired coronary and brachial arterial dilation occurred in the absence of traditional risk factors such as severe hyperglycemia, frank hypertension or dyslipidemia.

Disclosure

A. Villalobos-Perez: None. J. Feeley: None. K.Z. Abd-Elmoniem: None. K.B. Dietsche: None. J.R. Matta: None. M.S. Stagliano: None. L. Mabundo: None. E.L. Shouppe: None. M. Walter: None. S.T. Chung: None.

Funding

NIDDK/NIH Intramural Research Program
991-P: Metformin Plasma Concentration as a Biomarker of Treatment Responsiveness in Youth-Onset Type 2 Diabetes
Authors: DIETSCHE KATRINA B. , ZENNO ANNA , VILLALOBOS-PEREZ ALFREDO , DIXON SYDNEY A. , STAGLIANO MICHAEL S. , MABUNDO LILIAN , SHOUPPE EILEEN L. , ESTRADA DORIS E. , MEYERS ABBY , COGEN FRAN R. , WALTER MARY , WALTER PETER , CHUNG STEPHANIE T.
Published: May 2022

Metformin is the first-line therapy for youth-onset type 2 diabetes mellitus (Y-T2D) but is suboptimal in up to 50% of youth. The reasons for increased failure rates are unknown. Metformin plasma concentration reflects total body distribution and kinetics but is not used clinically in adults because peak metformin concentration varies widely. Few studies, and none in youth, have measured trough therapeutic concentration as a potential biomarker of response. We hypothesized that trough metformin plasma concentrations after short-term therapy would be associated with treatment response. In this secondary analysis of a randomized trial of metformin alone vs. metformin and liraglutide (combo) therapy Y-T2D youth, we determined the relationship of metformin concentration with glycemia. Nineteen Y-T2D: age 15.4±2.1 (12-20y) mean±SD (range) , 61% female, Tanner Stage IV-V, BMI 40.0±8.0 (22.1-53.4 kg/m2) were randomized to 2000mg/day metformin (n=10) or 2000mg metformin+ 1.8mg liraglutide (combo, n=8) for 3 months after a 5-7 day drug-free run-in period. At baseline, youth on combo had higher HbA1c (7.1±0.7; 6.2±0.6%, P=0.006) but had similar BMI, fasting glucose, and 2hr glucose on OGTT. Metformin concentrations increased (combo:337±559 vs. metformin: 420±433 (1.6-1537 ng/mL) , P=0.7) and negatively correlated with change in 2hr glucose (combo: r=-0.9, P=0.002; metformin: r=-0.73, P=0.02) , fasting glucose (combo: r=-0.59, P=0.13; metformin: r=-0.64, P=0.06) , and change in HbA1c (combo: r=-0.89, P=0.01, metformin: r=0.31, P=0.4) . Metformin adherence measured by pill counts was 78% with no difference by group (combo: 80±20; metformin: 75±16%) . Metformin concentrations were not associated with percent adherence to medication or change in weight (P>0.10) . Overall, metformin concentrations were widely variable in Y-T2D but associated with improvements in glycemia after 3 months and should be explored as a viable biomarker for predicting treatment response in Y-T2D.

Disclosure

K.B. Dietsche: None. A. Zenno: None. S.A. Dixon: None. L. Mabundo: None. E.L. Shouppe: None. D.E. Estrada: None. F.R. Cogen: None. M. Walter: None. P. Walter: None. S.T. Chung: None.

Funding

NIDDK/NIH Intramural Research Program
Application of Guidance and Counseling Media in Overcoming Learning Loss
Authors: Padmi Ni Made Diah , Sarmila Sarmila
Published: May 2022

Guidance and Counseling is closely related to information. During the Covid-19 Pandemic, Guidance and Counseling services are carried out online and must be able to carry out services optimally. So that the process of delivering information can only be done online. In this case the BK teacher must think about how the service material can be delivered communicatively even though it is online. BK media is a means of delivering service material. Initially, the media became a means of supporting counseling guidance, but during the COVID-19 pandemic, the media became the main means of delivering service material with the aim of being better understood by students. The purpose of this study is to describe the skills of BK teachers in using guidance and counseling media in overcoming Learning Loss. The research method used is descriptive qualitative. Based on the research conducted, it was obtained an average score of 68 with high, medium and low categories. Of the 30 teachers who participated, 40% of them, namely 12 teachers, had a score below the average of 68.
The Mental Health State and Psychological Well-Being of School Teachers during COVID-19 Pandemic in Malaysia
Authors: Rosli Aina Mardhiah , Bakar Abu Yazid Abu
Published: May 2022

This study was conducted to determine the level of mental health and psychological well-being of school teachers during the Movement Control Order (MCO) enforced throughout COVID-19 pandemic in Malaysia. The study sample consisted of 274 male and female school teachers in Selangor state, Malaysia. This quantitative data was obtained using an online questionnaire developed via 'Google form' application, and was analyzed using SPSS software version 28.0. Perceived Stress Scale (COVID-19 PSS-10) English Version shows Alpha Cronbach's value of α = 0.719. The validity test of the instrument Ryff's Psychological Well-Being Scale (PWB) English Version shows the alpha Cronbach's α = 0.86. The set of questionnaires was analyzed descriptively, independent sample t - test was also conducted. The study found that respondents have a moderate level of psychological well-being. There were no significant differences between the genders of teachers. The findings of the study are expected to help reduce the level of stress faced by teachers’ aims to preserve their psychological health in order to ensure the well-being of students and the continuity of the national education system
PENGARUH PENERAPAN MODEL PEMBELAJARAN KLARIFIKASI NILAI BERBASIS MULTIKULTUR TERHADAP KARAKTER PESERTA DIDIK KELAS VIII SMP
Authors: N.A. Udayana  , I.M.Candiasa  , I.G.L.A. Parwata
Published: May 2022

Penelitian ini bertujuan untuk mengkaji pengaruh model pembelajaran klarifikasi nilai berbasis multikultur terhadap karakter dengan mempertimbangkan sikap sosial pada peserta didik Kelas VIII SMP N 3 Tegallalang dengan pendekatan eksperimen post test only control group design. Populasi terdiri dari  158 peserta didik terbagi dalam lima kelas. Pengujian kesetaraan kelas dilakukan dengan uji F dari   hasil penilaian tengah semester (PTS), semua kelas setara. Selanjutnya dipilih secara random 4 kelas sebagai sampel, dan dipilih menjadi kelas eksperimen dan kontrol. Selanjutnya diberikan tes sikap sosial untuk memilih kelompok sosial tinggi dan rendah. Kelompok eksperimen diberikan teknik pembelajaran klarifikasi nilai berbasis multikultur dan kelompok kontrol diberikan model pembelajaran konvensional. Data karakter peserta didik dikumpulkan dengan angket menggunakan skala Likert. Analisis data untuk uji hipotesis dengan analisis varians (ANAVA) dua jalur, dilanjutkan uji Tukey pada taraf signifikansi 5%. Diperoleh  hasil seperti berikut. 1) Terdapat perbedaan karakter antara peserta didik yang mengikuti pembelajaran dengan model pembelajaran klarifikasi nilai berbasis multikultur dan  karakter peserta didik yang mengikuti pembelajaran konvensional. 2) Terdapat pengaruh interaksi antara model pembelajaran dan sikap sosial terhadap karakter siswa. 3) Untuk siswa dengan sikap sosial tinggi,   karakter peserta didik yang  mengikuti pembelajaran dengan model pembelajaran klarifikasi nilai berbasis multikultur lebih baik daripada yang mengikuti pembelajaran konvensional. 4) Untuk siswa dengan sikap sosial rendah,   karakter peserta didik yang mengikuti pembelajaran dengan model  pembelajaran konvensional lebih baik daripada yang mengikuti pembelajaran klarifikasi nilai berbasis multikultur. Dengan demikian disimpulkan bahwa penerapan model pembelajaran klarifikasi nilai berbasis multikultur dan sikap sosial berpengaruh terhadap karakter peserta didik.
PENGARUH KONSELING BEHAVIORA DAN JENIS KELAMIN TERHADAP MOTIVASI BERPRESTASI SISWA
Authors: N.P. Rusmayani  , N.M.S. Mertasari  , I.G. Ratnaya
Published: May 2022

Penelitian ini bertujuan mengetahui pengaruh konseling behavioral dan jenis kelamin terhadap motivasi berprestasi peserta didik kelas VIII SMP Negeri di kecamatan Tegallalang. Penelitian ini adalah penelitian eksperimen semu dengan rancangan factorial desain. Populasi penelitian ini adalah peserta didik kelas VIII SMP Negeri 3 Tegallalang yang berjumlah 158 orang. Sedangkan sampel dalam penelitian ini adalah sebanyak 96 orang.Instrumen yang digunakan dalam penelitian ini adalah kuisioner, dari hasil terkait motivasi berprestasi, selanjutnya diolah menggunakan pearson product moment dan analisis data menggunakan anava dua jalur. Hasil penelitian ini menunjukkan bahwa: 1) terdapat perbedaan motivasi berprestasi antara peserta didik yang mengikuti teknik modeling dan teknik asertif (Fhitung = 77,98 >Ftabe(0,05) = 2,47), 2) terdapat perbedaan motivasi berprestasi yang signifikan ntara peserta didik laki-laki dan perempuan (Fhitung = 24,16 > Ftabe(0,05) = 2,47), 3) terdapat pengaruh interaksi yang signifikan antara  model konseling dengan jenis kelamin terhadap motivasi berprestasi peserta didik (Fhitung = 341,17 > Ftabe(0,05) = 2,47), 4) motivasi berprestasi peserta didik yang mengikuti teknik modeling lebih rendah dari pada peserta didik yang mengikuti teknik asertif pada siswa laki-laki (μA1B1=168,46 <μA2B1=176,88), 5) motivasi berprestasi siswa yang mengikuti teknik modeling lebih tinggi dari pada siswa yang mengikuti teknik asertif pada siswa perempuan (μA1B2= 189,75>μA2B2=164,79), 6) motivasi berprestasi siswa laki-laki lebih rendah daripada peserta didik perempuan yang mengikuti teknik modeling (μA1B1= 168,46<μA1B2=189,75), dan 7) motivasi berprestasi peserta didik laki-laki lebih tinggi dari pada peserta didik perempuan yang mengikuti teknik asertif (μA2B1= 176,88>μA1B2=164,79). Dengan demikian, penerapan teknik modeling memiliki pengaruh positif terhadap motivasi berprestasi peserta didik perempuan, sedangkan penerapan teknik asertif memiliki pengaruh positif terhadap motivasi berprestasi peserta didik laki- laki.
Pembelajaran Matematika Berbantuan LKS Berbasis Discovery Learning dengan Pendekatan Kontekstual terhadap Kemampuan Komunikasi Matematis Siswa Kelas VIII
Authors: Aprioda Aprioda , Setiawan Irwan , Rosmaiyadi Rosmaiyadi , Utami Citra
Published: May 2022

Tujuan penelitian ini untuk: 1) mengetahui apakah kemampuan komunikasi matematis siswa yang diajarkan dengan menggunakan LKS berbasis discovery learning dan pendekatan kontekstual melebihi dengan yang diajarkan menggunakan LKS berbasis langsung; 2) mengetahui KKM siswa melalui LKS berbasis discovery learning dan pendekatan kontekstual; 3) mengetahui keterlaksanaan proses pembelajaran dengan menggunakan LKS berbasis discovery learning dan pendekatan kontekstual; 4) mengetahui self-confidence siswa ketika diajarkan dengan menggunakan LKS berbasis discovery learning dan pendekatan kontekstual. Deasin Penelitian True Eksperimental Design dan Posttest-Only Control Design. Teknik analisis yang digunakan berupa uji-t dua sampel independen, uji-t satu sampel, uji proporsi satu sampel, rata-rata presentase keterlaksanaan, dan rata-rata skor self-confidence siswa. Populasi penelitian merupakan seluruh siswa kelas VIII SMPN 17 Singkawang. Sampel penelitian yaitu kelas VIII A (eksperimen) dan  kelas VIII B (kontrol). Hasil penelitian berupa: 1) kemampuan komunikasi matematis siswa yang diajarkan dengan LKS berbasis discovery learning dan pendekatan kontekstual lebih baik dari yang menggunakan LKS berbasis langsung; 2) ketuntasan nilai belajar mencapai KKM; 3) keterlaksanaan proses belajar terlaksana sangat baik; 4) self-confidence siswa tergolong tinggi
Hubungan Permainan Tradisional Betengan Terhadap Gerak Lokomotor Siswa
Authors: Kuryanto Mohammad Syaffruddin , Pratiwi Ika Ari
Published: May 2022

Penelitian ini bertujuan untuk mengetahui hubungan positif antara permainan tradisional betengan terhadap gerak lokomotor siswa. Penelitian ini dilaksanakan di SD 1 Muhammadiyah Kudus. Penelitian ini menggunakan metode kuantitatif dengan pendekatan yang digunakan dalam penelitian ini adalah korelasional. Sampel yang digunakan dalam penelitian ini berjumlah 29 siswa. Penelitian ini menggunakan teknik pengumpulan data observasi. Penelitian ini dianalisis menggunakan uji korelasi product moment pearson dengan uji prasyarat linearitas dan normalitas. Hasil penelitian menunjukkan bahwa data memenuhi uji prasyarat dengan signifikansi linearitas sebesar 0,898 dan signifikansi normalitas sebesar 0,20. Terdapat hubungan yang signifikan antara permainan tradisional terhadap gerak lokomotor siswa dengan koefisien signifikansi 0,708 lebih besar dari 0,05 atau 0,708 lebih besar dari 0,5 dengan kategori tingkat hubungan sangat kuat. Hal ini menunjukkan bahwa hubungan permainan tradisional betengan memiliki hubungan yang kuat terhadap gerak lokomotor siswa.
Peran Kepala Sekolah Dalam Implementasi Program Bimbingan Dan Konseling di Sekolah
Authors: Putranti Dwi , Fithroni Fajar , Kusumaningtias Dhela
Published: May 2022

Pendidikan yang bermutu adalah pendidikan yang mengintegrasikan tiga komponen, yaitu: komponen manajemen dan kepemimpinan, pembelajaran yang mendidik, dan bimbingan dan konseling yang memandirikan. Bimbingan dan konseling merupakan wujud dari penyelenggaraan pendidikan yang bermutu melalui sistem pendidikan. Guru BK perlu merancang sebuah program sebagai usaha terencana dan terorganisir dalam layanan bimbingan dan konseling. Program yang telah dirancang tentunya akan diimplementasikan ke dalam suatu layanan yang konkrit. Peran kepala sekolah sebagai pemimpin pendidikan sangatlah diperlukan dalam mengimplementasikan program bimbingan dan konseling.  Ketidaktersediaan jadwal tatap muka antara siswa dan guru BK, kurangnya koordinasi antara kepala sekolah dengan guru BK, dan sarana dan prasarana yang kurang memadai bagi layanan bimbingan dan konseling diidentifikasi merupakan hasil dari kurangnya pemahaman kepala sekolah terhadap peran guru BK dan implementasi programnya dalam pendidikan. Pemahaman yang kurang baik dalam bimbingan dan konseling juga menyebabkan kurangnya peranan kepala sekolah dalam menjalankan tugasnya sebagai pemimpin pendidikan.  Komitmen dari Lembaga Pengembangan dan Pemberdayaan Kepala Sekolah (LPPKS), Lembaga Penjamin Mutu Pendidikan (LPMP), Pusat Pengembangan Pemberdayaan Pendidik dan Tenaga Kependidikan (PPPPTK), pihak sekolah, maupun pemerintah sangat dibutuhkan dalam penyiapan calon kepala sekolah, pembinaan dan pengembangan bagi kepala sekolah, maupun penerapan model pengembangan professionalitas yang sesuai dengan kebutuhan tersebut.
Media Konkret Sebagai Upaya Meningkatkan Kemampuan Mengungkapkan Kalimat Permintaan Maaf Pada Kelas II SD
Authors: Cahyono Taufiq Ardy , Ulya Himmatul , Ristiyani Ristiyani
Published: May 2022

This study aims to descrie the concrete media as an effort to improve the ability to express a sentence of apology i elementary school. The research method used is classroom action research. The subject of this study as much 24 student. Data collection techniques using interviews , observation and test. Concrete media is an object in the form of real or artificial object that have been used by teachers in conducting learning with the aim of student being able to easily understand the learning material. The result show that concrete media can improve the ability to express apology setences. Cycle I student complete with a percentage 77% and which is incomplete with a percentage 23% whie the cycle II student complete with a percentage 91% and which is incomplete with a percentage 9%.