bluuebunny/crossref_metadata_2025 huggingface dataset:
635-P: Message in an App: A Survey of Feedback Messages about Healthy Coping in Diabetes
Authors: YE QING , BOREN SUZANNE A. , KHAN UZMA Z. , SIMOES EDUARDO J. , KIM MIN
Published: June 2020

Healthy Coping (HC) is a key component of self-management for people with DM. HC includes physical exercise/activity and mood. Mobile apps are a promising tool to promote DSME/S for people with DM. Feedback messages can motivate people to change self-management behaviors. This study reports a survey of HC-related feedback messages in DM apps.

We searched “diabetes,” “blood sugar,” “glucose,” and “mood” in iTunes and Google Play to capture apps in English from August-October 2019. We identified 89 out of 1749 DM apps. We tested the apps by entering a range of normal and abnormal values to generate 326 feedback messages. We analyzed the messages regarding DM control, physical exercise, and mood, as well as feedback purpose and timing (Table 1).

All apps provided messages acknowledging input in real time. Many apps allowed self-monitoring of blood glucose (65%), however, out of these 174 feedback messages, none suggested behavioral modification (0%) and few advised goal setting (11%). Only some apps allowed input regarding exercise (12%) and mood (35%). Similarly, few messages suggested behavioral modification (11% and 6% respectively) or goal setting (11% and 6% respectively).

These findings indicate a lack of focus on HC especially regarding physical activity and mood with goal setting and behavioral modifications. Future DM apps should incorporate purposeful messages to engage people with DM in self-management.

Disclosure

Q. Ye: None. S.A. Boren: None. U.Z. Khan: None. E.J. Simoes: None. M. Kim: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092950); University of Missouri Research Council (URC-19-153)
64-LB: Fourteen-Item Mediterranean Diet Score as Indicator for Prediabetes in Taiwan, a Cross-Sectional Study
Authors: HOU YI CHENG
Published: June 2020

Background and Aims: Prediabetes is considered a high-risk state of type 2 diabetes and a reversible condition with lifestyle changes. The Mediterranean diet is one of the recommended dietary patterns for reducing the risk of type 2 diabetes. This study aims to find association between the degree of adherence to the Mediterranean diet and blood glucose level in prediabetes patients and healthy controls.

Methods: In this cross-sectional study 346 subjects were recruited between 2014 and 2019 at the Taipei Tzu Chi Hospital. The degree of adherence to the Mediterranean diet is measured by a 14-item Mediterranean diet adherence screener used in the PREDIMED trial. The blood glucose level is measured by fasting glucose (mg/dL) and glycated hemoglobin (%).

Results: The Mediterranean diet adherence score is significantly and inversely associated with both measures of blood glucose level. Adjusted data (95% confidence intervals) shows that each additional point in the Mediterranean diet adherence score decreases the risk of prediabetes with abnormal fasting glucose level by 60% and the risk of prediabetes with abnormal glycated hemoglobin by 22.4%.

Conclusions: The 14-item Mediterranean diet score is an effective indicator for prediabetes.

Disclosure

Y. Hou: None.

Funding

Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation (TCRD-TPE-109-RT-10)
640-P: Clinical Video Telehealth: An Effective Approach to Comprehensive Group Diabetes Self-Management Education and Support for Rural and Disabled Veterans
Authors: DINARDO MONICA , YOUK ADA O. , BEYER NICOLE , BEATTIE JANICE N. , OBROSKY D. SCOTT
Published: June 2020

Veterans are three times more likely to have diabetes than the general population. Diabetes self-management education and support (DSMES) is a critical component of diabetes care that galvanizes more informed and engaged patients. Many Veterans are disabled or reside in rural areas and have limited access to comprehensive DSMES. Clinical Video Telehealth (CVT) extends access to specialty services from regional Veterans Affairs (VA) Healthcare Centers to Community-Based Outpatient Clinics where many Veterans receive healthcare. The purpose of this study was to examine and compare proximal (3-6 month) and distal (12 and 18 month) metabolic outcomes (A1C, lipids, BMI and blood pressure) of Veterans who received comprehensive group DSMES via CVT vs. in-person . Veterans who received DSMES from 2012 to 2017 by CVT (n=197) and in-person (n=359) were identified in the VA computerized medical record. The CVT group was similar to those that attended in-person, but were less racially diverse. A linear mixed model was used to compare changes in metabolic outcomes within and between groups over time. A1C improved at 3 months and was sustained for 12-18 months in both groups. Neither group showed changes in lipids, BMI, or blood pressure.

In conclusion, CVT is an effective means of improving A1C by expanding DSMES access to Veterans who receive community care.

Disclosure

M. DiNardo: None. A.O. Youk: None. N. Beyer: None. J.N. Beattie: None. D. Obrosky: None.
642-P: Identifying Value Propositions to Engage Patients with Type 2 Diabetes in Shared Medical Appointments
Authors: RITCHIE NATALIE D. , BEGUM ANOWARA , DAILEY-VAIL JENNIFER , REMENTER JENNY , KOREN RAMONA A. , TRUJILLO SHARON A. , PHIMPHASONE-BRADY PHOUTDAVONE , CASSIDY KRISTIN A. , WEARNER ROBYN , WAXMONSKY JEANETTE , KWAN BETHANY
Published: June 2020

Objective: Type 2 diabetes (T2D) affects 12% of U.S. adults and is a major public health burden. Shared medical appointments (SMAs) are an effective strategy to deliver diabetes self-management education and support (DSMES) alongside medical care, yet recruitment is a common challenge. Enhanced communication strategies have been recommended, while identifying specific messaging to engage patients with T2D remains needed.

Methods: The Invested in Diabetes project is a cluster-randomized, pragmatic comparative effectiveness trial of two models of SMAs using an evidence-based DSMES curriculum. To aid recruitment at 22 primary care clinics, a group of patient, practice and research stakeholders used value proposition design strategies to develop tailored messaging on how SMAs can reduce pains and yield gains related to T2D. Patient stakeholders further refined messages to ensure patient-driven language. Here we describe value propositions for patients with newly diagnosed or uncontrolled T2D, diabetes distress, and comorbid conditions, plus concerned others.

Results: General messaging emphasized how SMAs may help patients with T2D through expert education, addressing concerns, behavior change strategies, problem-solving, stress-coping skills, normalizing, and peer support. Messaging emphasized respect for autonomy (“you are your best health advocate”) coupled with available support (“you don’t have to go it alone”). For uncontrolled T2D, messages further conveyed opportunities to “finally take control” of T2D. For diabetes distress, messages also conveyed how SMAs may reduce feeling overwhelmed by T2D. Concerned others were encouraged to show support by telling patients about diabetes SMAs.

Conclusions: Value proposition themes include how diabetes SMAs can improve T2D control and related stress, which may aid patient engagement. For clinics offering diabetes SMAs, messaging can be delivered by care team members and integrated into various recruitment activities.

Disclosure

N.D. Ritchie: None. A. Begum: None. J. Dailey-Vail: None. J. Rementer: None. R.A. Koren: None. S.A. Trujillo: None. P. Phimphasone-Brady: None. K.A. Cassidy: None. R. Wearner: None. J. Waxmonsky: None. B. Kwan: None.

Funding

Patient-Centered Outcomes Research Institute (IHS-1609-36322)
643-P: Positive Impact of Experience-Based Delivery Methods on Diabetes Education
Authors: GASTALDI GIACOMO , SANTOS MAMED MARCELO DOS
Published: June 2020

Diabetes self-management education (DSME) favors health outcomes and health-related quality of life. Nevertheless, achievement of glycemic control often remains low despite DSME interventions. Current validated DSME group activities provide educational, psychosocial and behavioural support with or without experience-based delivery methods (EBDM). The aim of the study is to explore the impact of EBDM on the learning process. The facilitator transcribed and coded the data collected during filmed interview of participants to 3 different DSME group trainings: 1.Problem solving (expert logic, no EBDM) 2.Educational (informative logic, no EBDM) 3. DAFNE course (experiential logic/with EBDM). 22 participants with type 1 diabetes were included (n=5 for the expert logic field; n=7 for the informative logic field; n=10 for the experiential logic field) with a semi-structure plan based on three identical questions. Discourse analysis and content analysis of the interviews were organized to evaluate learning acquisition through participant’s discourses. The results have shown that the participants in the expert and informative logic define diabetes by the physiological aspects of the disease and testify about difficulties that are not addressed during the trainings or by describing the coordination of care (general practitioners, specialists, patient associations). They also report difficulties in relation to emotional management. The participants in the third field are able to link the definition of diabetes with individual experience and to associate their difficulties on the side of emotions. DSME intervention based on experience-based delivery method permits a reorganization of disease experiences with positive impact on the learning process which favors embodied diabetes.

Disclosure

G. Gastaldi: Consultant; Self; Medtronic, Novo Nordisk A/S. Other Relationship; Self; Dexcom, Inc. M. Dos Santos Mamed: None.
644-P: Social Media Campaign Raises Awareness of Diabetes Risks and Programs in Hispanic Communities
Authors: PHILIS-TSIMIKAS ATHENA , RUIZ MONICA , FORTMANN ADDIE L. , AGUILAR EFREN , JOHNSON RACHEL , KIENAST AMANDA , WALKER CHRIS
Published: June 2020

Strong evidence for improving clinical outcomes exists for the Diabetes Prevention Program (DPP) and diabetes self-management education (DSME) yet traditional methods of education and outreach have been minimally effective at engaging high-risk Hispanics. Scripps Whittier Diabetes Institute, San Diego, CA, has delivered culturally appropriate DSME and DPP programs for over 25 years and was seeking an effective method to further engage diverse communities. Facebook is the number one platform for U.S. Hispanics’ communication. Nearly half (48%) of U.S. Hispanics’ Facebook friends are family members, compared to 36% for the total population. Hispanics are the most mobile and socially active group in the U.S. and converse in the language of their preference. On-line messaging developed in Spanish and English utilized patient stories to increase understanding of diabetes risk and encourage an online risk assessment. The audience included adults ages 40+ in Chula Vista; along the Mexican American border. The campaign landing page included calls to action, helpful information regarding diabetes risk factors and links to inspiring patient stories. Nurturing emails were sent to all leads with lifestyle tips and call to action to register for a diabetes program. Bi-lingual telephone outreach was conducted within one week of the risk assessment completion to make a personal connection and answer questions. In the first 75 days of the campaign, 92 assessments were initiated: 66 completed: 26 abandoned. Of the leads sent: 75% were from the Spanish language campaign; 0.67% click-through-rate from Facebook to the landing page; of the 1800 clicks, 75% came from the Spanish language ads; 60-75% of the clicks are from a female audience for both English and Spanish; and nearly 50/50 split between at risk and not at risk for T2DM.This social media campaign pilot was effective in increasing awareness of diabetes risks, DPP and DSME in Hispanic communities, especially in the Spanish speaking, female population.

Disclosure

A. Philis-Tsimikas: Advisory Panel; Self; Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. M. Ruiz: None. A.L. Fortmann: None. E. Aguilar: None. R. Johnson: None. A. Kienast: None. C. Walker: None.

Funding

Woltman Family Foundation
647-P: Short-Term Continuous Glucose Monitoring Use in Adolescents with Type 1 Diabetes Enhances Empowerment
Authors: ILKOWITZ JENIECE , RAISINGANI MANISH , WU FEN , CHEN YU , GERSON JESSICA , GALLAGHER MARY PAT , FRANKLIN BONITA
Published: June 2020

Background: Studies in adults with type 1 diabetes (T1D) show Continuous Glucose Monitoring (CGM) significantly lowers HbA1c however, the benefit of CGM use in adolescents has been elusive. We asked if short-term CGM use would have an effect on adolescents with poorly controlled T1D.

Methods: In a randomized open label study we recruited 12 CGM naïve subjects with T1D, with an HbA1c >8% and ages 13-18 years. Visit 1 (V1) entailed consent, survey completion (Stage of Change (SOC), Diabetes Empowerment Scale (DES-SF), Pediatric Quality of Life (PedsQL), diabetes knowledge) and randomization to treatment (T), CGM Dexcom G4 for 1 week, or control (C). Both groups received daily diabetes care communication for the 1 week between V1 and Visit 2 (V2). Visit 3 (V3) was 1 month later and Visit 4 (V4) was at 3 months. Surveys were completed at all visits and HbA1c at V1 and V4.

Results: Subjects (n=12) had an average age of 15.5 years and consisted of six Hispanic and five males. There were no significant (NS) differences between subject characteristics in the C (n=3) and T (n=9) groups. Compared to V1, there were NS changes in SOC and average number of boluses or blood glucoses (BGs) between the groups. The change in DES-SF from V1 to V4 was significant (p=0.04) for the T compared to the C. The decrease in HbA1c between V1 and V4 (-1.5%) in the T vs. an increase in the C (.4%) was NS (p=0.10) but clinically meaningful. Although NS, there was an increase in average BGs/day (+1.7) and a decrease in 7 day average BG (-81mg/dl) for T vs. the C (+0.1 BGs and -28mg/dl) from V1 to V2.

Conclusions: Research on CGM use or its emotional effects in adolescents with poorly controlled T1D is limited. This study demonstrated a significant impact on diabetes empowerment with short-term use of CGM. Although NS, this was associated with an increased number of BG checks and a decreased average BG during CGM use plus a decreased HbA1c at 3 months. Use of more advanced CGM systems may hold promise for adolescents with T1D through greater empowerment.

Disclosure

J. Ilkowitz: None. M. Raisingani: None. F. Wu: None. Y. Chen: None. J. Gerson: None. M. Gallagher: None. B. Franklin: None.
654-P: Detection of Insulin-Derived Amyloid Deposits and the Management of Insulin Injection Site Using CGM and Abdominal Wall CT Examination
Authors: NISHIHARA HARUMI , SUDO TOMIKO , SASAKI JUNKO , HASEGAWA NORIKO , ISHII MASUMI , KOIZUMI CHIAKI , HIRAOKA MEGUMI , IKEJIMA SHIN , HIRAI AIZAN , SUZUKI MIKA
Published: June 2020

Repetitive injection of insulin causes subcutaneous amyloid deposits leading to impaired blood glucose control due to delayed absorption of the drugs. Amyloid deposits in abdominal wall is detected by CT examinations. Proper selection of the injection site avoiding amyloid deposits is essential. The present study was conducted to establish a novel method for the management of injection site avoiding amyloid deposits.

The present study included 50 diabetic patients who were treated with insulin over 5 years. Two weeks CGM was performed using Free Style Libre Pro. In the case of significant day to day variation in blood glucose control, abdominal wall CT examination was performed. In front abdominal wall, 36 small circular zones were set to identify the site of injection, named “no-injection zone” which caused impaired blood glucose control due to delayed absorption of insulin by amyloid deposits. Site rotation seat was developed for the management of insulin injection site.

Among 50 patients, 33 patients were shown to have “no-injection zone” (average; 8.5 zones). In the patients whose HbA1c is over 8% (n=15), a significant improvement in HbA1c from 9.0% to 7.8% was observed without any changes in daily dose of long-acting insulins by the management of injection site.

The management of injection site using CGM, abdominal CT and site rotation seat improves blood glucose control.

Disclosure

H. Nishihara: None. T. Sudo: None. J. Sasaki: None. N. Hasegawa: None. M. Ishii: None. C. Koizumi: None. M. Hiraoka: None. S. Ikejima: None. A. Hirai: None. M. Suzuki: None.
656-P: Multidisciplinary Predialysis Team Education for Patients with Diabetic Nephropathy Produced Not Only Good Effects on the Hemodialysis Course, but Also Prolonged the Survival
Authors: HITOMI MAMIKO , SATO TERUKO , MORIYA TATSUMI
Published: June 2020

To determine whether or not a multidisciplinary individual team approach (MTA) benefited the hemodialysis (HD) course and prognosis after HD induction in patients with diabetic nephropathy (DN), we compared the effect of an MTA on the HD course of 42 DN patients with that of 33 DN patients managed by a dietitian approach alone (DA) (n=75 total; 50 men, 62±12 years old; 73 with type 2 diabetes mellitus). In all cases, HD was initiated between January 2010 and June 2016. There were no significant differences in the HbA1c or age between the groups when serum creatinine (S-Cr) was 2.0 mg/dL at the study start. MTA staff members were doctors, dietitians, nurses, laboratory technologists, and pharmacists. The team provided broad education, including advice on nutrition, medication, medical exams, and foot care. The duration from S-Cr 2.0 mg/dL to HD induction was significantly longer in the MTA group (3.3±2.2 yrs) than the DA group (2.3±1.8 yrs; p=0.021). The MTA group had a shorter hospitalization for HD induction and lower cost per admission than the DA group (44±33 days vs. 32±20 days, p=0.035; $20,506 ±14,219 vs. $14,554 ± 826, p=0.019). Urine collection (24-h) was more frequent in the MTA group than the DA group (likelihood ratio 5.05; p=0.025). Patients with urine collection tended to live longer than those without it (8.2±3.1 yrs vs. 6.9±2.6 yrs, p=0.075). The CTR at the HD induction tended to be smaller in the MTA group than in the DA group (53.0±5.7% vs. 55.6±7.3%, p=0.057). The hematocrit value in the MTA group (29.2±4.6%) was significantly better than in the DA group (26.5±4.0%, p=0.004). A Kaplan-Meier survival analysis showed that the MTA group had a better survival than the DA group (log rank 4.430, p=0.035). An MTA provided multiple effects that postpone HD induction, better clinical HD course, cost reduction, and prolonged survival compared with a DA, even when observation was started at the same S-Cr level.

Disclosure

M. Hitomi: None. T. Sato: None. T. Moriya: None.
658-P: Regular Diabetes Ward Round Is Associated with Better Infection Control and Lower Mortality Rate in Inpatients Younger than 80 Years Old
Authors: CHOU SHENGPU , HARAGUCHI MIKIKO , IMAI MIEKO , ISHIBASHI MIDORI , MASANO MIKA , IWATA YOSHIE , ODA YUKO , MOTOGAMI TOMOKO , NAKAMURA SUNAO
Published: June 2020

Background: While good glycemic control during hospitalization has been reported to have better outcomes and reduced complications, achieving this is difficult in hospitals where diabetes specialists are not present or understaffed. Diabetes ward round by an independent and specialized team (DMWR) is one of the solutions for regular monitoring of glycemic control in inpatients, few studies existed to assess its effectiveness.

Material and Methods: A team composed of two diabetes specialists, one specialized nurse, one dietician, one pharmacist, and one assistant conducted DMWR from May 2017. Hospital inpatients who were at risk of poorly controlled glycemia were given adequate advice to prevent hyperglycemia and hypoglycemia. A total of 384,422 capillary blood glucose measurements were taken from all hospitalized patients from April 2015 to March 2019 and the changes in frequency of hyperglycemic and hypoglycemic episodes were analyzed. Infection control was evaluated by episodes of blood cultures. The mortality rate at discharge and within 90 days of discharge were also calculated.

Results: The odds ratio (OR) for the frequency of pre-prandial hyperglycemia before and after DMWR was 0.430 (95% confidence interval (CI): 0.407, 0.454). The OR for that of severe hypoglycemia was 0.371 (95% CI: 0.265, 0.520). The number of blood cultures was significantly reduced by 26% after DMWR. The mortality rate within 90 days of discharge was also significantly decreased in patients aged less than 65 (OR 0.363, 95%CI: 0.216, 0.609) and from 65 to 79 (OR 0.689, 95%CI: 0.541, 0.856), respectively.

Conclusion: DMWR resulted in improved glycemic control and reduced staff burden for managing severe hypoglycemia and preventable infection events. Moreover, the mortality rate of patients less than 80 years of age was also reduced over the same period, suggesting that stabilizing blood sugar was beneficial for lowering mortality rate in the younger patient population.

Disclosure

S. Chou: None. M. Haraguchi: None. M. Imai: None. M. Ishibashi: None. M. Masano: None. Y. Iwata: None. Y. Oda: None. T. Motogami: None. S. Nakamura: None.
663-P: Medication Adherence (MA) Is an Independent Predictor for Glycemic Control Even after Adjustment for Lifestyle Confounders in Japanese Patients with Type 2 Diabetes
Authors: YAGUCHI YUTA , FUJIHARA KAZUYA , YAMADA MAYUKO H. , SATO TAKAAKI , KITAZAWA MASARU , YAMAMOTO MASAHIKO , SEIDA HIROYASU , YAMANAKA NAUTA , MATSUBAYASHI YASUHIRO , SONE HIROHITO
Published: June 2020

The impact of MA on glycemic control may be affected by lifestyle confounders but little is known on this topic. We investigated clinical variables significantly associated with MA for OHA and the association between MA and glycemic control considering the effects of smoking, drinking alcohol, exercise and dietary habits in Japanese with DM using a large claims database. Analyzed were 6651 DM patients with medication records for OHA for at least 1 y (mean age 54 y, HbA1c 7.2%). MA was evaluated by the proportion of days covered (PDC), and PDC <80% was defined as non-adherence. Mean PDC was 80.7% and 31.8% of patients were non-adherent. Logistic analysis indicated that older age and taking ≥2 concomitant medications were significantly associated with adherence (odds ratio (OR) 1.34 (95% CI 1.24-1.44) and 1.19 (1.01-1.40), respectively) while smoking and skipping breakfast were significantly associated with non-adherence (OR 0.88 (0.78-0.99) and 0.60 (0.51-0.71), respectively). Multiple regression analysis showed that PDC was negatively correlated with HbA1c after adjusting for lifestyle factors. HbA1c decreased by 0.2% with a 25% increase in PDC. MA was significantly associated with glycemic control even after adjustment for lifestyle factors, suggesting the importance of improving MA in parallel with lifestyle education.

Disclosure

Y. Yaguchi: None. K. Fujihara: None. M.H. Yamada: None. T. Sato: None. M. Kitazawa: None. M. Yamamoto: None. H. Seida: None. N. Yamanaka: None. Y. Matsubayashi: None. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.
664-P: The Case for Targeted Diabetes Medication and Device CME for PCPs
Authors: LEVINE BRIAN J. , MCDERMOTT JAMES M. , LACKNER JOHANNA B. , SHOGER ERIK , STONER KEATON C. , BEASER RICHARD S. , CLOSE KELLY L.
Published: June 2020

Objective: This study aimed to evaluate primary care physicians’ (PCPs) perceptions of and desired improvements to diabetes continuing medical education (CME).

Methods: In March-April 2019, 306 U.S.-based PCPs who treat people with diabetes and earn diabetes CME credits completed an online survey.

Results: On average, respondents regularly see 391 people with diabetes (38% on insulin) for checkups and allot 16% of annual CME credit hours to diabetes. More than 75% of PCPs believe that improved PCP education could enhance care for people with diabetes and 82% believe that new diabetes technologies and therapies will change their practice significantly over the next five years. Respondents commonly reported that CME does not adequately cover diabetes drugs/devices, cost/insurance, or behavioral health. More than 80% of surveyed PCPs currently initiate and manage diabetes medications, though >55% would prefer to outsource to a diabetes specialist. The trend is reversed for diabetes devices: 34% of PCPs in this study currently initiate and manage CGM, whereas 54% would like to, and 24% currently initiate and manage insulin pumps, whereas 53% would like to. Respondents most commonly used journal articles and online courses—used by 79% and 65%, respectively—to obtain diabetes CME credits, though academic/medical conferences were regarded as the most useful. Nearly all PCPs also believe improved patient education would improve diabetes care.

Discussion: PCPs in this study believe both online and live CME, alongside improved patient education, can help them adapt to the rapidly evolving diabetes management landscape. More PCPs would prefer to outsource diabetes medication management than do currently, suggesting discomfort with managing these medications. Conversely, PCPs would like to take a more active role in diabetes device management. CME could help close both gaps in order to enhance PCPs’ comfort and efficacy in managing diabetes. CGM should be emphasized given its dual applications in diagnostics and therapy.

Disclosure

B.J. Levine: Employee; Self; Onduo. J.M. McDermott: Other Relationship; Self; Various. J.B. Lackner: None. E. Shoger: None. K.C. Stoner: Other Relationship; Self; Various companies and organizations. R.S. Beaser: None. K.L. Close: Other Relationship; Self; Abbott, Air Liquide, American Diabetes Association, AstraZeneca, Dexcom, Inc., Janssen Pharmaceuticals, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust, Lilly Diabetes, Merck & Co., Inc.

Funding

The Leona M. and Harry B. Helmsley Charitable Trust
668-P: Experiencing a New Role for the Diabetes Educators Recruiting for Longitudinal Studies, Kuwaiti Experience
Authors: RAHME ZAHRA , TAHA NEHAD A. , MESBAH NAGLAA
Published: June 2020

Background: Kuwait is the second highest country in the incidence of T1D globally. Familial study of this disease may disclose certain causative agents responsible for passing the disease through families. The recruitment of T1D patients and their family members to participate in a Kuwaiti autoimmune diabetes (KADS) Study was challenging. It is a longitudinal study, it required taking blood samples every 6 months for 3 years duration for all family members of a person with diabetes. It is important to note that, in Kuwait, convincing families to participate in researches were an extremely difficult task which needs a highly skilled personal to persuade family participations.

Aim: This abstract aimed to examine different recruitment approaches which were used and highlights the role of diabetes educators (DE) in the recruitment process.

Method: Three recruitment approaches were examined.1-Physician-approach; recruitment took place through their physicians follow up visit.2-Research coordinator (RC) approach recruitment took place in the clinic area. While patient is waiting for his medical appointment the research coordinator offers participating in the research.3-DE approach Recruitment took place through their educator follow up visit.

Results: Physicians were able to recruit 22 participants, but none of them completed the process of participation. While the RC could not recruit any participants. However, the DEs were able to recruit 274 participants.

Conclusion: Although the Kuwaiti families are generally obedient to their doctors, the physician were not able to recruit only few participants for this study. In contrast, the prolonged pre-established good relationship between the patient, family and the DE resulted in mutual trust and facilitated the process of recruitment. Hence, more subjects were recruited compare to the physician and the RC approaches. Thus, the DE approach was proved to be a successful approach to recruit people for researches.

Disclosure

Z. Rahme: None. N.A. Taha: None. N. Mesbah: None.
671-P: Recruitment and Retention of Minority Women for Women in Control 2.0: A Virtual Diabetes Self-Management Education Study
Authors: BRAGG ALEXA , GARDINER PAULA , WOODS SHAKIYLA B. , HOWARD JESSICA M. , MITCHELL SUZANNE
Published: June 2020

Background: Research is needed to improve diabetes care of minority women who are disproportionately affected by type 2 diabetes. Yet, barriers exist that hinder efforts to include minority women in research. Evidence suggests that successful study enrollment requires multiple recruitment strategies. Little is known about the correlation between recruitment strategy and retention. We aim to examine the relationship between Women in Control (WIC) recruitment strategies, enrollment rates, and retention.

Methods: We utilized multiple strategies to recruit minority women, including culturally-tailored invitation letters and phone calls to targeted Boston Medical Center patients, referrals from clinicians and WIC participants, word of mouth, social media, and posted flyers. We analyzed WIC recruitment data to determine the proportion of participants recruited by each method. We then assessed the proportion of WIC participants who adhered to the Diabetes Self-Management Education (DSME) study protocol by recruitment method.

Results: Overall, targeted recruitment methods (letters and phone calls) yielded the highest number of screens and enrollments with a total of 975 screened, 207 found eligible, 195 enrolled - with 75% of those enrolled, attending 5 out 8 DSME medical group visits (MGV). Recruitment flyers generated the second most potential participants with a total of 73 screened, 18 found eligible and enrolled - with 83% attending 5 out of 8 MGV. All other recruitment methods (clinician or participant referral, word of mouth, social media and unknown source) combined yielded a total of 85 screened, 23 found eligible, 23 enrolled - with 78% attending 5 out of 8 MGV.

Conclusion: Although we used multiple methods to recruit minority women, our data shows that targeted recruitment - using culturally tailored messaging - was the most effective recruitment method. There was no relationship between recruitment method and retention in the intervention.

Disclosure

A. Bragg: None. P. Gardiner: None. S.B. Woods: None. J.M. Howard: None. S. Mitchell: Speaker’s Bureau; Self; Merck Sharp & Dohme Corp. Stock/Shareholder; Self; See Yourself Health, LLC.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106531)
675-P: Diabetes Care and Education Specialists: Opportunities to Improve Glycemia in Disadvantaged Communities
Authors: MON SANN , MEHROTRA NEHA , REN DIANXU , DEJESUS CARLA , SIMINERIO LINDA M.
Published: June 2020

The number of people with DM continues to increase, with an inverse proportion of providers and specialists available to provide comprehensive care and support. This is especially troublesome for those at highest risk in underserved areas. Diabetes self-management education and support (DSMES) are critical to achieving quality outcomes. Yet reports show that patients are not participating in traditional DSMES approaches, subsequently DSMES programs are at risk of closure. In response, diabetes educators (DEs), now referred to as Diabetes Care and Education Specialists, are seeking new opportunities to provide services that include attention to behavioral and psychosocial issues. A coordinated care (CC) model was organized to address complex needs of those with DM in a disadvantaged community. The local endocrinologist sought assistance from a hospital-based program to provide coordinated care and DSMES on established clinic days. The DE was available for ongoing follow up and liaising to community services. Overarching goal was to lower mean A1C <8%. Of 80 patients who received care in the DM clinic, majority with type 2 DM (80%) 52.5% F, mean age 57.1±14.1 years, BMI of 34.1 49±10.4 kg/m2 and A1C 9.2%, 49 patients agreed to participate in the CC program while 31 patients received usual care (UC) (traditional visit with endocrinologist only). No statistical differences were found in age, sex, BMI, or mean A1C between groups at baseline. Percent of patients with A1C <8% in CC as compared to UC was 26.5% vs. 29% at baseline (p=0.8); 65% vs. 61.5% at 3 months (p>0.99), 59.3% vs27.8% at 6months(p=0.07); 66.7% vs. 35% at 12 months (p=0.03). The majority of patients in the CC group, maintained lower A1C levels, meeting the immediate target of <8%, while the UC group experienced a consistent rise in A1C over the course of the intervention. A provider-DE model offers a framework for providers and DEs to help a population of patients with complex needs to reach and sustain improved glycemia.

Disclosure

S. Mon: None. N. Mehrotra: None. D. Ren: None. C. DeJesus: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company.
677-P: Use of a Hybrid Closed-Loop System Lowers CHO Requirements during Prolonged Exercise
Authors: MUELLER-KORBSCH MICHAEL , FRUEHWALD LISA , HEER MICHAEL , FANGMEYER-BINDER MARIA , REINHART-MIKOCKI DAVID , FASCHING PETER
Published: June 2020

Some individuals with type 1 diabetes (T1D) use the DIY Kit RileyLink Loop System (Loop) during exercise to avoid hypoglycemia and maintain optimal glucose levels; however, the system has no regulatory approval. This exploratory retrospective analysis assessed carbohydrate (CHO) requirements for maintaining glucose in target range (70-180 mg/dL) during and after 2 days of prolonged cycling, comparing the Loop with rtCGM plus insulin pump (rtCGM+P). Seven T1D adults (2 female/5 male, age 41±11 years, 6.1±0.8% A1C) were enrolled. Cycling was divided into two parts each day (Part 1, 28 miles; Part 2, 17 miles) with an hour lunch between parts. CHO intake was lower in the Loop group vs. rtCGM+P on Day1. (Table 1) More CHOs were required on Day2 than Day1 with Loop use (rtCGM+P users did not cycle on Day2). Prandial insulin doses were notably lower at the Day2 lunch meal vs. Day1 44 g CHO/IU vs. 6 g CHO/IU. Loop users vs. rtCGM+P users spent notably less time <70 mg/dL on Day 1 (5.4 ± 4.4% vs. 12 ± 17%, respectively) and Post Exercise Day (3.8 ± 2.8% vs. 0.5 ± 0.7%, respectively). Time spent within 70 - 180 mg/dL were comparable on Day1 (84 ± 16% vs. 82 ± 17%, respectively) and Post Exercise Day (88 ± 10% vs. 91 ± 11%, respectively. Use of the Loop was associated with lower CHO requirements during prolonged exercise. Loop settings must be adjusted before and after exercise to maintain glucose levels <220 mg/dL.

Disclosure

M. Mueller-Korbsch: Research Support; Self; Dexcom, Inc., Menarini Group, Novo Nordisk A/S. L. Fruehwald: None. M. Heer: None. M. Fangmeyer-Binder: None. D. Reinhart-Mikocki: None. P. Fasching: None.
679-P: Endothelial and Hematopoietic Progenitor Cells Are Reduced at Rest and Have an Attenuated Mobilization Response to Exercise in People with Type 1 Diabetes
Authors: TAYLOR GUY S. , SMITH KIERAN , SCRAGG JADINE , BASHIR AYAT , FLATT ANNELIESE , STEVENSON EMMA J. , SHAW JAMES A. , ROSS MARK D. , WEST DANIEL J.
Published: June 2020

Aims: Endothelial and Hematopoietic Progenitor Cells (EPCs and HPCs) promote vascular health through secreting proangiogenic factors and replacing damaged cells. Exercise has been shown to be a mobiliser of these rare cells in healthy individuals, however, the response in chronic diseases such as type 1 diabetes (T1D) is unclear. We compared EPC and HPC counts at rest and after acute exercise in people with and without T1D.

Methods: Thirty T1D participants (38±12 years, HbA1c 58.5±9.3 mmol/mol-1, diabetes duration 20±13 years) and 30 age, sex, BMI and fitness matched non diabetes controls were recruited. After a maximal exercise test, participants attended a second visit to complete 45mins of walking at 60%VO2peak. Blood samples were taken at rest, immediately and 1 hour post exercise. Circulating levels of two HPCs and five EPC phenotypes were enumerated by flow cytometry. Data (mean±SD) were analysed by mixed model ANOVA and t-test with significance accepted at p≤0.05.

Results: The T1D group had significantly lower rest count of HPCs and EPCs, ranging from 21 to 41% lower across all samples compared to the control. Exercise mobilized all cell phenotypes in both groups, with significant increases from rest to post exercise, while HPCs and CD34+CD31+ EPCs remained elevated 1hr post exercise. However, the change (Δ) in HPCs and EPCs from rest to post exercise was greater in the control versus T1D group, with higher CD34+CD45dim HPCs (p=0.03, Δ 48±65 vs. 24±33 cells/ml), as well as CD34+CD31+ (p=0.04, Δ 23±19 vs. 15±25 cells/ml) and CD34+VEGFR2+ EPCs (p=0.02, Δ 24 ±24 vs. 15±31 cells/ml).

Conclusion: People with T1D have reduced numbers of HPCs and EPCs at rest and also display a blunted exercise induced increase in these rare blood vessel protecting cells. Further research is needed to understand the clinical significance of an attenuated exercise mobilization of these EPCs and HPCs phenotypes in predicting future cardiovascular complications in T1D.

Disclosure

G.S. Taylor: None. K. Smith: None. J. Scragg: None. A. Bashir: None. A. Flatt: None. E.J. Stevenson: None. J.A. Shaw: Advisory Panel; Self; Medtronic. Speaker’s Bureau; Self; Novo Nordisk A/S. M.D. Ross: None. D.J. West: None.

Funding

Diabetes Research & Wellness Foundation (to D.J.W.)
683-P: Menstrual Cycle and Glycemic Differences during Prolonged, Fasting Exercise in Females with Type 1 Diabetes
Authors: MCGAUGH SARAH M. , ZAHARIEVA DESSI , POONI RUBIN , D’SOUZA NINOSCHKA C. , YARDLEY JANE E. , RIDDELL MICHAEL
Published: June 2020

Glycemic control may differ throughout the menstrual cycle, with increased incidence of hyperglycemia in the luteal phase. However, it is unclear if glycemic differences exist in the follicular vs. luteal phase during prolonged fasted exercise in T1D. The aim of this study was to determine if the early follicular vs. luteal phase impacts blood glucose levels during and post-exercise.

Females with T1D (n = 7, age 28±6 years, A1c 6.9±0.6%) completed two 2-hr aerobic exercise sessions (∼45% VO2peak), during the luteal (days 18-24) and early-follicular phases (days 1-6) of menstruation. Carbohydrate (CHO) intake (0.3g/kg/hr) occurred every 30-min if glucose was between 72-180 mg/dL.

No differences existed between the two phases for starting glucose, changes in glucose, CHO consumption and CHO oxidation during exercise (Table). Baseline glucagon was elevated in the luteal (28±25pg/mL) vs. follicular phase (13±12pg/mL; P<0.05). Following exercise, overnight time in hyperglycemia (>180 mg/dL) was greater in the luteal (59±44%) vs. follicular phase (21±30%; P<0.05).

Overall, glycemic responses during prolonged fasting exercise are similar between luteal and follicular phases in women with T1D, as are CHO intake needs. However, after exercise in the luteal phase, glycemia tends to be elevated and appears to contribute to greater time in hyperglycemia.

Disclosure

S.M. McGaugh: None. D. Zaharieva: Speaker’s Bureau; Self; Ascensia Diabetes Care, Insulet Corporation, Medtronic. R. Pooni: None. N.C. D’Souza: None. J.E. Yardley: Research Support; Self; Abbott, Dexcom, Inc., LifeScan Canada. Speaker’s Bureau; Self; Dexcom, Inc. M. Riddell: Advisory Panel; Self; Zucara Therapeutics Inc. Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc., Insulet Corporation. Speaker’s Bureau; Self; Medtronic, Novo Nordisk A/S.
684-P: Associations between Self-Reported Symptoms and Physical Activity Measured by Accelerometer in Adults with Type 2 Diabetes
Authors: ZHU BINGQIAN , KIM MIN JUNG , FRITSCHI CYNTHIA
Published: June 2020

Objectives: Fatigue and sleep disturbance are common in adults with T2D. The symptoms carry contextual variations and may influence physical activity (PA). This study examined the associations between these symptoms and PA measured by an accelerometer.

Methods: Fifty-three T2D adults completed a 7-day period during which they wore an ActiGraph-GT3X on the non-dominant wrist and completed a diary each morning. The diary assessed prior-night sleep and fatigue level (0-10) and feeling rested (1-5) upon awakening. Daytime PA data from the ActiGraph-GT3X were scored following the Freedson algorithm, including sedentary behavior, light- and moderate-intensity PA. The repeated 7-day data were analyzed using linear mixed models including both inter- and intra-individual sleep and fatigue variables as predictors of PA.

Results: Participants were 60.3 (range 50-76) years and 29 (54.7%) were females. The mean values for fatigue and feeling rested were 3.1 (range 0-8.6) and 3.3 (range 1.6-5.0), respectively. Controlling for age, sex, BMI, and diabetes duration (estimate=-2.4, p=0.021), inter-individual fatigue and feeling rested were not related to moderate-intensity PA; however, intra-individual fatigue (estimate=-4.0, p=0.029) and feeling rested (estimate=8.0, p=0.045) upon awakening were significantly associated with moderate-intensity PA. There were no significant associations between other sleep variables (e.g., sleep duration and efficiency) and PA variables.

Conclusions: At the inter-individual level, fatigue and feeling rested were not related to moderate-intensity PA. In contrast, at the individual level, lower fatigue and more restful sleep were associated with higher levels of moderate-intensity physical activity. These findings highlight the importance of addressing both inter- and intra-individual effects of symptoms commonly reported by T2D patients on physical activity in research and clinical practice.

Disclosure

B. Zhu: None. M. Kim: None. C. Fritschi: None.

Funding

University of Illinois at Chicago; National Institute on Aging (P30AG022849)
693-P: Oxidative–Antioxidant Balance after Maximum Intensity Exercise in Men with Type 1 Diabetes Treated with a Personal Insulin Pump vs. Healthy Control
Authors: MATEJKO BARTłOMIEJ , TOTA ŁUKASZ , MORAWSKA MAłGORZATA , MROZINSKA SANDRA , PILCH WANDA , PALKA TOMASZ , KIEC-WILK BEATA , MALECKI MACIEJ , KLUPA TOMASZ
Published: June 2020

One of the main reasons for the development of many diabetes complications is chronic hyperglycemia, which results in a number of mechanisms generating excessive production of reactive oxygen (ROS) and cause of avalanche growth of free radicals. Excessive production of ROS in the body or insufficient antioxidative barrier of the body can lead to intracellular damage. Intense physical exertion, may also violate the dynamic balance of prooxidants and antioxidants. The aim of the study was to verify the level of prooxidative-antioxidative balance in men with type 1 diabetes versus control group after maximum intensity exercise. The study included 30 men with type 1 diabetes treated with a personal insulin pumps aged 23.4 ± 5.1 with 11.4 ± 6.0 years of diabetes duration and mean HbA1c 7.2 ± 0.9%. 23 healthy men aged 24.7 ± 2.9 years were included in the control group. The march-running test on the treadmill to determine the maximal oxygen consumption (VO2max) was performed. Before and 60 minutes after the test total antioxidant status TAS (Immundiagnostik AG ImAnOx test, KC5200) and total prooxidative status TOS (test by Immundiagnostik AG PerOx, KC5100) in plasma were measured. The average level of VO2max (44.7 ± 5.7 vs. 56.0 ± 7.3) in the group of people with diabetes was significantly lower (p = 0.000) compared to the control group. Both before and after maximum exercise higher values of TOS levels (p = 0.000) was observed in patients with T1DM. The level of TAS before exercise was comparable in both groups, whereas after exercise it was significantly higher in the control group (p = 0.0000). In the diabetic group after maximum effort a decrease while in the control group a slight increase in TAS level was observed (p = 0.0174). The TOS/TAS [%] ratio was significantly higher both before and after the maximum effort in the T1DM group. Results of our study underline importance of increase oxidative stress in T1DM patients accompanying intense exercise.

Disclosure

B. Matejko: Other Relationship; Self; Dexcom, Inc., Roche Diabetes Care. &. Tota: None. M. Morawska: None. S. Mrozinska: Other Relationship; Self; Roche Diabetes Care. W. Pilch: None. T. Palka: None. B. Kiec-Wilk: None. M. Malecki: None. T. Klupa: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Roche Diabetes Care, Sanofi. Employee; Spouse/Partner; Ascensia Diabetes Care.

Funding

Polish Diabetes Association (2017); University of Physical Education (185/BS/INB/2018)
697-P: Exercise Training Remodels Adipocyte-Specific Extracellular Matrix Proteins and Alters Innervation and Vascularization in Inguinal White Adipose Tissue
Authors: NIGRO PASQUALE , VAMVINI MARIA , MIDDELBEEK ROELAND , HIRSHMAN MICHAEL F. , GOODYEAR LAURIE J.
Published: June 2020

Recent studies demonstrate that exercise training causes pronounced changes in inguinal white adipose tissue (iWAT). While most of these studies have focused on adaptations related to enhanced lipolysis and beiging of adipocytes, other tissue remodeling processes include innervation and vascularization, and changes in collagen and glycoprotein-rich extracellular matrix (ECM), all critical for adipose tissue function. Here, we determined the effects of exercise training on these iWAT adaptations. Mice were housed in individual cages with (Trained) or without (Sedentary) access to running wheels for 11 days (n=8/group). Exercise training significantly increased: iWAT neuronal innervation assessed by immunolabeling of synaptophysin (2.2 fold; p<0.01) and tyrosine hydroxylase (2.3 fold; p<0.001); and vascularization as assessed by increased lectin staining (1.5 fold; p<0.01), Vegfa mRNA (1.5 fold; p<0.05) and Angpt2 mRNA (2.6 fold; p<0.05). Since decreases in ECM components have been suggested to allow for increased innervation and vascularization in tissues, we collected conditioned media from trained and sedentary iWAT to determine if adipocyte-specific ECM proteins are changed by training. Quantitative proteomic profiling using mass spec showed that exercise training significantly increased 23 proteins and decreased 32 proteins in the iWAT-conditioned media. Interestingly, pathway analysis revealed that 14 of the 32 downregulated proteins are adipocyte-specific ECM components [collagens (COL1A2,COL14A1), laminins (LAMA4, LAMB1, LAMB2), glycoproteins (NID1, NID2)] (p<0.001: FDR <0.001). These findings support the hypothesis that exercise training leads to remodeling of ECM, which in turn regulates increased innervation and vascularization, and could facilitate exercise-induced training effects on iWAT.

Disclosure

P. Nigro: None. M. Vamvini: None. R. Middelbeek: None. M.F. Hirshman: Stock/Shareholder; Self; Abbott Laboratories, AbbVie Inc., Amgen, Colgate-Palmolive, Eli Lilly and Company, Medtronic. L.J. Goodyear: None.