bluuebunny/crossref_metadata_2025 huggingface dataset:
Progressive Improvement in Endothelial Nitric Oxide Release due to Synthase Dimer Formation with LDL Reductions below 70 mg/dL during Hyperglycemia
Authors: MASON R. PRESTON , DAWOUD HAZEM E. , SHERRATT SAMUEL , MALINSKI TADEUSZ
Published: June 2018

In diabetes, endothelial cell (EC) dysfunction is characterized by reduced nitric oxide (NO) release and increased nitroxidative stress due to NO synthase (eNOS) dimer uncoupling. Reductions in LDL improve EC function but the effect is not well understood at levels below the target of 70 mg/dL. We measured NO and peroxynitrite (ONOO−) release as well as eNOS dimer formation in ECs under hyperglycemic conditions following progressive reductions of LDL in vitro. Human umbilical vein endothelial cells (HUVECs) were incubated with LDL at concentrations ranging from 150 to <10 mg/dL with high glucose (250 mg/dL). Cells were stimulated with calcium ionophore, and assayed for NO and ONOO− release using porphyrinic sensors. eNOS dimer levels were measured using immunochemical approaches. Results showed that reductions in LDL levels had a disproportionate benefit on endothelial NO and ONOO− release below 70 mg/dL. A reduction in LDL levels from 70 to <10 mg/dL produced a 181% increase in NO release (163 ± 18 to 458 ± 34 nM; p<0.0001) and 116% decrease in ONOO− release (393 ± 27 to 182 ± 23 nM; p<0.0001), corresponding to a 513% increase in the NO-to-ONOO− release ratio (0.42 ± 0.04 to 2.56 ± 0.40; p<0.0001), a comprehensive indicator of EC function. These changes also correlated with increased eNOS dimer formation by 819%. By contrast, only a modest 27% change in EC function was observed as LDL levels were reduced from 150 to 70 mg/dL with regard to the NO-to-ONOO− release ratio. In the absence of hyperglycemia, the benefits of LDL lowering on EC function and eNOS dimerization were also very evident, but to a lesser extent. Thus, progressive improvements in endothelial NO bioavailability and eNOS dimer formation were observed at LDL levels below 70 mg/dL to <10 mg/dL. These in vitro data suggest that reductions in LDL to very low levels may be effective in reversing EC dysfunction for the diabetic patient.

Disclosure

R. Mason: Research Support; Self; Amarin Corporation, Amgen Inc., Pfizer Inc.. Consultant; Self; Amarin Corporation. Speaker's Bureau; Self; Pfizer Inc.. H.E. Dawoud: None. S. Sherratt: None. T. Malinski: None.
A Neural Signature of Metabolic Syndrome—Preliminary Results
Authors: KOTKOWSKI EITHAN , FRANKLIN CRYSTAL , FOX PETER T.
Published: June 2018

As of 2012, metabolic syndrome (MetS) has been estimated to impact 34.7% of the U.S. population (Aguilar, 2015). Meeting the criteria for MetS increases one’s risk for developing cardiovascular disease and type 2 diabetes mellitus (T2DM). However, only recently have researchers begun to probe its effects on brain structure and function. Recent studies have shown that in humans, increased levels of obesity and hyperglycemia are correlated with decreased executive function, processing speed, memory, as well as higher incidences of depression, among others (Yates, 2012). Evidence also suggests that effects of MetS and neurocognitive dysfunction are bidirectional and complex, with genetic, environmental, and behavioral causes playing an important role (Biessels, 2014). In our study, we use voxel-based morphometry (VBM), a well-established structural MRI imaging analysis, to investigate regional gray matter atrophy differences between age- and sex-matched healthy controls (n = 108) and individuals meeting the International Diabetes Federation criteria for MetS (n = 108) from a homogenous Mexican-American cohort. We find that, indeed, there is a significant difference in gray matter density between individuals meeting the criteria for MetS and their age- and sex-matched healthy controls with statistically significant involvement in the following brain regions: bilateral caudate nuclei, orbitofrontal cortex, right parahippocampus/amygdala, right posterior insula, and posterior cerebellum. Additionally, when regressing out key components of MetS such as waist circumference and obesity, we find diverging gray matter atrophy patterns suggesting differential involvement of MetS components on gray matter structure.

Disclosure

E. Kotkowski: None. C. Franklin: None. P.T. Fox: None.
Insulin or Metformin for Glucose Control during Wound Healing in Diabetes?
Authors: MROZIKIEWICZ-RAKOWSKA BEATA , MIECZKOWSKI MATEUSZ , SIWKO TOMASZ , BUJALSKA-ZADROZNY MAGDALENA , GRZELA TOMASZ , WOLINSKA RENATA , DE CORDE ANNA E. , FOLTYNSKI PIOTR , CZUPRYNIAK LESZEK
Published: June 2018

Good glycemic control is crucial for the proper wound healing in diabetes. It is not clear whether there is any additional effect on wound healing of any antidiabetic drugs beyond improvement in glucose control. We conducted an experimental study aiming at assessing the effect of insulin and metformin on the wound healing. The study was performed in 45 male Wistar rats with streptozotocin-induced diabetes divided into 3 groups: group 1 received human NPH insulin intraperitoneally (5 j.m./kg b.w.) once daily, group 2 received metformin intragastrically (500 mg/kg b.w.) once daily and group 3 (controls) were given saline intraperitoneally. The treatment goal was to achieve blood glucose levels of 350-450 mg/dl in order to reflect hyperglycemic conditions often associated with wound development. After 30 days of antidiabetic treatment the rats had the thin layer of the skin cut out from the dorsal skin 2x2 cm. The wounds were assessed every 3 days with digital photography and wound biopsy. The wounds healing was followed-up for 9 days. Mean blood glucose levels in all groups after 30 days of treatment and during wound healing follow-up ranged 350 and 450 mg/dl. After 3 days healing in the rats treated with insulin was more advanced than in the control group, and it was more advanced than in the metformin group after 6 and 9 days. There were no differences between the metformin and control groups at any stage of the study. Wound tissue samples taken from the insulin treated animals presented with significantly lower level of inflammatory infiltration than those obtained from the rats treated with metformin. Immunohistochemical assessment showed the greatest density of centers of profileration in insulin treated animals.

In conclusion, insulin treatment was more beneficial than metformin for the wound healing process in animal model. As the observations were made at a similar level of hyperglycemia in all groups, it might be speculated that there is an additional effect of insulin on wound healing beyond glucose lowering action.

Disclosure

B. Mrozikiewicz-Rakowska: None. M. Mieczkowski: None. T. Siwko: None. M. Bujalska-Zadrozny: None. T. Grzela: None. R. Wolinska: None. A.E. de Corde: None. P. Foltynski: None. L. Czupryniak: Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company. Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company. Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Merck Sharp & Dohme Corp., Merck & Co., Inc., Polpharma, Servier.
3D Microstructural Fiber Tracking of the Human Calf Muscles in Individuals With and Without Type 2 Diabetes during Rest and Exercise
Authors: EDALATI MASOUD , SORENSEN CHRISTOPHER J. , HASTINGS MARY , ZAYED MOHAMED A. , MUELLER MICHAEL J. , ZHENG JIE
Published: June 2018

Aim: This work explores underlying microstructural fiber differences in the calf muscles of individuals with and without type 2 diabetes mellitus (DM) at rest and during an isometric exercise.

Methods: Twenty-one subjects were examined in a 3T MRI scanner. Two groups were tested: 8 participants without DM (WDM) and 13 participants with DM. We used a custom-made MRI compatible ergometer that consisted of a brake-like pedal with an adjustable pressure gauge. Diffusion tensor imaging was performed on calf at rest and during a plantarflexion exercise. Regions of interests (ROI) were manually drawn on medial and lateral gastrocnemius (MG and LG), as well as on soleus (SOL).

Results: In the MG, the fiber length changes (%) were -29.07±6.71 for the WDM, and -52.53±15.for the DM group (P<.001). Exercise fiber density (P<.01) and angle (P<.05) changes were also significantly different between groups. The DM resulted in more fiber disarrays with loss of fiber during exercise (Fig 1).

Conclusions: While more changes in the fiber indices were observed in the DM during exercise, significant difference was shown in the MG muscle. These changes may reflect diabetic damage by altering muscle microstructure.

Disclosure

M. Edalati: None. C.J. Sorensen: None. M. Hastings: None. M.A. Zayed: None. M.J. Mueller: None. J. Zheng: None.
The Roles of NLRP3 Inflammasome and ADAR1 in Diabetic Foot Ulcer
Authors: WANG FANG , ZHAO LILING , YANG WENJUN , HE HONGHUI , MO ZHAOHUI
Published: June 2018

Infected diabetic foot ulcer (DFU) is an important problem because it is a limb or even life threatening, and burdens a great financial load to the community. It’s shown that circulating inflammatory proteins are reputed to be of poor value for diagnosing DFU as lack of specificity. Therefore it's necessary to investigate newer discussed inflammatory parameters. NLRP3 inflammasome, a multiprotein complex consists of NLRP3, ASC and pro-caspase-1 and controls the production of IL-1β and IL-18, is an important contributor to the development of type 2 diabetes. The RNA-specific adenosine deaminase (ADAR1) is interferon-inducible double stranded (ds) RNA-binding protein, which is demonstrated to inhibit the production of type I interferons and various proinflammatory cytokines such as TNF-a and IL-6. But little is known about the ex vivo profile of NLRP3 inflammasome and ADAR1 in DFU. On this basis the aim of our study was to evaluate the role of NLRP3 inflammasome and ADAR1 in subjects with DFU in comparison with subjects without DFU. We completed a study including 20 healthy volunteers, 20 newly diagnosed type 2 diabetic (T2D) patients and 30 DFU patients (wagner2-4). Then peripheral blood mononuclear cells were collected from all subjects and NLRP3, ASC, Caspase-1, ADAR1 contents were detected by real-time PCR. The results showed that mRNA of NLRP3, ASC, Caspase-1 in T2D patients were significantly higher than those of healthy persons, while 2-fold lower than DFU patients (both P < 0.05); ADAR1 mRNA in T2D patients were significantly higher than those of healthy persons (P < 0.05). Interestingly, however, ADAR1 mRNA in DFU patients were decreased by 3-fold compared with T2D (P < 0.05), indicating that ADAR1 is increased in low-grade inflammation state but decreased in severe infectious state. This study suggests that NLRP3 inflammasome and ADAR1 may be useful markers to diagnose and follow the DFU. Further investigation is needed and it will be interesting to investigate the connection between them.

Disclosure

F. Wang: None. L. Zhao: None. W. Yang: None. H. He: None. Z. Mo: None.
Evaluating Evidence-Based Strategies to Build and Support Lifestyle Change Programs for People at High Risk for Type 2 Diabetes
Authors: MENSA-WILMOT YVONNE , BOWEN SHELLY-ANN , BROWN ROSS I. , BONNER TIMETHIA , FARRIS KIMBERLY D. , RUTLEDGE GIA E.
Published: June 2018

This study discusses preliminary outcomes from a subset of national grantees implementing evidence-based engagement strategies to scale the National Diabetes Prevention Program (National DPP) and reach people at risk for type 2 diabetes, including population subgroups who experience health or socioeconomic disparities. Quantitative and qualitative analyses were conducted using progress reports submitted in years 1 and 2 by grantees (health departments in 17 states and 4 large cities). Evaluation reports were analyzed using MAXQDA software to identify facilitators and barriers to implementing these strategies. Grantees worked to increase prediabetes screening, testing, referral, and enrollment among vulnerable, high-risk participants. Major strategies implemented included (1) developing tailored marketing plans to reach and engage persons with prediabetes, (2) implementing culturally tailored media campaigns, and (3) funding lifestyle coach trainings and professional development opportunities on motivational interviewing. Media metrics show > 2 million people were reached (increase of 794% from baseline) and > 17,000 people (increase of 86% from baseline) with prediabetes enrolled in programs. Facilitators included partnerships, technical assistance to build capacity, and development of referral policies. Barriers included lack of referral processes, unclear communication among partners, and language barriers in some populations. As grantees worked to increase awareness of prediabetes and extend the reach of the National DPP, they created a network of partners, engaged community stakeholders, and developed activities to sustain the programs by leveraging existing resources.

Disclosure

Y. Mensa-Wilmot: None. S. Bowen: None. R.I. Brown: None. T. Bonner: None. K.D. Farris: None. G.E. Rutledge: None.
I Wanted Diabetes Out—Lived Experiences of Diabetes Burnout from Bloggers with Type 1 Diabetes
Authors: ABDOLI SAMEREH , VORA AMIT C. , HESSLER DANIELLE M. , STUCKEY HEATHER L.
Published: June 2018

Objective: To define and understand diabetes burnout through thematic analysis of narrative posts, written by adults with type 1 diabetes (T1D), published in publicly available blogs.

Research Design and Methods: A qualitative thematic analysis of 35 posts published in 21 blogs from the U.S., UK, and Ireland, written by adults with T1D, provided the basis for definition(s) of diabetes burnout. Data management (Nvivo 11 Pro) and analysis included three phases: immersion, reduction, and interpretation (kappa=.91).

Results: Findings included five main themes that described diabetes burnout: (1)Burnout is a “detachment” from diabetes care; (2) the “demanding life” of diabetes leads to burnout; (3) struggling with “perfect” numbers adds to burnout; (4) “life events” are catalysts to burnout; (5) and overcoming burnout is like “climbing out of a difficult hole.”

Conclusions: Analysis of blogs provided unique insights into the concept of diabetes burnout. Five themes were identified that ranged from detachment from diabetes care to difficulties in overcoming diabetes. These data provide a next step into understanding diabetes burnout and factors that may co-occur. Further research needed to advance science of diabetes burnout to improve quality of care and quality of life of individuals with diabetes.

Disclosure

S. Abdoli: None. A.C. Vora: Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc., Sanofi-Aventis, Janssen Pharmaceuticals, Inc. D.M. Hessler: Consultant; Self; Eli Lilly and Company. H.L. Stuckey: Consultant; Spouse/Partner; Calibra Medical, Eli Lilly and Company. Research Support; Spouse/Partner; Novo Nordisk Inc.. Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc..
Diabetes Self-Management Education via Telemedicine in the United States Air Force
Authors: WATSON NINA , ACUNA DORIS G. , WARDIAN JANA L. , COBB ELLEN C. , BEAVERS DAVID , SAUERWEIN TOM J.
Published: June 2018

Diabetes Self-Management Education (DSME) is recommended for patients with a new diagnosis or without prior diabetes education. However, not all Military Treatment Facilities (MTFs) have capacity to provide this resource to patients, which creates a disparity in healthcare. The Diabetes Center of Excellence (DCOE) has an ADA-recognized DSME program and potential to fill this gap through DSME via telemedicine. The Military Interagency Satellite Training (MIST) system, which utilizes satellite technology to broadcast one-way video and two-way audio to distance learners, is available at all MTFs. To test the concept, DSME was broadcast to Randolph Air Force Base (RAFB) from October 2016-October 2017. During this time, 181 patients enrolled in DSME classes; 127 were DCOE patients and 54 were from RAFB. Among data collected were pre/post patient knowledge tests and the validated 17-item Diabetes-related Distress Scale (DDS-17). Knowledge significantly increased from baseline to Class 4. Few patients completed all 4 classes and 6 month follow-up (n=16). Patients had an increase in all DDS-17 domains at the completion of Class 4; however, by 6 months, distress returned to baseline levels. Patient satisfaction surveys were completed at DCOE (n=429) and RAFB (n=227) at each encounter and provider satisfaction surveys were collected from RAFB facilitators. Patients at RAFB reported higher satisfaction (99.1%) than DCOE patients (97.2%). In fact, most measures of satisfaction were higher in RAFB patients than DCOE patients. Moreover, facilitators expressed high satisfaction with DSME via MIST and all facilitators were willing to conduct more classes in this format. Initiation of the DSME Telehealth program presented challenges, especially in technology-related issues and documentation at 6 months. The pilot program allowed the DCOE to gain valuable feedback from our remote site. Technology issues have largely been resolved enabling us to provide an even better experience to our new sites in 2018.

Disclosure

N. Watson: None. D.G. Acuna: None. J.L. Wardian: None. E.C. Cobb: None. D. Beavers: None. T.J. Sauerwein: Speaker's Bureau; Self; Merck & Co., Inc., AstraZeneca.
Employee Health: Diabetes Self-Management with Wireless Meter
Authors: BRUCH JOHN , STANCIL MICHELLE D. , ODOM JESSICA M. , NELSON BRYCE A. , REULBACH LINDSAY S. , RUSS-SELLERS REBECCA , BURNS ALYSON GHIZZONI , LINDHOLM MAINE R. , DAWSON JONDA , SCHWECKE NATHAN A.
Published: June 2018

In 2014, Greenville Health System spent more than double on employees with A1c greater than 7.5% compared to employees with A1c less than 7.5%. Visits with a primary care physician every three months may be inadequate to meet the needs of a patient with uncontrolled diabetes. The goal of the study was to improve care for a targeted population of employees of a large health care system with type 1 or 2 diabetes. The intervention combined diabetes education, telehealth, a wireless enabled meter, and algorithms for medication adjustments.

Methods: Fifty patients were given a wireless enabled meter that links to secure portal for the healthcare professional, the patient, and a support person. The primary objective was to achieve a 15 percent reduction in patients’ average baseline A1c. Secondary objectives included improving patient’s understanding of diabetes and self-management of diabetes, increasing adherence rates of diabetes monitoring and medication utilization, decreasing rates of hypoglycemic or hyperglycemic events, and reduce overall cost of healthcare. Patients were contacted by a diabetes educator every 2-4 weeks. A medication algorithm was used to titrate insulin and non-insulin medications and initiate additional treatments.

Results: Patients were followed for an average of 27.6 months. Baseline A1c average of 10.248 was reduced to an average of 8.392 (absolute reduction of 1.856 or 18% reduction from baseline). Compared to baseline, at 12 months patients reported improvement in their self-rated diabetes knowledge, self-monitoring behaviors, and self-management behaviors. Participants increased their outpatient visits with primary care providers and Endocrinology. Average cost for both endocrinology and PCP visits decrease from pre-enrollment to one year post enrollment.

In conclusion, by combining diabetes education, medication algorithms, and remote glucose monitoring, participants improved their knowledge of diabetes and self-care and experienced improved glycemic control.

Disclosure

J. Bruch: None. M.D. Stancil: None. J.M. Odom: None. B.A. Nelson: Speaker's Bureau; Self; Dexcom, Inc.. L.S. Reulbach: None. R. Russ-Sellers: None. A. Ghizzoni Burns: None. M.R. Lindholm: None. J. Dawson: None. N.A. Schwecke: None.
Results of a Culturally Tailored Multidisciplinary Intervention on Diabetes Self-Care and Glycemic Outcome in Lebanese Patients with Type 2 Diabetes
Authors: SUKKARIEH-HARATY OLA , BASSIL MAYA , EGEDE LEONARD E.
Published: June 2018

Background: Enhancing diabetes self-care is known to improve glycemic control of patients with type 2 diabetes mellitus (T2DM). According to American Diabetes Association guidelines, a multidisciplinary and culturally appropriate intervention is needed for optimal diabetes self-care and glycemic outcomes. There is no published study that evaluated an educational intervention targeting diabetes self-care and glycemic outcomes in Lebanese patients with T2DM.

Aim: The aim of this pilot-study was to test the effect of culturally-tailored educational program targeting diabetes self-care on glycemic control of Lebanese patients with T2DM, of low socioeconomic status.

Methods: A sample of 27 adults (Age: 61±10 years, 59% males, A1C: 8.98±1.38%) diagnosed with T2DM for at least one year was recruited from two dispensaries in Beirut. Participants received culturally-tailored, multidisciplinary educational sessions based on the Information-Motivation-Behavioral model and on American Diabetes Association’s National Standards for Diabetes Self-Management Education and Support. Summary of Diabetes Self-Care Activities (SDSCA), Social Support Scale (SS), Diabetes Fatalism Scale (DFS), and Diabetes Knowledge Test (DKT), as well as blood samples (HbA1c, Fasting Plasma Glucose) were collected at baseline and three months post-intervention.

Results: Results revealed improvements in various diabetes self-care activities (Diet and Self-Monitoring Blood Glucose) after 3 months, which was reflected in a significant decrease in glycaemia (A1C: -0.6%; Fasting Plasma Glucose: -35 mg/dl; p<0.05).

Conclusion: This is the first intervention study showing the effectiveness of a culturally-tailored, multidisciplinary education program in improving glycemic control and diabetes self-care behavior of Lebanese patients with T2DM. It sets the stage for larger scale implementation with more representative sample.

Disclosure

O. Sukkarieh-Haraty: None. M. Bassil: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..
Promoters of and Barriers to Engagement in Type 2 Diabetes Mellitus (T2DM) Populations with Real-World Technological Interventions
Authors: DUVALL KEVIN R. , TRASY ANJALI , MURRAY ERIN , MILAM ROBERT , SAYRE TOBIAS , BEAL ANNE C.
Published: June 2018

Glycemic control is often complicated by patients’ lack of adherence to treatment regimens and suboptimal self-efficacy behaviors. New technological interventions can help self-management, but it is often difficult to engage patients and maintain use. A systematic literature review of Medline, Embase, Cochrane CENTRAL, and manual searching identified literature reporting on technological interventions for T2DM to evaluate patient satisfaction affecting adherence. Observational studies and pragmatic clinical trials reporting intervention adherence and patient experience were evaluated for perceived promoters or barriers of intervention. The search retrieved 329 publications. Fourteen met criteria for inclusion and were analyzed. Adherence rates varied, ranging from 32-90% in web-based programs, to 28- 90% in telemedicine programs. Shorter follow-up times generally indicated better adherence. Patient-specific feedback was reported for 1,000 patients in 11 studies. Common patient-reported promoters of initiation and adherence included high level of provider interest, motivating, encouraging and personally relevant educational messaging. Barriers for the interventions included lack of motivational messaging, educational value, redundancy, technology-related limitations and overload concern. Technological interventions such as smartphone applications and patient web portals offer an opportunity to increase self-management in T2DM, further aided by strong healthcare provider promotion, support and engagement. In developing new technological interventions, it is important to consider easy-to-use individually-tailored content that is both motivational and educational. These programs will offer the best opportunities for adoption by providers and improved self-management by patients. Further review is needed to identify which technological interventions are most efficacious.

Disclosure

K.R. Duvall: Employee; Self; Sanofi. Stock/Shareholder; Self; Insulet Corporation, Sanofi, Becton, Dickinson and Company. A. Trasy: Employee; Self; Sanofi. Employee; Spouse/Partner; Bayer US. E. Murray: Consultant; Self; Sanofi. R. Milam: Employee; Self; Doctor Evidence. T. Sayre: None. A.C. Beal: Employee; Self; Sanofi. Board Member; Self; AcademyHealth.
Type 1 Diabetes—The Comic Book
Authors: PATEL MAYANK B. , KAR PARTHA , MCLAUGHLIN DANIEL G.
Published: June 2018

Background: Disney, Marvel and DC Comics have done much to embed their superhero creations in the public domain, through movies and art. Acquiring superpowers and learning to live differently can be associated with shock and bewilderment, whilst being viewed with suspicion, ignorance and misunderstanding by others. These issues can be extended to those who develop type 1 diabetes. These individuals often have to dispel myths and challenge ignorance from both public and healthcare professionals. Whilst there are resources available to help, it can be challenging to find appropriate educational materials that younger people with type 1 diabetes can easily relate to.

Aims: To develop a new type 1 diabetes resource for younger people.

Methods: Working with individuals living with type 1 diabetes, the project group took the current popularity of superheroes as inspiration. Based on real life experiences, ‘type 1: Origins’, the comic book, chronicles the early experiences of a young man developing type 1 diabetes and some of the challenges he faces.

Results: Since its launch in October 2016, this free to access online comic book has had over 7000 international downloads. There has been a positive response from people with diabetes, their parents and the wider public. Several key UK diabetes charities have also endorsed and championed its use as part of diabetes education. In October 2017, the comic won a UK nationally coveted ‘Diabetes: Quality in Care’ award as ‘Best Diabetes Collaboration initiative of the year’.

Discussion: The authors believe that this collaboration has produced the first diabetes educational resource of this kind. It has been centrally recognized by NHS England as an innovative way for raising the profile of type 1 diabetes. Following its successful launch, there are plans to translate the story into different languages. A sequel is in development, in which safety in hospitals around type 1 diabetes will be a theme. Comic link: https://revolvecomics.com/diabetes-type-1-origins-comic/.

Disclosure

M.B. Patel: None. P. Kar: None. D.G. McLaughlin: None.
The Use of Quality Improvement Continuing Medical Education to Improve the Evaluation of Diabetic Retinopathy
Authors: ROBINSON KATIE , ESGRO ROBERT A.
Published: June 2018

Rationale: Diabetic Retinopathy (DR) is a leading cause of vision loss worldwide. While regular screening can lead to earlier interventions, reduce vision loss, and improve patient outcomes, baseline screening in patients at risk for DR has traditionally been low.

Methods: To improve screening rates for DR, Vindico Medical Education and staff from the Cole Eye Institute at the Cleveland Clinic (CC) developed and executed a quality improvement CME (QI-CME) initiative within a closed network of endocrinologists and primary care physicians (PCPs) who see patients with diabetes. Interventions included a series of live, print, and web-based CME activities focused on the timely referral of patients with diabetes for ophthalmic evaluation.

Results: At baseline, 95.5% and 71% of endocrinologists and PCPs, respectively, asked their patients about ophthalmologic signs and symptoms, though there was significant delay in the time between initial patient visit and follow-up with ophthalmology among the providers (173.2 days for endocrinologists and 184.8 days for PCPs). After delivery of the QI-CME within the closed system, there were significant gains in knowledge and competence as well as a 125-day and 130-day reduction in time between initial patient visit and ophthalmology follow-up, among endocrinologists and PCPs, respectively.

Conclusion: This program demonstrated that the sequential delivery of targeted CME coupled with patient chart reviews within a closed health system is a relatively simplistic, yet powerful model to address this practice gap toward improved patient outcomes by avoided vision loss. Notably, this model may be easily adopted to engage additional pertinent audiences, such as ophthalmologists, or to different therapeutic areas that rely on timely referral to a specialist for appropriate care.

Disclosure

K. Robinson: None. R.A. Esgro: None.
An Evaluation of the Diabetes Conversation Map™ Program—Are Program Factors Associated with Health Outcomes and Health Care Utilization at 12 Months Post-Enrollment?
Authors: SRULOVICI EINAV , LEVENTER-ROBERTS MAYA , CURTIS BRADLEY , HE XUANYAO , AKRIV AMICHAY , HOSHEN MOSHE B. , ROTEM MINA , GOFER ILAN , SHADMI EFRAT , KEY CALANIT , LEVIN-IAINA NOMY , STRIZEK ALENA , FELDMAN BECCA S.
Published: June 2018

Background: The Diabetes Conversation Mapࡊ Program serves Clalit Health Services members with type 2 diabetes Mellitus (T2DM) for over 7 years, administered by over400 trained certified nurses. A formal evaluation of the programmatic factors of Mapࡊ has not yet been performed.

Methods: This was a retrospective cohort study of 5,597 participants with T2DM who enrolled in the Map™ program between 1.1.2010 and 4.1.2015. Using Gamma and Poisson regression models and testing for hierarchical regression with random effects, we assessed the association between program factors (nurse instructor, enrollment year, and number of Map™ sessions attended), and outcomes (laboratory test results, adherence, and healthcare utilization) during a 12 month follow-up period.

Results: Introducing the random effect of nurses who conducted the sessions yielded a low explained variance. Similarly, there were no significant differences in the outcomes across year of enrollment. However, Map™ participants who attended at least one session had on average a 2.1% reduction in HbA1c levels compared to those who enrolled but did not attend any sessions. Among participants who attended 1 session, the frequency of hospital admissions decreased by 55%, a decreased that did not change up to 4 sessions, compared to those who attended 0 sessions. There was no increased benefit in attending more than 4 sessions on frequency of hospital admissions within the follow-up period. The number of sessions was not associated with any other outcomes.

Conclusions: Our results suggest that attending up to four sessions in the Map™ program is associated with improved HbA1c and decreased hospitalizations, and this does not vary by enrollment year or instructor. We suggest that nurses who instruct the Map™ program should try to improve participants' attendance to at least four sessions in order to maximize reductions in these two outcomes.

Disclosure

E. Srulovici: None. M. Leventer-Roberts: None. B. Curtis: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. X. He: None. A. Akriv: None. M.B. Hoshen: None. M. Rotem: None. I. Gofer: None. E. Shadmi: None. C. Key: None. N. Levin-Iaina: Employee; Self; Eli Lilly and Company. A. Strizek: None. B.S. Feldman: None.
Combining Insulin and Incretins in T2DM Management—Effect of Online Education on Physician Knowledge and Competence
Authors: TRIER JOACHIM , MCCARTHY ROBERT F. , COLAGIURI STEPHEN
Published: June 2018

Purpose: To determine if online medical education for diabetologists/endocrinologists (diabs/endos) and primary care physicians (PCPs) can improve knowledge regarding treatment options for intensification of insulin in patients with T2DM, the rationale, clinical evidence, and benefits of novel basal insulins/GLP-1 receptor agonist (GLP-1 RA) fixed-ratio combinations (FRCs) and competence related to the practical aspects of initiating and titrating such FRCs.

Methods: The educational activity consisted of a 30-min online video panel discussion with synchronized slides. Educational effect was assessed with a repeated pairs pre- and post-assessment study with a 3-item, multiple-choice, knowledge and competence questionnaire and a confidence assessment. For all questions, each participant acts as his/her own control. A χi-squared test assessed statistical significance at the P <.level. The activity launched November 30, 2016; data were collected until January 23, 2017.

Results: Participation in the activity significantly (P <.05) improved knowledge/competence of diabs/endos (average from 28% to 55%, n=99) and PCPs (average from 24% to 52%, n=129) with respect to initiating novel insulin FRCs in patients with T2DM, in particular understanding the benefits of novel short- and long-acting FRCs, how a basal insulin/GLP-1 RA FRC is effective in HbA1c reduction whilst offering better tolerability compared to monotherapy. Confidence levels in starting and titrating such FRCs in patients with T2DM uncontrolled on basal insulin also improved (57% in diabs/endos, 67% in PCPs).

Conclusions: Participation in an online video panel discussion improved knowledge, competence and confidence regarding the clinical benefits and use of novel insulin FRCs in appropriate patients with T2DM. Further education is warranted on these topics and for selecting the correct titration scheme for transitioning patients with uncontrolled T2DM receiving basal insulin.

Disclosure

J. Trier: None. R.F. McCarthy: None. S. Colagiuri: Advisory Panel; Self; AstraZeneca, Elsevier, Medscape, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier.
Ocho Pasos a la Buena Salud (Eight Steps to Better Health)—A Diabetes Education Program for Low-Literacy Latinos With or at Risk for Type 2 Diabetes (T2D)
Authors: CREASON JAMIE , CONNEELY MARY M. , AXELROD CEARA , BEVIER WENDY C. , SWARTZENTRUBER JENIFER , KERR DAVID
Published: June 2018

Ocho Pasos (Eight Steps) is a culturally relevant diabetes education program designed for low-income, low literacy Latino adults. The main focus is to improve health for those challenged with multiple socio-economic barriers. Classes are taught in Spanish over 8 weeks in a community setting. Diabetes-friendly diet modifications, compatible with culturally appropriate food traditions (e.g., reducing Tortilla consumption), are emphasized. Education, covering T2D risk factors, self-monitoring, stress management, and physical activity, is delivered using images, food models, and visual and tactile teaching aids. HBA1C [A1C Now® (PTS Diagnostics, Indianapolis, IN)], BMI, and waist circumference (WC), are measured at first and last classes.

Between July 2015- Dec 2017, 478 adults were enrolled with complete pre- and post-class data available for 127 [77% women]. Of these 38 had HBA1C ≥6.5%, 43 between 5.7-6.4%, and 46 <5.7% at entry. For those with initial HBA1C≥6.5%, this decreased 0.74% [p<0.01]. For those between 5.7-6.4%, HBA1C fell 0.13% vs. entry, [p<0.05]. BMI decreased from 30.7±6.2 to 30.2±6.1 kg.m2 (p<0.01) and WC from 39.5±5.5 to 38.6±5.1 in, [p<0.01]. Daily average Tortilla consumption decreased from 5.1±2.7 to 2.4±2.7 tortillas/day [p<0.01]. Participants who decreased daily tortilla consumption showed a significant reduction in their HBA1C (p<0.05), and 52% also reported more exercise after attending. Participants with HBA1C ≥6.5% had the greatest class attendance; 55% attended >5 classes.

Ocho Pasos a la Buena Salud is an effective diabetes education program for Latinos who face serious health care challenges for achieving optimal glycemic control or prevention of T2D.

Disclosure

J. Creason: None. M.M. Conneely: None. C. Axelrod: None. W.C. Bevier: None. J. Swartzentruber: None. D. Kerr: Advisory Panel; Self; Glooko, Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Sanofi-Aventis. Stock/Shareholder; Self; Cellnovo. Advisory Panel; Self; Novo Nordisk Inc..
Marketing and Communication Strategies to Increase Enrollment in National Diabetes Prevention Program—Implications for Evaluation of Technical Assistance
Authors: MENSA-WILMOT YVONNE , BOWEN SHELLY-ANN , THUMMALAPALLY SHARANYA , MURPHY MONICA D. , RUTLEDGE GIA E.
Published: June 2018

Under a 4-year federally funded program, states (18) and large cities (4) are implementing approaches to scale and sustain the National Diabetes Prevention Program (National DPP) a structured, evidence-based, year-long lifestyle change program to prevent or delay onset of type 2 diabetes in people with prediabetes or at risk of developing the disease. This study examines grantee utilization of health marketing strategies to increase enrollment in the National DPP, targeting both general and high-risk populations experiencing health or socioeconomic disparities, and the technical assistance (TA) provided to grantees to implement and evaluate their marketing strategies. Analysis of Yr2 annual performance measure reports indicated that 2.2 million people were reached through traditional (print, television, radio, etc.) and social media (Facebook, Wiggio, YouTube, etc.). Over 17,000 new participants enrolled in National DPP with more than 2,000 from high-risk populations. Qualitative analysis of grantee evaluation reports and TA records revealed barriers and facilitators, such as unavailability of National DPP programs and consistent provider referrals, respectively. TA to assist grantees with program activity and performance measure alignment helped grantees improve data collection and reporting. However, gaps continue to exist between activities implemented and data reported. Recommendations for future TA include 1) providing early guidance on marketing strategies, 2) assisting grantees with outcome assessment, and 3) demonstrating linkages between marketing efforts and performance measures.

Disclosure

Y. Mensa-Wilmot: None. S. Bowen: None. S. Thummalapally: None. M.D. Murphy: None. G.E. Rutledge: None.
The Alarming Inadequacy of Adult Vaccination—Vaccination Rates in Diabetic Patients
Authors: FEYIZOğLU GÜNEş , KARSLI ASLI , OGUZ AYTEKIN
Published: June 2018

Aim: DM is a disease that causes immune incompetence due to various reasons. Therefore, the risk of infectious disease and the risk of complications, morbidity and mortality related to infectious disease in diabetic patients are increased compared to healthy adults. Patients with DM are advised to get vaccinated for

influenza once every year, tetanus every 10 years, hepatitis B if they did not complete their routine vaccinations and pneumococcus for once. Researches reveal the lack of adult vaccination awareness, even in high risk group of patients. This study is designed to determine the adult vaccination rates (VR) in diabetic patients who are in routine follow-up in our outpatient diabetes clinic.

Methods and Findings: Diabetic patients that applied to Istanbul Medeniyet University Goztepe Training and Research Hospital Diabetes Outpatient Clinic between January and July 2017 were included in the study. Patients were selected by simple random sampling and their demographic data were recorded. Patients were asked if they were vaccinated for influenza in last year, tetanus in last 10 years, hepatitis B and pneumococcus. In the 846 (535 female, 311 male) type 2 DM patients that were included in the study, the average age was 58.7(32-86) and the average years with diabetes was 11,2(1-50). VR were 17.6% (n=149) for influenza, 18.6% (n=157) for tetanus, 8.6% (n=73) for hepatitis B and 5.4% (n=46) for pneumococcus.

Results and Discussion: This study demonstrates that adult VR in our diabetic patients are inadequate. Adult vaccination policy programs recommend the aim of 90% influenza and 60% pneumococcus VR. Even though our population consists of diabetes patients with seemingly high consciousness levels, attending their regular doctor appointments, their VR are far below the targeted rates. The fact that unvaccination rates are exceeding 80% for influenza and 90% for pneumococcus points out to the significance of increasing adult VR as a health issue of priority and urgency in diabetic patients.

Disclosure

G. Feyizoğlu: None. A. Karsli: None. A. Oguz: None.
Results from the First Culturally-Tailored, Multidisciplinary Diabetes Education in Lebanon—Effect on Cardiovascular Risk Factors
Authors: BASSIL MAYA , SUKKARIEH-HARATY OLA , ABI KHARMA JOELLE L. , EGEDE LEONARD E.
Published: June 2018

Background: Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care, and is known to reduce cardiovascular risk factors of patients with type 2 diabetes (T2D) (American Diabetes Association [ADA], 2017). According to ADA, effective DSME is multidisciplinary, patient-centered, as well as age and culturally appropriate (ADA, 2017). Despite ranking second in the world in the prevalence of diabetes, there is no reported intervention addressing diabetes self-care in the Arab world.

Aims: The aim of this pilot-study was to test the effect of the first culturally-tailored educational program targeting diabetes self-care on cardiovascular risk factors of Lebanese patients with T2D.

Methods: A sample of 27 adults (Age: 61±10 years, 59% M, A1C: 8.98±1.38%) diagnosed with T2D for at least one year was recruited from two dispensaries in Beirut. Participants received culturally-tailored, multidisciplinary educational sessions based on the Information-Motivation-Behavioral model and on ADA’s National Standards for Diabetes Self-Management Education and Support. Anthropometric measures (weight, height, BMI, waist circumference, body fat mass and fat-free mass) and blood samples (Triglycerides, Total, LDL and HDL cholesterol) were collected at baseline, 3 months and 6 months post-intervention.

Results: Waist circumference (107.52±12.91 vs. 106.59±12.01) and cholesterol/HDL ratio (4.45±1.39 vs. 4.06±1.29) decreased at 6 months post-intervention (p=0.02).

Discussion and Conclusion: This is the first intervention study showing the effectiveness of a culturally-tailored, multidisciplinary education program in improving body adiposity and blood lipids of Lebanese patients with T2D, and thus reducing their cardiovascular risk factors. It sets the stage for larger scale implementation with more representative sample.

Disclosure

M. Bassil: None. O. Sukkarieh-Haraty: None. J.L. Abi Kharma: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..
Evaluation of the Second Diabetes Campaign Round for Diabetic Palestine Refugees at Unrwa Health Centers
Authors: KISHK NADA M. ABU , SHAHIN YOUSEF M. , TURKI YASSIR , MITRI JOANNA , SEITA AKIHIRO
Published: June 2018

Introduction: UNRWA has a mandate to provide assistance and protection to a population of around 5 million Palestine refugees (PRs) in Jordan, Lebanon, Syria, West Bank and Gaza. UNRWA is the main primary healthcare provider for them. DM is a common problem among PRs with a prevalence of 11.0%. A high percentage of these patients are obese (64.0%) or overweight (26.0%). In 2013, UNRWA conducted the first round of a DM campaign to raise DM patients’ awareness on healthy lifestyle and to improve their ability to manage DM. In 2014, a second round was conducted with the same aims.

Method: Using a Quasi-experimental study, DM1, DM2 or DM2 and HTN patients’ diagnosed ≥ 1 year prior to study initiation were included. 1,600 participants from the 32 UNRWA’s largest health centers (HCs) were included. Each HC conducted weekly group sessions for six months, including education, healthy cooking, and physical exercise. Body measurements, 2hrPPGT, blood pressure and the attendance of sessions, were collected on a weekly basis. Demographical data, pre- and post- questionnaires and cholesterol levels were collected before and after the campaign. Paired T-test in SPSS Version 21 was used.

Results: Out of 1,600 patients, 1,599 [1187 (74.0%) females and 412 (26.0%) males] completed the campaign; 576 (36.0%) patients had DM2, 960 (60.0%) had DM2 and HTN and 62 (4.0%) had DM1. After the campaign, the average weight loss was 2.6 kg (95% CI: 2.4-2.7). In addition, 22% lost ≥5%, 25% lost 3%-5%, and 30% lost 1%-3% of their weight. Significant improvements were seen in blood glucose, cholesterol and waist circumference (p≤0.001 for all). The attendance rate of the sessions was 70.6% in total.

Conclusions: This campaign has focused on healthy lifestyle awareness raising using group sessions with various activities, has resulted in better DM care outcomes of PRs with DM. Such campaigns need to be sustained and expanded. Local community and NGOs partnerships observed during the campaign should be strengthened and sustained.

Disclosure

N.M. Abu Kishk: None. Y.M. Shahin: None. Y. Turki: None. J. Mitri: Research Support; Self; National Dairy Council, Kowa Pharmaceuticals America, Inc.. Research Support; Spouse/Partner; AbbVie Inc., Janssen Pharmaceuticals, Inc., Takeda Pharmaceuticals U.S.A., Inc., Gilead Sciences, Inc.. Consultant; Spouse/Partner; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Biogen, AbbVie Inc.. A. Seita: None.
The Impact of Restricted Gestational Weight Gain on Fetal Growth during Dietary Treatment in Women with Gestational Diabetes Mellitus
Authors: KURTZHALS LISE , NØRGAARD SIDSE , RONNEBY HELLE , SECHER ANNA L. , TABOR ANN , MCINTYRE H. DAVID , DAMM PETER , MATHIESEN ELISABETH R.
Published: June 2018

Aim: To investigate the impact of maternal gestational weight gain during dietary treatment (GWG-diet) on fetal growth in pregnancies complicated by gestational diabetes (GDM).

Material and Methods: A retrospective cohort study of 382 consecutive women diagnosed with GDM <34 weeks and live singleton births in our center in 2011-2017. The women were stratified according to restricted (53%), appropriate (17%) and excessive (31%) weekly GWG-diet (Institute of Medicine guidelines) to estimate compliance to a calorie-restricted diabetes diet (1700 kcal daily). Insulin therapy was initiated according to local clinical guidelines.

Results: Glucose tolerance, HbA1c, GWG before dietary treatment (GWG-before) and fetal abdominal circumference standard deviation (SD) score were comparable across the three GWG-diet groups at referral at 276±51 weeks. The women were followed for 100 ±51 weeks, 54% received insulin therapy and the average GWG-diet in the three groups was 0 kg, 3 kg and 5 kg, respectively. Women with excessive weekly GWG-diet, also had increasing HbA1c (p=0.014) during dietary treatment and infants with a birth weight SD-score of 0.59 ±1.6, while women with restricted weekly GWG-diet also had decreasing HbA1c (p=0.001) during dietary treatment, and infants with a birth weight SD-score of 0.15 ±1.1, without intrauterine growth restriction. Excessive GWG-diet and late pregnancy HbA1c were predictors of infant birth weight SD-score (p<0.001) after correction for parity, uptake area, pre-pregnancy BMI and insulin therapy.

Conclusion: Restricted GWG-diet was associated with more appropriate fetal growth in women with GDM. GWG-diet and late pregnancy HbA1c were modifiable clinical predictors of infant birth weight SD-score.

Disclosure

L. Kurtzhals: None. S. Nørgaard: None. H. Ronneby: None. A.L. Secher: None. A. Tabor: None. H. McIntyre: Speaker's Bureau; Self; Novo Nordisk Inc.. Research Support; Self; Danish Diabetes Academy. P. Damm: Advisory Panel; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S. E.R. Mathiesen: Speaker's Bureau; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S, Novo Nordisk Foundation, Novo Nordisk A/S.