bluuebunny/crossref_metadata_2025 huggingface dataset:
60-LB: Oral Diabetes Medication Adherence in Emerging Adults with Youth-Onset Type 2 Diabetes: TODAY2 iCount Study
Authors: TRIEF PAULA M. , KALICHMAN SETH , WANG DONGLIANG , DREWS KIMBERLY , ANDERSON BARBARA , WEINSTOCK RUTH S.
Published: June 2020

Background: Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) participants have youth-onset type 2 diabetes (T2D) and often poor glycemic control. The role of medication adherence is unknown.

Aims: To assess oral diabetes medication adherence in the TODAY2 cohort; To assess participant factors related to adherence.

Methods: Participants provided data at TODAY2 visits and at 3 monthly unannounced phone pill counts. Those taking ≥80% of pills were classified “high adherent,” those taking <80% of pills were defined “low adherent.” If not taking oral medications (meds) they were asked reasons and adjudicated (no need for meds vs. non-adherent). The unadjusted association of each factor with adherence status was assessed by ANOVAs (continuous variables) and Pearson χ-square (categorical variables). Factors with p<0.2 were entered into logistic models for adherence.

Results: Of 381 individuals, 224 were either taking oral meds (n=190) or taking none though meds were recommended (n=34) [mean age 25 yrs, 67% female, 18% white, 34% black, 39% Hispanic, 84% <$36K income]. Per pill counts, 66.1% were low adherent (includes 15.2% adjudicated non-adherent). Unadjusted results: HbA1c was lower in high vs. low adherent groups (9.2% vs. 10.0%, p<0.04). Racial/ethnic differences in adherence (55.3% non-Hispanic whites, 60.2% Hispanics, 85.7% non-Hispanic blacks were low adherent, p<0.002). Of those with/without insurance, 65.5%/91.4% were low adherent (p<0.004). After adjustment, race/ethnicity (p<0.02) and insurance status (p<0.007) remained related to adherence. HbA1c, age, gender, education, income, employment, BMI, T2D duration, family history, and no. of complications did not relate to adherence.

Conclusion: In emerging adults with youth-onset T2D, poor adherence to oral diabetes meds was common, and significantly more likely in those without health insurance and in non-Hispanic blacks. Interventions are needed to improve adherence and outcomes.

Disclosure

P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. S. Kalichman: None. D. Wang: None. K. Drews: None. B. Anderson: None. R.S. Weinstock: Board Member; Self; JDRF. Consultant; Self; Insulogic LLC. Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Jaeb Center for Health Research, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc.

Funding

National Institutes of Health (R01DK110456)
600-P: Single-Cell RNA Sequencing Identifies Novel Molecular Targets of Endothelial MicroRNA-200b in Diabetic and Ischemic Wounds
Authors: SINGH KANHAIYA , HERNANDEZ EDWARD , KUMAR MANISHEKHAR , RUSTAGI YASHIKA , MOHANTY SUJIT K. , ABOUHASHEM AHMED S. , KHANNA SAVITA , ROY SASHWATI , SEN CHANDAN K.
Published: June 2020

Injury induced transient downregulation of endothelial miR-200b is required to jump-start wound angiogenesis but the underlying mechanisms remain unclear. To interrogate the transcriptional changes, single-cell RNA sequencing was performed on ∼15000 human endothelial cells following treatment with miR-200b inhibitor or its mimic. The 3’ scRNA-seq analysis was conducted using the Chromium single cell system (10x Genomics). Unsupervised clustering using CellRanger identified 13 cell clusters, few of which were miR-200b responsive. To verify the novel potential targets of miR-200b identified in endothelial cells, we used Stable Isotope Labelling by Amino acids in Cell culture (SILAC) based proteomic analysis using mass spectrometry. A total of 3818 proteins were detected which were then filtered using statistical cut-offs (p value < 0.05; % change > 10%) identifying 319 proteins targeted by miR-200b. To dissect mechanisms involved in vascular function post-miR-200b silencing in vivo, we generated miR-200b-429fl/fl-Tie2 Cre mice where endothelial miR-200b levels was depleted. The therapeutic significance of miR-200b inhibition was studied using ischemic hind limb in these mice. Perfusion imaging was performed using Laser Speckle Perfusion imaging. Color-coded perfusion maps were acquired at different time-points post-surgery (d3, d7, d10, d14) and average perfusion was calculated using PimSoft v1.4 software. Inhibition of endothelial miR-200b rescued hindlimb ischemia with improved perfusion (n=5). This rescue was associated with increased abundance of CD31+/vWF+ vasculogenic cells at the site of injury (n=5). This work identified miR-200b regulated endothelial cell clusters, the functionality of which are explained by SILAC proteomics. These findings provide insight into novel mechanisms explaining how transient inhibition of endothelial miR-200b helps switch vascular homeostasis into an angiogenic fate in response to injury.

Disclosure

K. Singh: None. E. Hernandez: None. M. Kumar: None. Y. Rustagi: None. S.K. Mohanty: None. A.S. Abouhashem: None. S. Khanna: None. S. Roy: None. C.K. Sen: None.

Funding

National Institutes of Health (GM108014); Eli Lilly and Company; Indiana Collaborative Initiative for Talent Enrichment (to C.K.S., S.R.)
608-P: Empagliflozin Ameliorates Ankle-Brachial Index in Real-World Setting in Indian Patients with Type 2 Diabetes Mellitus
Authors: PADHYE DAKSHATA
Published: June 2020

Ankle Brachial Index (ABI) is an established marker for screening peripheral vascular disease and an independent predictor of amputation, cardiovascular event and mortality risk in patients with diabetes. We conducted a longitudinal cohort study using electronic health record data from the Conquer Diabetes Podiatry Center Registry (CDPCR) evaluating 29 patients for the ABI values, who have been adherent to empagliflozin for more than 24 weeks. Normal ABI was defined as >0.9 and <1.4. The assessment parameters included the risk of regression of high ABI versus progression to high ABI (risk-ratio), proportion (%) of patients with ABI decline of >0.15. Based on assumptions of 5% alpha-error, 25% progression-rate to high ABI, and risk-ratio of 3 with 50% error margin, sample size of 54 was determined. ANOVA was used for the statistical analysis. 58 baseline readings of ABI, from 29 patients of T2DM, were analyzed. Mean age was 57 years, duration of diabetes was 11 years. 45% of patients were females. Mean baseline ABI was 1.3, with 11 abnormal readings (11 high, 0 low). The mean duration of exposure to empagliflozin was 16 months. At follow-up, mean ABI was 1.28. Of the 11 high baseline ABI readings, 5 regressed to normal. Of the 47 normal baseline ABI readings, 7 progressed to high ABI. Relative risk of regression versus progression for high ABI, was 3.66 (95% CI 1.53, 8.75; p = 0.003). Then Number Needed to Treat (NNT) was 3. No patient had ABI decline of >0.15, or developed low ABI, at follow-up. This real-world evidence suggests possible role of empagliflozin in mediating regression of high ABI. We postulate that these clinical benefits may be in part due to the ability of empagliflozin to maintain vascular health especially in a pro-inflammatory environment of endothelium in patients with diabetes. Further, larger long-term randomized trials would be helpful to corroborate our findings.

Disclosure

D. Padhye: None.
616-P: Path Analysis to Assess the Effect of Health Literacy on Glycemic Control in African-American Adults
Authors: WILLIAMS JONI S. , EGEDE LEONARD E.
Published: June 2020

Background: While health literacy has been shown to influence health outcomes, recent evidence suggests nearly 25% of African American (AA) adults have below basic health literacy compared to only 9% of White Americans. This disparity may contribute to poorer outcomes observed in AA adults with type 2 diabetes mellitus (T2DM). Therefore, the aim of this study was to assess the pathways for the relationship between health literacy and diabetes outcomes in AA adults with T2DM.

Methods: Data from 277 AA adults with T2DM from the southeastern U.S. were analyzed. Path analysis was used to assess the direct and indirect relationships between health literacy (comprehension and numeracy) and self-care and between self-care and glycemic control (HbA1c). We hypothesized that health literacy would have both a direct and indirect effect on HbA1c via self-care behaviors (specific diet, general diet, exercise, blood sugar monitoring, foot care).

Results: In the path analysis for comprehension, health literacy did not have a direct effect on HbA1c (p=0.247), but did have a direct effect on specific diet (β=-0.18; p=0.002), blood sugar monitoring (β =-0.21; p<0.0001), and foot care (β=-0.13; p=0.032) and an indirect effect on HbA1c through specific diet (β=-0.13; p=0.043) and blood sugar monitoring (β=-0.29; p<0.0001). In the path analysis for numeracy, health literacy had a direct effect on glycemic control (β=-0.12; p=0.047) and specific diet (β=-0.13; p=0.039), blood sugar monitoring (β=-0.14; p=0.019), and foot care (β=-0.12; p=0.048) and an indirect effect on HbA1c through specific diet (β=-0.13; p=0.042) and blood sugar monitoring (β=-0.29; p<0.0001).

Conclusions: In this sample of AA adults with T2DM, only numeracy had a direct effect on glycemic control, whereas both comprehension and numeracy had direct effects on self-care behaviors. These findings suggest the need for greater emphasis on increased numeracy for interventions in AA adults with T2DM.

Disclosure

J.S. Williams: None. L.E. Egede: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861)
628-P: Educational Sessions at ADA Camp Midicha Improve Carbohydrate Counting and Insulin Calculation in Children with Type 1 Diabetes Mellitus
Authors: JOSEPH MINA , DEGNAN BERNARD M. , SZPUNAR SUSAN
Published: June 2020

Introduction: Type 1 diabetes mellitus (DM) is one of the most common chronic diseases in children. The ability of affected children to calculate carbohydrate consumption per meal, apply a correction factor based on their blood glucose and administer an accurate dose of insulin is a key component for good diabetes control. Multiple studies, however, have shown that insulin dosage calculations, particularly carbohydrate assessment, are inaccurate in > 50% of children with DM. Surveys of attendees at diabetes camps show that campers and camp personnel have reported increased confidence and ability in counting carbohydrates and administering insulin, but no quantitative tools have been used in these reports. The aim of this study was to determine whether educational sessions provided during a one-week diabetes camp would improve carbohydrate counting and insulin dosage calculation in children with type 1 DM.

Methods and Materials: We consented 144 parents/campers with type 1 DM to participate in the study. The Pediatric Carbohydrate Quiz (PCQ) was administered to the children before or on the first day of camp. All subjects participated in camp activities, which included dietary education. A post-intervention PCQ was administered on the last day. Pre- and post-camp test scores were compared using the paired t-test.

Results: Over 2 sessions, 79.2% (114/144) of campers completed both questionnaires. Their mean age was 13.8 ± 1.5 years, 61.4% female, 84.2% White and 16.4% first-time campers., The highest possible score on the PCQ administered is 72. The mean pre-camp PCQ score was 59.0 ± 7.1 vs. a mean post-camp score of 61.2± 5.9 (p<0.0001). The degree of improvement for female campers was greater than for males.

Conclusion: Attendance at a one-week session at Camp Midicha improved the ability of adolescent campers to assess carbohydrate counting and calculate insulin doses.

Disclosure

M. Joseph: None. B.M. Degnan: None. S. Szpunar: None.

Funding

Ascension St. John Hospital
633-P: Impact of Simulation-Based CME on Clinicians’ Knowledge and Competence Related to Hypoglycemia Management
Authors: KARANDREA SHPETIM , AGARWAL NEHA , JAMROGIEWICZ AMANDA
Published: June 2020

We sought to determine if real-time patient simulation technology, designed to mimic a patient visit, could improve clinicians’ knowledge/competence regarding the management of hypoglycemia in patients with type 2 diabetes (T2D). The patient simulation technology, DecisionSim, was incorporated as part of a live symposium, and changes in competence and knowledge were evaluated using pre-/post-assessment questions. A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p <0.05 indicated statistical significance). The live activity took place on October 26, 2018. In total, 66 allied health professionals (PAs, RNs, NPs, PharmDs, CDE/RDs) and 41 MDs/DOs answered the assessment questions. An increase in knowledge was observed, albeit not statistically significant (4% relative increase compared to baseline, p = 0.6). A significant increase in competence in selecting the most appropriate treatment to address hypoglycemia risk for a patient with T2D was observed (120% relative increase compared to baseline, p <0.0001). 82% selected the correct treatment decisions in the branching simulation platform, including the intensification of therapy that addresses HbA1c goals while minimizing the risk of hypoglycemia in a virtual patient with T2D. Additionally, 83% indicated in the post-activity survey that they would make changes to practice based on information received, including to provide patient-centered care, assess the current diabetes guidelines, and use diabetes treatments that minimize hypoglycemia. Continued educational gaps were identified: lack of knowledge about the benefits of GLP-1RA/insulin combinations (17%), and lack of competence in individualizing T2D therapy in the context of hypoglycemia risk (21%). These results indicate that simulation-based CME can lead to significant improvements in competence related to hypoglycemia management, as well as commitment to change among learners.

Disclosure

S. Karandrea: None. N. Agarwal: None. A. Jamrogiewicz: None.

Funding

Sanofi US (IME-2017-12078)
636-P: A Process of Developing an Education Document Repository: A Quality Improvement Initiative
Authors: MILLAN-FERRO ANDREINA , HIGGINS LAURIE A. , RIZZOTTO JO-ANNE M.
Published: June 2020

Diabetes Self-Management Education and Support is the foundation of any diabetes program. Providing consistent and up-to-date educational materials (EM) can be challenging for any diabetes program. In 2017, a Quality Improvement (QI) Initiative was started to ensure that all clinicians (> 35 Certified Diabetes Care and Education Specialist and 60 diabetes care providers) across our network, had a standardized approach to development and maintaining patient EM.

The QI plan had three aims: person with diabetes (PWD) should receive the most current information, providers should have access to current EM for all diabetes related topics and PWD should receive a consistent message across the education disciplines. The need for a web based application to host EM was identified. An inventory of all EM showed a total of 351; a centralized process overseen by a multidisciplinary committee was developed, core EM aligned with the AADE7 Self-Care BehaviorsTM were identified. New standards included: Reviewing and updating EM every 2-3 years (or sooner reflecting the most current practice), format should be conducive to learning, and templates should be consistent within categories.

Results: Share Point was chosen as the web based application and the Education Document Repository (EDR) was built and launched in 2018. The percentage of EM that met the newly developed standards increased from 20% at baseline to 80%, and the work load of maintaining the EM decreased by 30%. The EDR hosts 250 EM, has 13 categories and the highest percentage of EM belong to: nutrition 30%, technology 19% (pumps and CGMs), pediatrics 12% and medications 10%. In addition to the AADE7, other categories were created; such as: pediatrics, young adults, pregnancy to address the need of our patient population and user experience. Through this initiative all diabetes programs within our network of 10 locations across 6 states, have access to high quality patient EM. As our network grows we will be able to provide EM without delay.

Disclosure

A. Millan-Ferro: None. L.A. Higgins: Consultant; Self; Eli Lilly and Company. J.M. Rizzotto: None.
637-P: Factors Related to Recruitment and Retention of Patients into Diabetes Group Visits
Authors: NAIK AADITI G. , STAAB ERIN M. , LI JEFFERINE , WAN WEN , SCHAEFER CYNTHIA T. , CAMPBELL AMANDA , QUINN MICHAEL T. , BAIG ARSHIYA A.
Published: June 2020

Background: Diabetes is a chronic disease requiring medical treatment and self-management. Group visits (GVs) are one way to deliver care and provide self-management education to patients with diabetes. While studies have examined the impact of GVs on clinical outcomes, no study to date has examined factors related to recruitment and retention of patients in diabetes GVs.

Methods: We examined the association between patient characteristics and GV attendance of 83 patients enrolled in a GV intervention in six Midwestern FQHCs in an ongoing cluster randomized trial. Patients with uncontrolled type 2 diabetes (A1C >8%) who were seen in clinic in the past year were eligible. Linear mixed models were used to evaluate associations between retention of patients and race, language, comorbidities burden, diabetes empowerment score, diabetes distress score, diabetes social support, and duration of diagnosis. A Chi-squared analysis was performed to compare enrolled and unenrolled patients and test for association with patient recruitment method.

Results: Of 280 eligible patients reached by FQHCs, 44% (24/55) of patients contacted in person were recruited into the study, compared to 25% (56/225) of those contacted by telephone and/or mail (P=0.006). In the multivariate analysis, patients with more GV attendance were associated with higher diabetes empowerment score (P=0.03) and likely heavier comorbidities burden (P=0.08).

Conclusion: In-person recruitment for group visits was more effective than recruitment by telephone or mail. Patients with more comorbidities and those who felt less empowered to manage their diabetes at baseline were most motivated to attend GVs, suggesting that patients with multiple chronic conditions who need more support in disease management may be most interested in receiving care in a group setting. This finding may be especially important for FQHC providers taking care of underserved populations who face greater barriers to self-management in traditional care settings.

Disclosure

A.G. Naik: None. E.M. Staab: None. J. Li: None. W. Wan: None. C.T. Schaefer: None. A. Campbell: None. M.T. Quinn: None. A.A. Baig: None.

Funding

Office of Minority Health (1 CPIMP171145-01-00)
646-P: Dulce Digital-Me: An Adaptive M-Health Intervention for Underserved Hispanics with Diabetes
Authors: FORTMANN ADDIE L. , PHILIS-TSIMIKAS ATHENA , BAGSIC SAMANTHA R.S. , VITAL DANIELA G. , JONES JENNIFER A. , SANDOVAL HALEY , SAVIN KIMBERLY L. , CLARK TAYLOR , LUU KIMBERLY , GODINO JOB G. , GALLO LINDA
Published: June 2020

Hispanics have a 66% higher risk of developing type 2 diabetes (T2D), and exhibit worse outcomes than non-Hispanic whites. Many Hispanics lack access to diabetes self-management education and support (DSME/S) due to practical, cultural, and other barriers. Mobile health (mHealth) technology has the potential to circumvent such barriers and expand the reach of DSME/S. A 3-group, randomized controlled trial is currently underway to evaluate the effectiveness of mHealth DSME/S approaches in improving diabetes outcomes among predominantly low income, Hispanic adults with T2D and HbA1c ≥ 8% at a Federally Qualified Health Center in Southern California. Dulce Digital-Me (DD-Me) is an adaptive mHealth intervention that integrates educational text messaging with personalized goal-setting and feedback. Over 6 months, participants receive 2-3 messages/day, and are provided with a glucometer and pillbox that wirelessly transmit real-time data to a cloud. Ecological momentary assessment (EMA) gauges progress in healthful eating, exercise, and emotional well-being. Participants’ progress in lifestyle changes, medication adherence, and BG monitoring frequency and control is compared to pre-defined targets. Real-time feedback is delivered via automated, algorithm-driven messaging or by medical assistant Health Coach (n = 104 in each group). The control group (n = 207) receives educational text messages alone. Preliminary analyses (N = 163) showed higher BG monitoring frequency in the DD-Me Health Coach group (M = 7.02 ± 0.45 checks/week) versus the DD-Me algorithm-driven (M = 4.80 ± 0.49) and control groups (M = 5.25 ± 0.65), p <.01. Trends towards better medication adherence in the DD-Me groups (M = 6.78 ± 0.60 pillbox openings/week) relative to control (M = 5.40 ± 0.53) were also observed (p = 0.15). Focus groups revealed high satisfaction with the intervention. DD-Me will provide guidance on how to optimize digital health approaches for at-risk, underserved patients with diabetes.

Disclosure

A.L. Fortmann: None. 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. S.R.S. Bagsic: None. D.G. Vital: None. J.A. Jones: None. H. Sandoval: None. K.L. Savin: None. T. Clark: None. K. Luu: None. J.G. Godino: None. L. Gallo: None.

Funding

National Institutes of Health (1R01DK112322)
65-LB: Regression of Prediabetes following Two Years Treatment with a Continuous Care Intervention Emphasizing Carbohydrate Restriction: A Single-Arm, Prospective, Longitudinal Study
Authors: MCKENZIE AMY , ATHINARAYANAN SHAMINIE J. , MCCUE JACKSON , ADAMS REBECCA N. , MCCARTER JAMES P. , VOLEK JEFF
Published: June 2020

Regression from prediabetes (preD) to normoglycemia (NG) is associated with reduced progression to type 2 diabetes (T2D). Carbohydrate restriction including nutritional ketosis (CR) has emerged as a safe, effective, and sustainable treatment for regression of hyperglycemia in T2D, yet its multi-year effects on preD are unknown. Also, some patients have difficulty initiating and/or sustaining provider-recommended lifestyle changes. Thus, we hypothesized that a remotely delivered continuous care intervention (CCI) emphasizing CR would improve glycemia and weight in patients with preD. In a single-arm, prospective, longitudinal study, we assessed incidence of regression from preD to NG, progression from preD to T2D, and prevalence of metabolic syndrome (MetS) and class II or greater obesity in participants following two years of treatment. Patients with a preD diagnosis enrolled in the study (n=116). Outcomes were assessed among 96 participants (age: 52±10 y; BMI: 39.2±7.1 kg/m2) with preD defined as HbA1c<6.5% with metformin use or HbA1c 5.7-6.4% (inclusive) without glycemic control medication. Retention at two years was 75% (72/96). The crude incidence for first occurrence of regression from preD to NG (HbA1c <5.7% without medication) was 47.6 cases per 100 person-years. Estimated cumulative incidence of NG at two years was 52.3%. One new case of T2D each year was observed, and crude incidence of T2D diagnosis was 1.5 cases per 100 person-years. Estimated cumulative incidence of T2D at two years was 3%. Prevalence of MetS was reduced from 94% to 30% at one and 47% at two years (both P<4.4x10-16). Prevalence of class II or greater obesity was reduced from 67% to 38% at one and 39% at two years (both P<.0013). Among two-year completers, 62.5% achieved ≥7% weight loss. Given these observations, this study demonstrates the potential utility of a CCI emphasizing CR for treatment of preD.

Disclosure

A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. S.J. Athinarayanan: Employee; Self; Virta Health Corp. J. McCue: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. R.N. Adams: Employee; Self; Virta Health Corp. J.P. McCarter: Employee; Self; Abbott Laboratories. Stock/Shareholder; Self; Virta Health. J. Volek: Advisory Panel; Self; Atkins Nutritionals, Cook Keto, Virta Health Corp. Stock/Shareholder; Self; PangeaKeto, Virta Health Corp. Other Relationship; Self; Beyond Obesity.

Funding

Virta Health Corp
651-P: Randomized Controlled Trial of Technology-Assisted Case Management in Low-Income Adults with Type 2 Diabetes (TACM-DM): Effect on Quality of Life and Blood Pressure
Authors: EGEDE LEONARD E. , KNAPP REBECCA G. , WALKER REBEKAH J. , GARACCI EMMA , WILLIAMS JONI S.
Published: June 2020

A novel RCT tested the efficacy of a technology-assisted case management (TACM) program in a low-income, rural population previously where nurses titrated medication over the phone instead of in a clinic. The primary analysis showed significant improvement in glycemic control at 6-months post-randomization dropping HbA1c by 1%. This study aimed to test if the intervention was also effective at dropping blood pressure without compromising quality of life. One hundred and thirteen adults with poorly controlled diabetes (HbA1c>= 8%) were randomly assigned to the TACM intervention or usual care. Participants received a two-in-one telehealth system to monitor glycemic and blood pressure control, which uploaded daily to a central server. A nurse case manager was trained to titrate medication under the supervision of an internist and an endocrinologist every 2 weeks based on the readings. Outcomes were blood pressure and quality of life (SF-12) at 6-months. Baseline adjusted mixed models using a random intercept were used to evaluate change at 6-months for the TACM intervention group compared to usual care. There were no statistically significant differences in systolic blood pressure, physical component of quality of life, or mental component of quality of life between the TACM and control group. However, there was a significant change in diastolic blood pressure over time, with the TACM group decreasing at 6-month (p=0.02), whereas the control group remained stable (p=0.53). Diastolic blood pressure decreased 5.22 mm Hg at 6-months in the TACM group (p=0.04). Technology-assisted case management by a nurse with medication titration under physician supervision was efficacious in improving diastolic blood pressure without compromising quality of life in low-income rural adults with diabetes.

Disclosure

L.E. Egede: None. R.G. Knapp: None. R.J. Walker: None. E. Garacci: None. J.S. Williams: None.

Funding

U.S. Department of Defense (W81XWH-10-2-0057)
660-P: Novel Gaming Approach to Increase Participation in Peer-to-Peer Discussion-Education Session for Transitioning Adolescents and Young Adults (AYA)
Authors: FINNEY JESSICA , CHARRON-PROCHOWNIK DENISE , KRALL JODI T. , DIAZ ANA M. , LIBMAN INGRID
Published: June 2020

To help maintain glycemic control and prevent complications for transitioning AYA with type 1 diabetes mellitus (T1D), a Diabetes Transition Program (DTP) was created at an academic children’s hospital to provide clinical care, peer support, information and skills building for self-advocacy and diabetes management. Peer-group sessions were facilitated by a multidisciplinary team on relevant issues. This abstract describes a novel educational approach to engaging group participation, discussion and further enhancing decision-making skills regarding complication risks; and to describe participant reaction from field/observation notes. Group sessions on complication and prevention were facilitated by a CDE nurse. Original sessions provided handouts with Q and A posed by CDE for discussion. A novel gaming approach was then instituted. In each session, participants were divided into 2 subgroups. Each subgroup was given two stacks of cards. One group matched cards having names of complications (i.e., cardiovascular problems) with cards having examples of screening tests and prevention strategies (e.g., BP, LDL). The other group matched complications with S and S of the complication (e.g., heart attack). Groups came together and shared results for each complication which initiated discussion. Observations of group dynamics were noted. DTP has had 153 patients (49% males, mean age 1st visit 18.8yrs, range 17-24yrs). Each group session averaged 5-6 AYA. Compared to the original format, group dynamic observations of the novel gaming approach include: increased peer-to-peer discussion, greater openness to share thoughts with group, increased critical thinking skills, complete participation. It appears that this novel gaming approach facilitated patient learning by stimulating participant-initiated discussion, peer-to-peer interaction and support, and interest in topic. More formal evaluation of this method is warranted.

Disclosure

J. Finney: None. D. Charron-Prochownik: None. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. A.M. Diaz: None. I. Libman: Consultant; Self; Novo Nordisk A/S.
672-P: Comparing Latina Experiences with Diabetes Self-Management Education (DSME) in a Virtual World (VW) vs. the Face-to-Face Format (F2F)
Authors: MELO KATHERINE , BRAGG ALEXA , LAIRD LANCE D. , GARDINER PAULA , HOWARD JESSICA M. , MITCHELL SUZANNE
Published: June 2020

Purpose: To characterize Latina experiences of a Spanish-language DSME program delivered in the VW versus a F2F format.

Methods: Qualitative analysis of transcripts from three semi-structured focus groups conducted with 22 randomly selected Latina women enrolled in the Women in Control (WIC) DSME comparative effectiveness study. Two researchers coded the data and conducted a qualitative thematic analysis. Audio recordings were transcribed verbatim.

Results: A total of 73 Latinas living with uncontrolled type 2 diabetes enrolled in the WIC study with an average age of 52yo, ∼75% had less than a high school diploma and more than 40% reported low health literacy. Four overarching themes were identified and applied to both VW and F2F formats, including (1) the impact of depression on diabetes self-care, (2) strong desire for actionable education (3) high value on peer coaching and positive group culture. One additional theme was identified among VW participants - (4) Positive Technological Development (PTD) - the sense of agency developed through learning to use technology for DSME.

Conclusion: Latina women with diabetes with low health and computer literacy were positively impacted by the Women in Control DSME program both in F2F and in a VW. The VW platform facilitated PTD even among those with very low literacy and computer experience.

Disclosure

K. Melo: None. A. Bragg: None. L.D. Laird: None. P. Gardiner: 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 (R01DK106531-05S1)
68-LB: Use of Real-Time CGM Is Associated with Fewer Hospitalizations Compared with SMBG in the Insulin-Treated Medicare Population
Authors: PUCKREIN GARY , MARRERO DAVID G. , PARKIN CHRISTOPHER , NORMAN GREGORY J. , XU LIOU , LYNCH PETER M. , TAYLOR BRUCE T.
Published: June 2020

The Centers for Medicare and Medicaid (CMS) only allows coverage of CGM for beneficiaries with diabetes who are treated with insulin, (insulin injections ≥3/day or insulin pumps) and is currently performing SMBG ≥4/day. We used data from CMS to assess the clinical impact of using real-time CGM (Dexcom G5) by comparing a cohort of Medicare beneficiaries who acquired a CGM device from July 2017 thru January 2018 (n=841) with a cohort of beneficiaries (n=224,484) who continued SMBG during the same period. This cohort includes beneficiaries identified as insulin-treated in 2009 and survived through 2017. Overall, SMBG was associated with 35% more hospitalizations than CGM (35.5% vs. 26.2%) and 52% more inpatient visits (0.70 vs. 0.46) over 6 months (both p <0.0001). Reductions were seen across all demographic variables except non-whites. (Table 1.) The ADA estimates the cost of inpatient hospitalizations and emergency services among diabetes adults age ≥65 years in 2017 was $48.5 billion. These data suggest that wider use of CGM among CMS beneficiaries with diabetes could significantly reduce these costs through reduced hospitalizations and inpatient visits, and that CMS coverage for CGM should be broader than the current narrow coverage policy criteria.

Disclosure

G. Puckrein: None. D.G. Marrero: None. C. Parkin: Consultant; Self; Abbott, CeQur Corporation, Dexcom, Inc., DreaMed Diabetes, Novo Nordisk Inc., Onduo, Roche Diabetes Care, Valeritas, Inc. G.J. Norman: Employee; Self; Dexcom, Inc. L. Xu: None. P.M. Lynch: Employee; Self; Dexcom, Inc. Stock/Shareholder; Self; Dexcom, Inc. B.T. Taylor: Employee; Self; Dexcom, Inc.

Funding

Dexcom, Inc.
685-P: Exercise-Trained, but Not Cold-Exposed White Adipose Tissue Improves Metabolism and Regulates Molecular Pathways Related to Exosomes
Authors: VAMVINI MARIA , NIGRO PASQUALE , STANFORD KRISTIN I. , HIRSHMAN MICHAEL F. , MIDDELBEEK ROELAND , GOODYEAR LAURIE J.
Published: June 2020

Exercise training and cold exposure are very different physiological stimuli; yet both improve systemic metabolic health and have pronounced effects on the gene expression profile of subcutaneous white adipose tissue (scWAT). To test whether adaptations to scWAT mediate the beneficial effects of exercise training and cold exposure on glucose tolerance, we used a transplantation model. Donor mice were males and either sedentary, exercise trained (voluntary wheel running), or cold exposed (5°C) for 11 days. scWAT from donors was transplanted into sedentary recipients and mice were studied nine days later (n=3-5/group). Mice transplanted with scWAT from trained, but not cold-exposed mice, had improved glucose tolerance compared to mice transplanted with sedentary scWAT, suggesting unique adaptations to trained scWAT that confer beneficial effects on glucose homeostasis. To determine exercise-specific effects on scWAT, we performed quantitative proteomic profiling (QPP) of scWAT from another cohort of sedentary, trained and cold-exposed mice. Exercise training significantly increased 300 proteins and decreased 182 proteins, whereas cold increased 956 and decreased 2096. Interestingly, exercise uniquely upregulated 171 proteins. GO analysis revealed that a high percentage of these exercise-specific upregulated proteins were located in the extracellular exosome (36%) and extracellular region (22%). In contrast, the majority of the cold-specific upregulated proteins (64%) were located in mitochondrial-related structures. QPP of scWAT secretome using conditioned media revealed 14 unique exercise-induced upregulated proteins, localized exclusively to the extracellular exosome. Exercise training, but not cold, results in adaptions to scWAT that improve glucose tolerance. These results also reveal that there are dramatically different molecular signatures and pathways regulated by these two potent metabolic stimuli.

Disclosure

M. Vamvini: None. P. Nigro: None. K.I. Stanford: None. M.F. Hirshman: Stock/Shareholder; Self; Abbott Laboratories, AbbVie Inc., Amgen, Colgate-Palmolive, Eli Lilly and Company, Medtronic. R. Middelbeek: None. L.J. Goodyear: None.
698-P: Moderate-to-Vigorous Physical Activity Associated with Microalbuminuria in Type 2 Diabetes: A Cross-Sectional Study
Authors: OSAKA TAKAFUMI , HASHIMOTO YOSHITAKA , SENMARU TAKAFUMI , USHIGOME EMI , ASANO MAI , HAMAGUCHI MASAHIDE , YAMAZAKI MASAHIRO , FUKUI MICHIAKI
Published: June 2020

Background and Aims: Moderate-to-vigorous physical activity (MVPA) could reduce both the incidences of type 2 diabetes in the general population and of cardiovascular events in patients with type 2 diabetes. Several guidelines have indicated that patients with diabetes were advised to perform MVPA for >150 min per week. Recent studies have not shown apparent harmful effects of physical activity in patients with diabetic nephropathy. However, the association between physical activity and microalbuminuria remains unknown. Thus, MVPA time was evaluated using an accelerometer, and its association with microalbuminuria was investigated in the present cross-sectional study.

Materials and Methods: MVPA time was measured using a tri-axial accelerometer ActiGraph (ActiGraph Corp., Pensacola, Florida). Patients with diabetes were instructed to use the accelerometer for 7 days, except while bathing and sleeping. MVPA was defined as >1,952 counts per min. The association between MVPA and log urine albumin-to-creatinine ratio (UACR) was assessed using the linear regression model. In the multivariate model, age, gender, height, body weight, grip strength, blood pressure, sedentary time, hemoglobin A1c, estimated glomerular filtration rate, total cholesterol, insulin use, and ACE/ARB inhibitor use were used as covariates.

Results: Among 236 patients (157 men, 66.5%), the mean age, body mass index, hemoglobin A1c, daily MVPA, and median UACR were 65.5 ± 9.3 years, 23.3 ± 3.4 kg/m2, 7.4% ± 1.0%, 27.2 ± 24.5 min, and 11.8 mg/gCr, respectively. Approximately 7.7% of patients had microalbuminuria of >300 mg/gCr. Log UACR was associated with daily MVPA in the univariate (r = −0.17, P = 0.010) and multivariate models (ß = −0.14, P = 0.046).

Conclusion: MVPA time was associated with UACR in Japanese patients with type 2 diabetes. Although patients with severe diabetic nephropathy have low physical activity levels, patients included in this study had no or mild nephropathy.

Disclosure

T. Osaka: None. Y. Hashimoto: None. T. Senmaru: None. E. Ushigome: None. M. Asano: None. M. Hamaguchi: None. M. Yamazaki: None. M. Fukui: None.
70-OR: Change in A1C with and without Intermittent Use of CGM in Adults with Type 2 Diabetes Participating in the Onduo Virtual Diabetes Clinic
Authors: LAYNE JENNIFER E. , ZISSER HOWARD , BERGENSTAL RICHARD M. , GABBAY ROBERT A. , BARLEEN NATHAN A. , MILLER DAVID P. , DIXON RONALD F.
Published: June 2020

The Onduo Virtual Diabetes Clinic (VDC) for people with T2D combines a mobile app, remote personalized lifestyle coaching and connected devices. Differentiating features are live video consultations with board-certified endocrinologists for medication management and prescription of real-time CGM devices for intermittent use as clinically indicated. This analysis examined change in A1c from enrollment to follow-up at 6 mo in CGM vs. non-CGM user groups. Characteristics of CGM (n=213) and non-CGM (n=399) groups were similar. Overall, participants (n=612) were 53.5±8.7 yr, 61.1% female and 26.5% lived in a rural geography. Baseline A1c was 7.8%±1.7, 33.0% were on insulin and 23.5% on a sulfonylurea. A1c decreased significantly in CGM and non-CGM groups by 0.9%±1.7 and 0.4%±1.3, respectively (both p<0.001). Change in A1c stratified by CGM use and baseline A1c categories of >9.0%, 8.0-9.0%, 7.0-<8.0%, <7.0% are presented in the Table. These real-world data suggest that participation in the Onduo VDC was associated with significant improvement in A1c for participants not meeting ADA treatment targets. There was an approximately two-fold greater improvement in A1c with intermittent CGM use.

In conclusion, the VDC has potential to support people with T2D and their clinicians between office visits by increasing access to specialist care and advanced diabetes technology.

Disclosure

J.E. Layne: Employee; Self; Onduo. H. Zisser: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. R.M. Bergenstal: Consultant; Self; Ascensia Diabetes Care, Johnson & Johnson. Other Relationship; Self; Abbott, Dexcom, Inc., Hygieia, Lilly Diabetes, Medtronic, Novo Nordisk A/S, Onduo, Roche Diabetes Care, Sanofi, UnitedHealth Group. R.A. Gabbay: Advisory Panel; Self; FormHealth, Health Reveal, Lark, Onduo, Vida Health. N.A. Barleen: Employee; Self; Onduo. D.P. Miller: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. R.F. Dixon: Employee; Self; Onduo.
704-P: Influence of Acute Stress on Heart Rate and Glycemia during Exercise
Authors: HOBBS NICOLE , PARK MINSUN , CHU MINSEUNG , SONG YOUNGKWAN , QUINN LAURIE T. , SEVIL MERT , CINAR ALI
Published: June 2020

People with type 1 diabetes (T1D) have personal strategies for maintaining euglycemia while exercising which generally serves them well during training. Their strategy often yields wildly differing results during a competition. The influence of competition stress (notably, epinephrine causing prompt elevations in glucose) and high-intensity and/or long-duration efforts can yield dysglycemia. Two different studies were conducted to observe this phenomenon. In a small study of subjects with T1D completing athletic competitions, perceived stress level as reported by the individual is insufficient for determination impact upon glycemia. An elevated heart rate during the competition over what was observed at the same running pace in training was a better indicator of an increase in glycemia. To recreate an athletic stress scenario in a clinical setting, 13 subjects with T1D completed a low intensity treadmill protocol for 3 sessions: non-stress, verbally reported mental math with an audience, and stressful video games to observe the influence on glycemia and heart rate. The treadmill protocol, prior meal, and insulin doses were matched for each individual for the 3 sessions. When compared to the non-stress treadmill session, an elevated average heart rate was observed in 10 of the 13 video game sessions and an elevated average glucose was observed in 9 of the 13 video game sessions. In the mental math sessions, an average heart rate elevated heart rate was observed in 6 of the 13 sessions with 7 of 13 having a higher average glucose compared to the non-stress session. While individual response to acute stress yields a high degree of intersubject variability, the video game sessions may more closely match the competition stress experienced and physiological response to stress observed during an athletic competition. The cause of the stressor may be critical in detection of stress and predicting glycemic response for the management of T1D.

Disclosure

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

Funding

JDRF (A18-0036-001); National Institutes of Health (DP3DK101075, F31DK116524)
705-P: "Going for a Walk as the Only Option": Are Medical Diabetes Guidelines Relevant to People with Diabetes in Pakistan When It Comes to Physical Activity?
Authors: TARIQ OMAMA , ROSTEN CLAIRE , HUBER JORG W.
Published: June 2020

Background: It is recommended that people living with type 2 diabetes (PLwD) increase their levels of physical activity to help manage their condition. Previous studies have reported on strong family ties in South Asian culture. However, understanding of family involvement in relation to diabetes is South Asian culture is limited.

Objective: To explore the influence of family roles within South Asian culture on physical activity by PLwD.

Methods: 30 PLwD (13 men; aged 30-70 years), 17 family members of PLwD (4 men; 22-61 years) and nine doctors were recruited in metropolitan Lahore, Pakistan who mostly used state health services for relatively disadvantaged populations. Interviews were analyzed using thematic analysis.

Results: Three themes were identified: (1) Going for a walk as (the only) convenient physical activity; (2) The role of family members in influencing physical activity; (3) Cultural acceptance of walking as physical activity. Across all themes gender and age create flexibilities or constraints for the choices of physical activity, available to PLwD. Intersections of gender, age and in addition family roles appear to create most flexibility for younger men, e.g., going for a run instead of just walking, and the constraints for a younger woman who may need to find another woman so as to not walk on her own. For an older woman these constraints are less severe, as it is acceptable to her, her family and the wider culture to be seen walking on her own.

Conclusion: These complex pattern of flexibilities and constraints for urban dwellers who would not be able to afford or be permitted to use a fee charging sports facilities are not recognised by PROMPT, a recently published diabetes guideline for Pakistan. The findings suggest an urgent need to develop guidance which recognise familial expectations and propose lifestyle adjustments, acceptable to urban dwellers in a country like Pakistan.

Disclosure

O. Tariq: None. C. Rosten: None. J.W. Huber: None.
706-P: Recreational Soccer Training as a Tool Activity to Prevent Bone Issues in Type 2 Diabetes Patients
Authors: DE SOUSA MAYSA VIEIRA , DA SILVA MARIA R.
Published: June 2020

Bone formation is suppressed in the diabetic state, being the osteoporotic fractures a serious co-morbidity and complication of diabetes. A better lifestyle with proper diet and exercise have been linked to delay the progression of diabetes and may improve bone metabolism. With diabetes negatively affecting bone health we evaluated the impact of diet and exercise on serum bone markers, hormones and densitometry. This study assessed effects of twelve weeks of recreational soccer training combined with a caloric restricted diet (SO+D) vs. diet alone (D) in markers of bone health of type 2 diabetes (T2D) patients. Training sessions were performed for 40 min, 3 times per week for 12 weeks. We examined the following baseline and postprandial serum bone markers of formation: procollagen type 1 N-terminal propeptide (P1NP), and osteocalcin (OC); and C-terminal telopeptides of type I collagen (CTX) as bone resorption marker. Bone metabolic hormones such as parathyroid hormone (PTH) and 25-hydroxyvitamin D (25[OH]D) were also measured.

Results: Compared to baseline levels, the first soccer session for SO+D induced acute increases of osteocalcin (35.0 ± 14.3 to 48.0 ± 26.3 ng/mL, P<0.05) and CTX remained unchanged. Osteocalcin, P1NP and CTX were lower in the D group (P<0.05). Compared to the D group, SO+D group resulted in increased osteocalcin (P<0.05), while P1NP and CTX levels did not alter. After 12 weeks, bone mineral density increased in both SO+D and D groups (P<0.05) and baseline levels of PTH remained unchanged, whereas 25[OH]D increased only in SO+D group (19.1±1.2 to 22.1 ± 1.4 ng/mL, P<0.05). Diet alone or combined with soccer training improved bone health status among T2D patients elicited by suppression on bone resorption marker and increased bone mineral density. However, recreational soccer training enhanced bone formation marker and vitamin D levels decreasing risk factors associated with osteoporosis and osteoporotic fractures in T2D patients better than diet alone.

Disclosure

M. Vieira de Sousa: None. M.R. da Silva: None.

Funding

Fundação de Amparo a Pesquisa do Estado de São Paulo (2012/01400-0)