bluuebunny/crossref_metadata_2025 huggingface dataset:
474-P: Novel Changes in Chromatin 3D Architecture under Diabetic Conditions in Human Macrophages
Authors: REDDY MARPADGA A. , BHATTACHARYA SUPRIYO , TANWAR VINAY S. , MALEK VAJIR , ZHANG LINGXIAO , LANTING LINDA L. , PANDEY PRIYATAMA , CHEN ZHUO , WU XIWEI , NATARAJAN RAMA
Published: June 2024

Aberrant activation of monocytes and macrophages in diabetes increases chemokines and cytokines associated with chronic inflammation and diabetic vascular complications like atherosclerosis and nephropathy. Epigenetic mechanisms are implicated; however, the chromatin 3D reorganization during macrophage activation in diabetes is unclear. We examined chromatin architecture in human CD14+ monocytes (from healthy volunteers) differentiated into macrophages and treated with High glucose +TNF-α (HT, 72 h) versus normal glucose using HiChIP and ChIP-seq with H3K27ac antibody (enhancer mark) and integrated these datasets with gene expression (RNA-seq) and chromatin-accessibility (ATAC-seq) data. We found HT induced dramatic changes in transcriptional programs that regulate inflammatory pathways similar to CD14+ monocytes from diabetic volunteers. HT promoted extensive changes in open chromatin (OC) and chromatin loops between enhancers and other regulatory elements and disrupted transcriptionally active/inactive (A/B) genomic compartments and topologically associating domains. Upregulated inflammatory genes were associated with increased OC and promoter-enhancer loops, which were reduced at downregulated cell cycle genes. We identified key pro-inflammatory transcription factor motifs enriched in OC/chromatin loops, and interactions between distal enhancers and promoters of chemokine, cytokine, and upstream signaling genes. ChIP and 3C assays confirmed HT-induced H3K27ac at distal enhancers and enhancer interactions with the CCL2 and IRAK2 promoters. Moreover, HT-induced enhancers harbored SNPs linked with type 2 diabetes. These results reveal unique rewiring of the epigenome and chromatin 3D architecture by HT, which likely promotes macrophage activation in diabetes. They can reveal potential targets for epigenetic therapies to mitigate chronic inflammatory diabetes complications.

Disclosure

M.A. Reddy: None. S. Bhattacharya: None. V.S. Tanwar: None. V. Malek: None. L. Zhang: None. L.L. Lanting: None. P. Pandey: None. Z. Chen: None. X. Wu: None. R. Natarajan: None.

Funding

NIH RO1 DK065073, Arthur Riggs Diabetes and Metabolism Research Institute Endowment
48-OR: Novel Lipidated Interleukin-22 Reduces Body Weight and Improves Glucose Homeostasis in Mice
Authors: VAN DE BUNT MARTIJN , LOUISE KJØLBYE ANNE , JORGENSEN RASMUS
Published: June 2024

Introduction & Objective: Developing novel therapeutics is critical to provide additional treatment options and improve long‑term outcomes for patients with obesity and diabetes. The atypical cytokine interleukin-22 (IL-22) which acts on epithelial cells has shown a range of metabolic benefits. Here we demonstrate efficacy of a novel long-acting lipidated IL-22 agonist on reducing body weight and improving key metabolic parameters in mice.

Methods: The effect of lipidated IL-22 on obesity at 2 dose levels was investigated in two diet-induced obese (DIO) models - one at standard conditions and one at thermoneutrality including energy expenditure measurements while diabetic db/db mice were used to determine the effect of 3 dose levels on glucose homeostasis.

Results: Lipidated IL-22 dosed for 5 weeks resulted in a dose-dependent reduction in body weight (-7.7%, and -20.2%) compared to vehicle (-1.1%) in DIO mice accompanied by a dose-dependent reduction in food intake. However, the effect of IL-22 was partly food intake independent as weight-matched control animals consumed 16% less food than the lipidated IL-22 comparator group. EchoMRI showed more fat mass loss and less lean mass loss in the lipidated IL-22 group compared to its weight-matched control. Lipidated IL-22 did not increase energy expenditure compared to vehicle at week 1 and 4 in the DIO study at thermoneutrality. In db/db mice, IL-22 dose dependently reduced plasma glucose and %HbA1c at termination (-1.0, -1.3 and -1.7 compared to vehicle). This was accompanied by a dose-dependent improvement in HOMA-IR, in line with the significant reduction in fasting insulin observed in the DIO mice.

Conclusion: A novel long-acting lipidated IL-22 significantly reduced body weight and improved glucose homeostasis through a novel mode-of-action in a variety of mouse models. Safety and tolerability of lipidated IL-22 in humans is currently being investigated in a Phase 1 trial.

Disclosure

M. van de Bunt: Employee; Cytoki Pharma. A. Kjølbye: Employee; Cytoki Pharma. R. Jorgensen: Employee; Cytoki Pharma. Stock/Shareholder; Cytoki Pharma.
482-P: SCS for Painful DPN—Consistent Outcomes from Multiple RCTs and Real-World Data
Authors: BODE BRUCE W. , MURPHY MELISSA , VIGERSKY ROBERT A. , JOHANEK LISA , MARTINEZ MARLON , MARQUEZ ADRIAN , COLETTI FILIPPO , LARUE MADDIE
Published: June 2024

Painful diabetic peripheral neuropathy (DPN) is treated medically with antineuralgics, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors which are often not satisfactory long-term. Spinal Cord Stimulation (SCS) is an effective treatment alternative per 3 randomized controlled trials (RCTs) which consistently demonstrate that SCS is more effective than conventional medical management for painful DPN treatment. To assess “real-world” SCS efficacy for painful DPN, we qualitatively looked for consistency in outcomes between published RCT results and patient-reported outcomes collected using a digital health platform. We retrospectively analyzed demographics and characterized pain profiles using PROMIS-29 (Patient-Reported Outcomes Measurement Information System®) surveys at baseline to 3-month follow-up. Between Oct-2022 and Jul-2023, 295 DPN patients underwent SCS device trials while using the digital health platform, with 69.2% receiving a permanent implant. At the time of submission, paired data at baseline and 3-mo was available for 20 patients. The data shows significant improvement in 6 of the 7 functional domains of the PROMIS-29 survey (Table 1). These findings suggest SCS can provide significant improvement in DPN pain-related symptoms. Collectively, robust published outcomes from 3 RCTs in combination with real-world data support the efficacy of SCS for painful DPN.

Disclosure

B.W. Bode: Research Support; Omnipod. Speaker's Bureau; Omnipod. Research Support; Medtronic. Advisory Panel; Medtronic. M. Murphy: Advisory Panel; Medtronic. Consultant; Relievant. R.A. Vigersky: Employee; Medtronic. L. Johanek: Employee; Medtronic. M. Martinez: Employee; Medtronic. A. Marquez: Employee; Medtronic. F. Coletti: Employee; Medtronic. M. LaRue: Employee; Medtronic.

Funding

This study was sponsored by Medtronic.
492-P: Implementation of Retinal Scans in a Pediatric Diabetes Clinic to Improve Screening in a Non-commercially Insured Population
Authors: THAKUR ISHAAN , CHOUDHARY ABHA
Published: June 2024

Background: The SEARCH for Diabetes in Youth Registry reported the prevalence of diabetic retinopathy in children with Type 1 and Type 2 diabetes as 5.6% and 9.1% respectively. The American Diabetes Association recommends annual retinopathy screening in children ≥ 11 years of age or at onset of puberty whichever is earlier, 3-5 years after diagnosis of Type 1 diabetes. The screening is recommended annually immediately after diagnosis of Type 2 diabetes. In our academic endocrinology practice, we have 2000 established patients with Type 1 diabetes and 900 patients with Type 2 diabetes. Our non-commercially insured population is around 40%.

Methods: NIDEK Navis- EX retinal scanner was installed in June 2020 in the clinic for the Medicaid population to improve screening since this group had suboptimal retinal screening. The scan was performed by the medical assistants at check-in during the diabetes clinic visit based on eligibility. The images were transferred to the ophthalmology colleagues for a reading. Once the read was completed, the results were sent back to the patient’s electronic medical records.

Results: The retinal scan screening was at 37.4% for all insurance groups prior to the implementation of the scanner. After the installation of the scanner, the screening rates increased to 48.7%, 64.8%, and 64.8% at the end of years 1, 2, and 3 respectively in the non-commercially insured group. Among the 349 patients screened in our clinic during the 1st year, 7 had non-proliferative diabetic retinopathy.

Conclusions: We improved the retinopathy screening rates in the non-commercially insured population at our center. We are working with our institution, so we can perform retinal scans in our clinic for all our patients without a huge financial burden for our families.

Disclosure

I. Thakur: None. A. Choudhary: None.
5-OR: Renal Hypermetabolism in Youth-Onset Type 2 Diabetes (T2D)—A C-11 Acetate PET Scan Analysis
Authors: LEROUX MELISSA , JI CHOI YE , NGUYEN NHUNG , PYLE LAURA , TOMMERDAHL KALIE L. , RICHARD GABRIEL , BLONDIN DENIS , VAN RAALTE DANIËL , BJORNSTAD PETTER
Published: June 2024

Introduction & Objective: Renal hypermetabolism in youth-onset T2D presents a critical area of study due to potential metabolic implications. Prior kidney biopsy research indicated upregulated metabolic pathways, such as the TCA cycle and oxidative phosphorylation, in the proximal tubules of patients with T2D. However, the functional impact of these transcriptomic changes remains unclear. This study aims to evaluate oxidative metabolism in youth with obesity and T2D, and its clinical implications, using C-11 acetate PET scans.

Methods: This study involved 18 youths with obesity and T2D, and 11 normal weight controls (NWC). We employed C-11 acetate PET scans to measure cortical and medullary oxidative rates (k2), and cortical perfusion (F). Statistical analyses focused on comparing these rates between the two groups, along with spearman correlations between oxidative rates and urinary albumin-to-creatinine ratio (UACR).

Results: Youths with obesity and T2D exhibited significantly higher cortical (0.21 [0.15, 0.34] vs. 0.17 [0.14, 0.22] min-1, p=0.002) and medullary (0.20 [0.16, 0.35] vs. 0.14 [0.11, 0.18] min-1, p<0.0001) oxidative rates compared to NWC. Cortical perfusion was lower in the T2D group, but medullary perfusion did not differ significantly. The ratio of cortical and medullary K2/F was higher in T2D, indicating a metabolic mismatch. Additionally, higher oxidative rate (k2) and cortical k2/F ratio correlated with UACR (r: 0.41, p=0.038; r: 0.47, p=0.014, respectively).

Conclusion: The study demonstrates a pronounced elevation in oxidative metabolism and a notable mismatch between oxidative metabolism and perfusion in youths with obesity and T2D, compared to NWC. This is associated with increased albuminuria. These findings corroborate the transcriptional changes observed in kidney biopsies, particularly in the transcripts of TCA and oxidative phosphorylation, underscoring the functional relevance of these molecular alterations.

Disclosure

M. Leroux: None. Y. Choi: None. N. Nguyen: None. L. Pyle: None. K.L. Tommerdahl: None. G. Richard: Research Support; Eli Lilly and Company. D. Blondin: None. D. van Raalte: Consultant; Eli Lilly and Company. Research Support; Eli Lilly and Company, Boehringer-Ingelheim. Consultant; Boehringer-Ingelheim. Research Support; Merck & Co., Inc. Advisory Panel; Merck & Co., Inc. Consultant; Bayer Inc. P. Bjornstad: Consultant; AstraZeneca, Boehringer-Ingelheim. Advisory Panel; Lilly Diabetes, Novo Nordisk, Bayer Inc., Horizon Therapeutics plc.

Funding

NIH/NIDDK
5-PUB: Retrospective Study of Patients with Dyslipidemia With and Without Type 2 Diabetes Mellitus Treated with a Fixed-Dose Combination of Rosuvastatin/Ezetimibe
Authors: RODRIGUEZ VAZQUEZ ILEANA C. , RIOS-BRITO KEVIN F. , SANDER-PADILLA JOSE G. , RODRIGUEZ-ROCANDIO KARLA E. , LUGO-SÁNCHEZ LAURA A. , ARGUEDAS MARÍA M. , FLORES-HUANOSTA DIANA , GONZALEZ-CANUDAS JORGE , ROMERO YULIA
Published: June 2024

Introduction and Objective: Currently, dyslipidemia is one of the most common comorbidities in patients with Type 2 Diabetes Mellitus (T2DM), for which cardiovascular risk (CVR) is usually underestimated, being this the case where the use of combined therapy of statins and ezetimibe is considered one of the best options. The aim of the study was to evaluate a cohort of patients with dyslipidemia with and without T2DM treated with a fixed-dose combination (FDC) of rosuvastatin/ezetimibe.

Methods: Retrospective study, in patients with dyslipidemia with and without T2DM treated with FDC rosuvastatin/ezetimibe (10/10 or 20/10 mg once daily). Information was collected retrospectively, from patients' clinical records, including complete biochemical results and lipid profile from three visits (baseline, 2 and 4 months). Mann Whitney U and chi-square tests were performed for comparisons between groups, with SPSS 29v. statistical program.

Results: Data from 103 patients was collected (55.4% men), mean age of 56 years and body mass index (BMI) of 28.4 Kg/m2. Patients' median baseline glucose was 145mg/dL (IQR: 118; 228), and 138 mg/dL (IQR: 112.6; 191.5) for final follow-up visit for the group with T2DM (n=33), 90mg/dL (IQR: 86.2; 97.6) and 93mg/dL (IQR: 89.0; 97.0) for the no T2DM group (n=57), respectively. For the observed target values, by the end of follow-up 29% of patients without T2DM and 20% with T2DM had achieve triglyceride levels <150mg/dL (p= 0.001), while 36.8% vs 50.5%, respectively had achivied LDL-C levels <100mg/dL (p= 0.056) at the final visit. FDC treatment exhibited an appropriate safety profile.

Conclusion: FDC rosuvastatin/ezetimibe has shown a significant clinical impact on lipid profile biomarkers in patients with dyslipidemia with and without T2DM, mainly in the achievment of LDL-C reduction of <100mg/dL.

Disclosure

I.C. Rodriguez Vazquez: Employee; Laboratorios Silanes S.A. de C.V. K.F. Rios-Brito: Employee; Laboratorios Silanes S.A. de C.V. J.G. Sander-Padilla: Employee; Laboratorios Silanes. K.E. Rodriguez-Rocandio: Employee; Laboratorios Silanes S.A. de C.V. L.A. Lugo-Sánchez: Employee; Laboratorios Silanes S.A. de C.V. M.M. Arguedas: Employee; Laboratorios Silanes S.A. de C.V. D. Flores-Huanosta: Employee; Laboratorios Silanes. J. Gonzalez-Canudas: Employee; Silanes SA CV. Y. Romero: Employee; Laboratorios Silanes.

Funding

Laboratorios Silanes S.A. de C.V.
524-P: Diabetic Foot Ulcer Wound Dressings May Serve as an Untapped Source of Predictive and Monitoring Biomarkers of Healing Outcome
Authors: JOZIC IVAN
Published: June 2024

Introduction and Objective: The purpose of our study was to utilize discarded wound dressings from diabetic foot ulcers (DFUs) in order to identify potential predictive and diagnostic biomarkers by the proteomic analysis of cells and exosomes captured from wound exudate.

Methods: DFU patients were followed weekly for 4 weeks and change in wound size measured by EKARE inSight imaging equipment at each visit, at which point the wound dressing was collected. Cells from each dressing were then isolated, number of viable cells quantified and immunophenotyped by flow cytometry. Differential centrifugation was then used to isolate exosomes from each specimen, with exosomes purified using magnetic beads and validated by western blotting and FACS flow cytometry. Next, all samples were subject to trapped ion mobility spectrometry analysis of cellular and exosomal proteome. Lastly, we utilized m/z to identify and quantify relative peptide species, followed by analysis of hierarchical clustering of samples and functional annotation of identified clusters.

Results: From cellular immunophenotyping, we were able to determine those wounds which exhibited higher levels of gamma/delta T-cells (CD45+CD3+TCRg/d+) also exhibited trends towards reductions in wound size. Next, we were able to validate previous proteomic profiling reports of wound exudate that associated with poor healing outcomes (CTSG, LCN2, DEF1, MMP9, HBA, HBB, CAMP, VTN, among others). Lastly, our data suggests that healing wounds exhibit higher levels of ALB, SERPING1, CERU, CO3, POSTN, FN1, FGA (among others) in their week 1 dressings, and may act to serve as potential predictive biomarkers of healing wounds.

Conclusions: Together, our innovative approach to proteomic profiling of DFU wound dressings has demonstrated reproducible and encouraging results and we anticipate that higher recruitment will shed light on variability in healing outcomes and identify other potential biomarkers.

Disclosure

I. Jozic: None.

Funding

American Diabetes Association (11-22-JDFPM-07); National Institutes of Health (1R21AR083526-01)
529-P: Diagnosis Approach of Suspected Osteitis in Diabetic Foot Ulcer—The Multicentric French 2023 Survey
Authors: KEVORKIAN JEAN-PHILIPPE , FÉRON FLORINE , RIVELINE JEAN-PIERRE , GAUTIER JEAN-FRANÇOIS
Published: June 2024

Bedside Blind Bone Biopsy (B4) through healthy skin is a valid alternative to bone biopsy usually performed in the operating (OR) or radiology (RR) room for the diagnosis of diabetic foot ulcer osteitis (DFU) (IWGDF/IFDSA 2023 guidelines). From 12.17.2015 to 12.31.2023, in our Diabetology unit, 451 B4 have been carried out in 1434 patients admitted with a DFU (31%). B4 rate and performance increased with skill over time (B4 rate: 2023, 55% vs 2016, 15%, proven osteitis: 2023, 68% vs 2016, 50%).

A 19 items quiz has been emailed to the 159 DFU centers (10.22.23-11.07.23 request) in order to assess the diagnosis procedures habits in France in case of DFU suspected osteitis. Respondent rate is 47% (75/159, diabetology units 77%). Microbiological sampling is performed in 92% (samples other than bone biopsy or probabilistic treatment 8%). If bone biopsy performed, B4 is the procedure of choice in 42%, done in various circumstances (conventional hospitalization 79%, ambulatory 62%, consultation 41%). A >2 years experiment is declared in 72%, ≥2 B4/month 55%, ≥2 samples/B4 69%, specific bone biopsy trocar 38%, through healthy skin 79%, systematical post-B4 blood cultures 21%. Conventional bone biopsy (58%) is performed exclusively in the OR (58%) or in the RR (12%), in one or the other (30%). Treatment of DFU osteitis is based on non validated procedures in 16%. A DFU multidisciplinary team is available in 44% of the centers practicing B4. Despite its proven feasibility and valuable help for the diagnosis of DFU osteitis, B4 is poorly and imperfectly used in french DFU centers.

Disclosure

J. Kevorkian: None. F. Féron: None. J. Riveline: Board Member; Abbott, Novo Nordisk A/S, Sanofi, Eli Lilly and Company, Medtronic, Dexcom, Inc., Insulet Corporation, Air Liquide, AstraZeneca. J. Gautier: Board Member; Sanofi. Other Relationship; Sanofi. Speaker's Bureau; AstraZeneca, Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Pfizer Inc.
537-P: Community-Based Diabetes Management—Evaluating the Efficacy of Do Right! Diabetes Challenge
Authors: TRICHY NITHYA S. , MAHAFFEY HARRIS RENEE
Published: June 2024

Introduction & Objective: The Do Right! Diabetes Challenge is a comprehensive lifestyle intervention program designed for African Americans diagnosed with Type-2 Diabetes or Prediabetes in the Greater Cincinnati area. Recognizing the unique challenges faced by under-resourced communities, the ultimate goal of this intervention is to generate a sustainable impact on overall health and improve diabetes control.

Methods: We enrolled 22 participants for a 12-week intervention. Participants aged 18 or older with HbA1C ≥ 5.6 mg/dL, residing in the Greater Cincinnati area, were eligible for inclusion. The intervention consisted of weekly exercise sessions with a personal trainer, nutrition education classes, and life-coaching sessions. Key health metrics for diabetes, including HbA1C, total cholesterol, blood pressure, Body Mass Index (BMI), and waist circumference (in.) were measured before and after the intervention. Statistical analyses were conducted using a Wilcoxon Signed-Rank Test since all variables were matched, continuous, and nonparametric per the Shapiro-Wilk Test.

Results: Enrolled participants had a 1.47 mg/dL (p< 0.007) reduction in HbA1C levels after participating in the program compared to baseline. Additionally, there was a reduction of 12.72 mmHg (p< 0.002) in diastolic blood pressure and a reduction of 6.6 in. (p< 0.005) of waist circumference compared to baseline. However, no significant change in cholesterol levels, systolic blood pressure, or BMI was observed.

Conclusion: The Do Right! Diabetes Challenge significantly improved participant’s health measures including HbA1C, diastolic blood pressure, and waist circumference. The findings of the study underscore the potential benefit of targeted, comprehensive interventions for improving diabetes care in disadvantaged communities. In the future, a larger cohort will be enrolled to further investigate the longitudinal impact of community-based diabetes management for at-risk patient populations.

Disclosure

N.S. Trichy: None. R. Mahaffey Harris: None.
547-P: Success of Virtual Patient Simulation at Improving Comprehensive Management of Obesity in Patients with Prediabetes or Glucose Intolerance
Authors: LARKIN AMY , LACOUTURE MICHAEL
Published: June 2024

Background: We sought to assess the impact of online, virtual patient simulation (VPS)-based continuing medical education (CME) on performance of physicians (MDs) related to obesity in patients with prediabetes or glucose intolerance.

Methods: The intervention comprised two different patient scenarios in a VPS platform that allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision, followed by the opportunity for the learner to modify to their decisions. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) using a McNemar’s test. Data was collected November, 2022 through February, 2023.

Results: MDs (n=549) who completed at least 1 case were included (n=20 in practice <5 years, n=246 in practice >5 years).

Ordering obesity pharmacotherapy: MDs in practice >5 years had 28%-40% absolute improvement (P<.01; baseline 13%-15%) compared to MDs in practice <5 years had 20%-25% absolute improvement (P<.05; baseline 13%-15%).

Nonpharmacologic therapy: MDs in practice >5 years had 13%-19% absolute improvement (P<.01; baseline 48%-70%) compared to MDs in practice <5 years had 25%-30% absolute improvement (P<.05; baseline 50%-75%).

Continued Gaps: MDs in practice <5 years had the largest continued gaps in ordering obesity pharmacotherapy (60%-62%). MDs in practice >5 years had the largest continued gaps in nonpharmacologic approaches (17%-33%).

Conclusion: VPS can improve evidence-based clinical decisions related to comprehensive management of obesity in patients with prediabetes or glucose intolerance. This simulation was more effective at closing gaps in physicians in practice <5 years regarding nonpharmacologic options, but more effective in physicians in practice >5 years at pharmacologic therapy.

Disclosure

A. Larkin: None. M. LaCouture: None.

Funding

Developed through an independent educational grant from Novo Nordisk, Inc.
552-P: Barriers and Enablers to Diabetic Ketoacidosis (DKA) Prevention in Adults with Type 1 Diabetes—An Implementation Science Study
Authors: VERHOEFF NATASHA , CHEEMA WAJEEHA , MOJDEHI SARA , GAD HODA Y. , MUMFORD DOUG , ORSZAG ANDREJ , IVERS NOAH , BUDHRAM DALTON R. , BAKHSH ABDULMOHSEN M.K. , ABUABAT MOHAMMAD I. , WEISMAN ALANNA , PERKINS BRUCE A.
Published: June 2024

Introduction & Objective: DKA prevention depends strongly on patient knowledge and self-management skills, but educational tools are inconsistent and complex. To co-create a new tool with people living with T1D, we first aimed to determine key barriers and enablers to DKA prevention through identification of the perspectives of people living with T1D, their caregivers, and healthcare providers.

Methods: We conducted a qualitative study involving three independent focus groups. The focus group design and analysis were informed by the Action, Actor, Context, Target, and Time Framework (AACTT) to carefully define the key targeted behaviours for change and the Theoretical Domains Framework (TDF) to understand their determinants. The targeted behaviours related to testing ketone levels, acting upon ketone testing results, and seeking emergency medical care. Deductive coding and thematic analysis were used to categorize and describe barriers and enablers for each targeted behaviour.

Results: A total of 9 people living with T1D, 1 caregiver, and 12 healthcare providers participated in our focus groups. Five key themes relating to six TDF domains emerged that influenced one’s ability to engage in the targeted behaviours. Key barriers included: 1) a fundamental lack of understanding of the clinical relevance of ketones and DKA (knowledge, beliefs about consequences); 2) negative experiences with the healthcare system and lack of access to supplies (environmental context and resources); 3) inability to retain ketone knowledge among numerous self-management burdens (memory). Key enablers included: 1) reminders from physicians and/or technology (reinforcement); 2) community supports and accessible resources (social influences).

Conclusion: These key barriers and enablers to DKA prevention will inform the development of an educational tool co-created with people living with T1D designed to more effectively prevent DKA than do existing resources.

Disclosure

N. Verhoeff: None. W. Cheema: None. S. Mojdehi: None. H.Y. Gad: Consultant; Procter & Gamble. D. Mumford: None. A. Orszag: None. N. Ivers: Speaker's Bureau; Novo Nordisk. Consultant; Merck & Co., Inc. D.R. Budhram: None. A.M.K. Bakhsh: None. M.I. Abuabat: None. A. Weisman: None. B.A. Perkins: Advisory Panel; Abbott. Other Relationship; Novo Nordisk. Advisory Panel; Insulet Corporation, Nephris. Other Relationship; Medtronic. Advisory Panel; Sanofi, Vertex Pharmaceuticals Incorporated, Dexcom, Inc.

Funding

Diabetes Canada (Operating Grant OG-3-21-5572-BP)
562-P: A Social Media Intervention Shows Promise to Improve Health Outcomes in Low-Income Immigrants with Type 2 Diabetes—Evidence from a Pilot RCT
Authors: SHI YUN , ANN SEVICK MARY , TANG HAO , YANG XIMIN , JIANG YULIN , LIN NELSON , ONG IRIS H. , SU LIWEN , BAI YUJIE , HU LU
Published: June 2024

Objectives: To pilot test a social media-based intervention on glycemic control among low-income Chinese immigrants with Type 2 Diabetes (T2D).

Methods: We conducted a pilot RCT with 60 Chinese immigrants with T2D with 30 randomly assigned to the intervention group and 30 to the wait-list control group. The intervention group received two culturally and linguistically tailored videos per week for 12 weeks, covering diabetes knowledge, healthy eating, physical activity, medication adherence, glucose monitoring, and behavioral changes. In addition, they also received bi-weekly support calls from study community health workers to set goals, problem-solve, and address social determinants. HbA1c, dietary intake, and physical activity were assessed at baseline, 3, and 6 months.

Results: Most participants (mean age 54[11.5] years) were male (60%), employed (58%), had a high school education or less (70%), annual household income < $25,000 (50%), and limited English proficiency (88.3%). The two groups were comparable at baseline, except for employment status, which we adjusted for in our analysis. At 6 months, the intervention group had a significantly greater increase in fruit intake than the control group (0.19 cups vs. -0.27 cups, p=0.044). For other outcomes, despite no between-group differences, the intervention group had significant within-group reductions in HbA1c (1.4%, p<0.001), increased vegetable intake (0.53 cups, p=0.02), and reduced starchy food intake (-0.34 cups, p=0.012) at 6 months.

Conclusions: The notable improvement in HbA1c and dietary intake within the intervention group suggests the potential efficacy of the intervention. However, due to the limited sample size of this study, a larger-scale RCT with sufficient power is warranted to determine the efficacy conclusively.

Disclosure

Y. Shi: None. M. Sevick: None. H. Tang: None. X. Yang: None. Y. Jiang: None. N. Lin: None. I.H. Ong: None. L. Su: None. Y. Bai: None. L. Hu: None.

Funding

National Insitutes of Health (K99MD012811, R00MD012811)
563-P: How Continuing Education (CE) Supported Guideline-Based Treatment among Patients with Diabetes
Authors: ALLEN RUSSIE , WELCH LAUREN K.
Published: June 2024

Goal: To determine whether learners in a 2023 CE initiative increased their use of approved and recommended therapies compared to a control group of non-learners for the treatment of diabetes

Methods: Med Learning Group (MLG) conducted 37 CE activities in 2023 as part of an educational initiative supported by an independent educational grant from Novo Nordisk. The education focused on diabetes and treatment options with glycemic and extra-glycemic effects. Learners in each activity completed pre-/post-tests. MLG also provided identifying data on 11,119 learners (primary care physicians, cardiologists and advanced practitioners) to IQVIA, who then compared 11,084 of these learners to non-learners as a matched pair control. Control match criteria included geography, specialty, and prescribing behavior. IQVIA used claims data from pre- and post-education to identify change in the use of guideline-recommended and evidence-based therapies for patients among learners compared to control.

Results: Learners achieved a 31% gain in knowledge of the role of GLP-1 RAs in diabetes care based on pre-/post-test questions (N=4738). Via the claims analysis, learners also demonstrated increased appropriate application of guideline-recommended therapies in practice, with incremental new prescriptions of recommended therapies increasing significantly among learners compared to the matched control group of non-learners. The therapeutic landscape included GLP-1 RAs, SGLT2 inhibitors and GLP-1-GIP combination therapies. Learners selected 521,111 new guideline-recommended pharmacologic interventions for diabetes in the study period. This is 15,578 more (new) guideline-recommended treatments than the control group (p=0.0006).

Conclusion: Learners enhanced their use of guideline-recommended therapies post-education compared to carefully matched controls, demonstrating how CE can positively impact real-world medical practice.

Disclosure

R. Allen: None. L.K. Welch: None.

Funding

Novo Nordisk
575-P: Nigerian Patients with Noncommunicable Diseases Have Suboptimal Baseline Self-Efficacy Scores to Manage Chronic Diseases
Authors: EZENWAKA CHIDUM E. , TRIPARTITE RESEARCH COLLABORATION CONSORTIUM (TTRCC) THE
Published: June 2024

Introduction & Objective: Nigeria is one of the developing countries with a major burden of non-communicable diseases (NCDs) without disease self-management programme in its healthcare system. This study aimed to determine the baseline self-efficacy levels of Nigerian patients with chronic NCDs.

Methods: This is a cross-sectional study of patients with NCDs attending tertiary level clinics with full compliments of NCD healthcare professionals. Patients were interviewed on ten-Self-Efficacy questionnaires to Manage Chronic Disease (SEMCD) item scales that were appropriate for the Nigerian population. The patients were assessed under: (i) exercise regularly, (ii) help from community, family and friends, (iii) communication with physician, (iv) manage disease and (v) manage symptom self-efficacy domains. Data were analysed both descriptively and statistically using the SPSS software.

Results: The results showed that more females (59.4%) than males (40.6%) attended clinics during the 3 months study period, and the mean age of the patients did not differ between gender (p>0.05). About 40% of all the patients manage their NCDs with medications alone, a trend that is similar in male and female patients (p>0.05). While all the patients had a relatively lower self-efficacy scores under regular exercise scale (52-55%) and manage disease symptoms scale (53-55%), they tended towards higher self-efficacy scores under getting assistance from community, family, and friends (79-80%) and communication with attending physicians (81-85%).

Conclusion: Nigeria patients with NCDs at tertiary level institution clinics are less than optimal in disease self-management care. The observed sub-optimal self-efficacy levels might be a contributing factor to high premature NCD deaths in this population. It is recommended that this study population will benefit from introduction and implementation of disease self-management programme in the healthcare system.

Disclosure

C.E. Ezenwaka: None.
578-P: School-Partnered Type 1 Diabetes (T1D) Interventions—A Path to Successful Implementation
Authors: MARCH CHRISTINE , NAAME ELISSA , ALFINITO SOPHIA , RANKINE JACQUELIN , SIMINERIO LINDA M. , KAZMERSKI TRACI M. , ALBANESE-O'NEILL ANASTASIA , LYON AARON , MILLER ELIZABETH , LIBMAN INGRID
Published: June 2024

School-partnered interventions with clinical diabetes centers may help optimize child T1D health outcomes. Such interventions are under-studied and published examples are short-term with mixed benefit. We aimed to discover factors affecting implementation of T1D interventions in school to better design future programs. We conducted semi-structured interviews with school nurses (SN) in Pennsylvania (n=20) and West Virginia (n=10). Transcripts were coded by two reviewers using a consensus-driven approach. Major themes were aligned with an implementation science framework. SN represented various geographic settings (52% rural, 41% suburban, 7% urban) and years of experience (24% <5, 21% 5-10, 28% 11-20, 27% >20 years). SN from both states perceived factors to influence implementation of T1D interventions in school related to four themes. Theme 1 Motivating Factors: T1D interventions are prioritized as these students have complex medical needs and there is a dearth of available resources for school staff. Theme 2 Facilitators: Schools have existing structures which could support T1D interventions, including procedures to assemble multidisciplinary teams and expanded use of video conferencing since the pandemic. Theme 3 Challenges: Variable parent engagement and limited school health staffing may interfere with schools’ ability to participate in interventions. Theme 4 Peer Influence: Communication between school districts can influence adoption of interventions and should be considered when approaching school leaders. Differences in state policy for school health and insulin administration affected SN perceptions for who should lead interventions and funding for SN. Individual, school, and state-level factors will affect implementation of school-partnered T1D interventions. Understanding the unique systems for school health and working with key stakeholders may help tailor strategies to promote sustainable interventions in schools and improve T1D outcomes.

Disclosure

C. March: None. E. Naame: None. S. Alfinito: None. J. Rankine: None. L.M. Siminerio: Research Support; Becton, Dickinson and Company, Sanofi. Advisory Panel; embecta, Bayer Inc. T.M. Kazmerski: None. A. Albanese-O'Neill: None. A. Lyon: None. E. Miller: Other Relationship; Wolters Kluwer Health. I. Libman: None.

Funding

National Institutes of Health (K23DK135800)
58-PUB: Surrogate Markers of Impaired Glucose Tolerance among a Mexican-American Population without Diabetes
Authors: LABADAH JOSHUA , NARVAEZ GABRIEL , APAFLO JEHU N. , BAJPEYI SUDIP
Published: June 2024

Impaired glucose tolerance (IGT) is defined by an elevated 2-hour plasma glucose (≥140 and <200 mg/dL) during an oral glucose tolerance test (OGTT). IGT is a risk factor for diabetes development and is also classified as prediabetes according to ADA guidelines. Mexican-Americans have 1.9 times greater prevalence of diabetes compared to non-Hispanic Whites. The aim of this study was to identify blood markers associated with IGT in a predominantly Mexican-American population.

Methods: One hundred and fifty-two (77/75 male/female; 71.3% Mexican-Americans; age 26.89±10.05 years; BMI 27.39±5.90kg/m2) from border region of El Paso/Juarez participated in this cross-sectional study. Following an overnight fast, blood draw and OGTT was performed. Pearson correlation and unpaired T-test were used to analyze the data at a significance of 0.05α.

Results: White blood cell (WBC) (r=0.22, p=0.02), Neutrophil count (r=0.25, p=0.008), Platelets (r=0.27, p=0.003), Triglycerides (r=0.22, p=0.02), and Very low density lipoprotein (VLDL) (r=0.21, p=0.02) significantly correlated with 2-hour glucose. Following indices were also significantly elevated in IGT group compared to NBG: WBC [(NBG (5.25±1.76) x10^3/uL, IGT (5.89±1.38) x10^3/uL, p=0.046], Neutrophil count [NBG (2.80±1.19) x10^3/uL, IGT (3.33±1.26) x10^3/uL, p=0.044], Platelets [NBG (243.90±45.11) x10^3/uL, IGT (269.10±57.83, p=0.017], Triglycerides [NBG (91.04±50.39 mg/dL), IGT (119.20±62.99 mg/dL), p=0.017], VLDL [NBG (17.51±8.94), IGT (22.78±11.76), p=0.014].

Conclusion: Elevated WBC, neutrophil count, platelets, triglycerides and VLDL are indicative of IGT and are distinguished between individuals with NBG and IGT. Monitoring these surrogate markers during lifestyle modifications and interventions may contribute to the prevention of prediabetes and diabetes.

Disclosure

J. Labadah: None. G. Narvaez: None. J.N. Apaflo: None. S. Bajpeyi: None.
585-P: Development and Evaluation of "Diabetes Theater Café," a Café-Style Health Class Using Theater
Authors: OKAZAKI KENTARO
Published: June 2024

Introduction & Objective: Café-style communication between medical and non-medical personnel on health has become popular. However, there are few examples of the effectiveness of health café reported. There are also few reports on health education for residents using theatrical performances. Therefore, we chose diabetes as the theme, developed and implemented a café-type health class using theatrical performances ("diabetes theater café"), and examined its effectiveness.

Methods: Pre- and post-survey; 13 participants (residents) of a diabetes theater café held at a drugstore at Osaka, Japan, in October 2022 were asked to answer an original questionnaire (5-point Likert scale) on the theme. We used paired t-tests. The diabetes theater café was developed and implemented in a multidisciplinary collaboration of physicians, pharmacists, and theater artists. A short play based on the theme was performed by professional actors at the beginning of the program. Next, participants answered the theme (dilemma) using Yes/No cards ("You were invited for a drink by a person with whom you have a delicate distance. Do you tell them you have diabetes?). Participants were then divided into groups for a time of dialogue, at the end of the session, each group decided on one theme and created and performed a 2-minute play. Throughout the program, pharmacist and physician staff added commentary on diabetes and the subject matter as appropriate.

Results: With an introductory play, Yes/No cards, and group dialogue, participants were able to conduct the theater-style presentation without difficulty. Questionnaire surveys showed a significant increase in knowledge (mean 3.6 before to 4.3 after) and confidence (mean 2.6 before to 3.1 after) in the subject matter, as well as a high level of satisfaction (mean 4.3) with the program.

Conclusion: The results suggest the usefulness of the diabetes theater café as a method of diabetes health promotion targeting local residents through multidisciplinary cooperation.

Disclosure

K. Okazaki: Speaker's Bureau; Ono Pharmaceutical Co., Ltd.

Funding

The Sugiura Memorial Foundation
587-P: Knowledge and Attitudes about Diabetes in San Antonio
Authors: GEDALA AARAV , MADAN SHREYA , VENKATESH ARUNA
Published: June 2024

Introduction & Objective: Type 2 diabetes mellitus (T2DM) is a growing concern in San Antonio, Texas, with a prevalence rate (16%) exceeding the national average. About one in five affected individuals are unaware of their diagnosis. We aimed to assess the awareness levels of diabetes risk factors and complications within the Bexar County population.

Methods: We conducted a community-based study by administering surveys to individuals outside stores such as HEB and Walmart, as well as at a health fair where participants received complimentary health check-ups. Direct emails to complete the survey were also sent.

Results:A total of 273 individuals (Med. 42, 71% female, 44% Hispanic) completed our survey on diabetes awareness. Notably, 70.7% of respondents reported having family members with diabetes. When questioned to estimate the prevalence of diabetes or pre-diabetes in the general population over 45 years of age, 42.1% believed that 50-75% of the population had diabetes, and 44.3% estimated the figure to be between 25-50%. Approximately 81.0% perceived a higher risk of diabetes among those with a family history of the disease, but only 68.9% believed they were personally at risk. Concerning personal health practices, 80.2% of participants had previously undergone diabetes-related blood tests, and 81.3% believed in the preventability of diabetes, citing healthy eating (90.1%), regular exercise (89.1%), and weight management (71.4%) as key strategies. While a majority claimed familiarity with diabetes-related effects, 5.9% admitted a lack of awareness. Among those aware, 76.6% associated diabetes with heart disease, 76.9% with blindness, 77.3% with kidney disease, and 86.8% with limb amputation.

Conclusion: Our study, inclusive of women (70%) and minorities, revealed overestimations of diabetes prevalence. However, 80% identified family history as a risk factor, and nearly 90% recognized the importance of a healthy lifestyle. Further research should target specific demographics for public health interventions.

Disclosure

A. Gedala: None. S. Madan: None. A. Venkatesh: None.
595-P: Effect of Postprandial Sedentary Behavior Intervention on Blood Glucose Control in Patients with Type 2 Diabetes—A Randomized Controlled Trial
Authors: OSAKA TAKAFUMI , OKADA HIROSHI , FUKUI MICHIAKI
Published: June 2024

Introduction & Objective: Physical activity is crucial for optimal blood glucose control in type 2 diabetes. This study assesses the impact of postprandial sedentary behavior on blood glucose in patients with type 2 diabetes.

Methods: Twenty-six outpatient type 2 diabetes patients participated, wearing CGM (FreeStyle Libre Pro) and an accelerometer (GT3X-BT) for a 14-day observation. Baseline dietary intake was assessed. During the initial 7 days, participants followed routine activities. In the subsequent 7 days, the sedentary(SD) group was told to "sit for at least 30 minutes after meals," and the non-sedentary(nSD) group to "avoid sitting for at least 30 minutes after meals." Random assignment was disclosed on the 7th day. Primary outcome: change in mean blood glucose (Mann-Whitney U test). Secondary outcomes: changes in mean amplitude of glycemic excursions (MAGE) and within-group comparisons before and after the intervention using paired t-tests.

Results: Analysis included 23 participants (male: 14, mean age: 74.0±4.4 years, mean HbA1c: 6.9±1.0%). No group differences in activity and diet. Change in mean blood glucose was not significant between SD (-2.9±7.3 mg/dL) and nSD groups (-4.0±6.0 mg/dL) (p=0.735). However, a significant reduction was observed in mean MAGE change between the SD group (-2.2±11.1 mg/dL) and the nSD group (-12.3±12.7 mg/dL) (p=0.023). In within-group comparisons, mean blood glucose showed changes for the SD group from 151.9±31.7 to 149.0±35.6 mg/dL (p=0.097) and for the nSD group from 148.5±25.5 to 144.5±26.9 mg/dL (p=0.024). Mean MAGE values demonstrated changes within the SD group from 81.2±19.6 to 83.4±23.3 mg/dL (p=0.750) and within the nSD group from 105.0±28.0 to 92.7±22.9 mg/dL (p=0.005).

Conclusion: The directive to "avoid sitting for at least 30 minutes after meals" is a simple, effective strategy for improving blood glucose control in diabetes.

Disclosure

T. Osaka: None. H. Okada: None. M. Fukui: None.
61-PUB: Factors Associated with Pancreatic Anti-islet Antibodies in Persons with Newly Diagnosed Diabetes Mellitus
Authors: VICH PÉREZ PILAR , TAULERO-ESCALERA BELÉN , SALINERO FORT MIGUEL A. , CONSORTIUM LADA-AP
Published: June 2024

Introduction: Individuals initially diagnosed with diabetes mellitus (DM) may be positive for diabetes-associated autoantibodies (DAA+). The aim was to identify characteristics associated with DAA+ in a group of individuals with newly diagnosed DM, by comparing DAA+ individuals with their DAA-negative counterparts.

Methods: Cross sectional study of adults with DM. Data were collected on characteristics of 805 participants, including antibodies to glutamic acid decarboxylase (anti-GAD65), insulinoma-associated antigen IA-2 (IA-2A). Associated factors were assessed by multivariable logistic regression.

Results: Participants (56.6% male) had a median age of 61 years (IQR: 55-69) and a HbA1c of 7.0% (IQR: 6.5-8.2). DAA+ subjects were 7.2% (95% CI: 5.4-9.0). The variables strongest associated with DAA+ were age <50 (OR=2.33; 95% CI: 1.05-5.18), absence of arterial hypertension (OR=2.59; 95% CI: 1.23-5.47), absence of hypercholesterolaemia (OR=2.35; 95% CI: 1.22-4.52) and no family history of type 2 DM (OR=1.95; 95% CI: 1.03-3.70). Conversely, for each 5 cm increase in waist circumference, the odds of DAA+ decrease a 17.8%.

Conclusions: The proportion of DM subjects who are DAA+ is higher than in counterpart countries. Age <50 years at diagnosis, absence of arterial hypertension and hypercholesterolaemia, and absence of a family history of type 2 DM would make autoimmune DM more likely.

Disclosure

P. Vich Pérez: None. B. Taulero-Escalera: None. M.A. Salinero fort: None.

Funding

This study has been funded by Instituto de Salud Carlos III (ISCIII) through the project "PI19/01569" and co-funded by the European Union.