bluuebunny/crossref_metadata_2025 huggingface dataset:
534-P: Evaluating the Impact of a Simulation Module on Empathy Development in Nursing Students
Authors: EDSTROM GRETCHEN L.
Published: June 2023

Empathetic behaviors by nurses have been shown to improve both patient satisfaction and health outcomes. However, there has been a documented decline in empathy levels among the undergraduate population, including nursing students. For these reasons educators have sought ways to improve empathy development in nursing students. This quasi-experimental study used a pre/posttest design to evaluate the effectiveness of a simulation intervention using an expert patient (EP) with diabetes to enhance empathy in nursing students with the intention of providing a foundation in empathy development early in their nursing careers. The intervention included a prerecorded interview with an EP, a person who has diabetes for more than 30 years, presentation of five facts about diabetes and the importance of empathy, and a guided debriefing session regarding feelings for people with diabetes. The scripting for the interview was based on the Diabetes Distress Tool and reviewed by the expert panel. However, the answers provided by the EP were her own experiences, thoughts, and feelings. Batson’s Eight Components of Empathy, Kolb’s Experiential Learning Theory, and Jeffries Simulation Theory provided a theoretical foundation for the study. Demographic data related to gender, race, age, work experience in healthcare, and closeness to a person with diabetes did not show any statistically significant influence on empathy development. But, there was a documented increase in levels of empathy as measured by the Comprehensive State Empathy Scale after the teaching intervention. The paired t-test reported a significant difference between the pretest total (M = 103.7; SD = 17.98) and posttest scores (M = 110.1; SD = 21.11) t(67) = 3.23, p = 0.001, with a small to medium effect size (d = .39 95% CI [2.46 - 10.44]). The core findings of this research contribute to the scholarship of nursing education and theory-based teaching interventions by validating a successful teaching strategy for enhancing empathy in nursing students.

Disclosure

G.L.Edstrom: None.
537-P: Virtual Patient Simulation Assesses the Levels of Competency and Improves Performance of Advance Practice Providers in the Field of Diabetes and Cardiometabolic Medicine
Authors: IANCU IGAL , SHENTAL RACHEL , ZEHAVI LIRON , DRAZNIN BORIS
Published: June 2023

Introduction: A high level of medical knowledge of Advanced Practice Providers is extremely important to secure their role in the contemporary healthcare environment. Continuing Medical Education is the key element in improving their skills and level of competency.

Hypothesis: We hypothesized that a mobile and desktop VPS application that provides a self-propelled simulation of disease progression and the effects of treatments, would allow precise assessment of providers’ medical knowledge.

Methods: We used the Edocate® virtual patient simulation (VPS) platform to compare the level of competency in treating patients with type 2 diabetes and cardiovascular problems in two groups of nurse practitioners: diabetes-trained (DNP) and family medicine-trained (FNP). All participants completed the same VPS case before being asked to address a second case with similar problems, thus enabling us to assess improvement in their knowledge as well. For each case, the NPs received personalized and detailed feedback on their actions. Results: DNP were significantly more likely to achieve good glycemic control (78.6% vs. 46.8% in the FNP cohort), control of hyperlipidemia (57.1% vs. 40.0%), control of blood pressure (78.5% vs. 46.6%), and were more likely to use SGLT2i or GLP1 RA in patients with cardiovascular problems (78.4% vs. 66.7%). Both groups improved their performance markedly while working with their second patient, reaching levels of competency in key clinical areas between 83 and 100% in both groups.

Conclusion: Working with the VPS, DNP demonstrated a higher level of medical knowledge in diabetes and cardiovascular disease management than FNP. However, training with the VPS platform significantly improved the levels of competency in both groups supporting the notion that virtual simulation provides excellent tools for enhancing providers’ knowledge, critical for their real practice skills.

Disclosure

I.Iancu: None. R.Shental: None. L.Zehavi: None. B.Draznin: None.
538-P: Use of Real-Time Continuous Glucose Monitoring Supports Behavior Modification in Gestational Diabetes Mellitus—Results from an Ongoing Pilot Study
Authors: CEDENO BRIAN , FAY EMILY , EHRHARDT NICOLE M. , FONDA STEPHANIE J.
Published: June 2023

Gestational diabetes mellitus (GDM) is common, with 14% of women developing GDM. Although real-time continuous glucose monitoring (RT-CGM) has been shown to support behavioral/lifestyle modifications in patients living with type 1 and type 2 diabetes, no studies to date have assessed RT-CGM as a behavior modification tool for patients with GDM.

Participants diagnosed with GDM [prior to gestational age 24 weeks (early) or between 24-30 weeks (typical)] were randomized to use RT-CGM or continue self-monitoring of blood glucose (SMBG) using finger-sticks and wore 3 serial blinded CGM over the remainder of the pregnancy. Both groups continued their routine obstetric care. After delivery, RT-CGM participants completed a 44-question survey adapted from the Joslin Diabetes Center CGM questionnaire plus our published 8-question survey on behavior modification and CGM use.

To date, 70 participants have enrolled; 31 were randomized to RT-CGM. Twenty-four (4 early and 20 typical) have completed the post-delivery surveys. Demographics: 42% were Caucasian, 63% reported annual incomes of >$50,000, and 79% had achieved at least a bachelor’s degree. From RT-CGM use: 71% excluded or limited sugared beverages (29% never drank sugared beverages), 78% excluded or limited white rice (13% never ate white rice), 67% started reading labels for fiber content (17% of participants already read labels for fiber content), and 92% would walk or increase activity after a meal if they saw their glucose rising. Overall, 92% of participants felt like RT-CGM contributed to a healthier lifestyle during pregnancy. Sixty-three percent wanted to continue using RT-CGM.

Our study suggests that women with GDM perceive that RT-CGM supports improved lifestyle choices during pregnancy. Studies are ongoing to assess whether RT-CGM improves maternal and/or fetal outcomes, but advocacy is needed now to improve accessibility of RT-CGM in GDM.

Disclosure

B.Cedeno: None. E.Fay: None. N.M.Ehrhardt: Advisory Panel; Novo Nordisk, Dexcom, Inc., Consultant; Nestlé Health Science. S.J.Fonda: Research Support; Dexcom, Inc.

Funding

Dexcom, Inc. (IIS-2019-101)
542-P: Socio-clinical Correlations with Threat Perception and Self-Efficacy in People with T2D
Authors: HU JIANLI , CHEN SOPHIA K. , KIM SARAH , KELLY PATRICK J. , HOADLEY ARIEL , ZISMAN-ILANI YAARA , SWAVELY DEBORAH A. , BASS SARAH B. , RUBIN DANIEL J.
Published: June 2023

Interventions are needed to address health disparities among racial and ethnic minorities with type 2 diabetes (T2D).

In a novel application, the Extended Parallel Processing Model (EPPM) was used to categorize 168 adults with T2D from urban safety-net clinics and the local community by self-efficacy and perceived threat from T2D and cardiovascular disease based on validated measures. The EPPM groups were high threat (HT)/high efficacy (HE), low threat (LT)/low efficacy (LE), HT/LE, and LT/HE. Socio-clinical characteristics were compared across EPPM groups, threat level, and self-efficacy level.

HT/LE people had the lowest medication adherence and T2D management score, the highest A1C (p=0.10), and most microvascular complications relative to other EPPM groups. Gender, Race/Ethnicity, education, and health insurance did not vary by EPPM group.

HT people were younger, had lower medication adherence, more diabetic complications, more blood pressure medications, and more insulin use (p=0.08) than LT people.

LE people had lower medication adherence, lower T2D management score, and higher A1C (p=0.07) than HE people.

The EPPM is associated with clinical outcomes and self-management behaviors. This model may be useful to target people with T2D for behavioral intervention. Moving people from HT/LE to LT/HE may improve T2D management and outcomes.

Disclosure

J.Hu: None. S.K.Chen: None. S.Kim: None. P.J.Kelly: None. A.Hoadley: None. Y.Zisman-ilani: None. D.A.Swavely: None. S.B.Bass: None. D.J.Rubin: Research Support; AstraZeneca.
548-P: The Effects from Type 2 Diabetes Management Programs on Mental Health and Diabetes Distress
Authors: GLÜMER CHARLOTTE , HVIDBERG ALBERTE D. , HELGSTRAND LINE A.
Published: June 2023

Impaired mental health among patients with type 2-diabetes (T2DM) constitutes a major challenge as it has negative influence on T2DM self-management, HbA1c and complications. Inclusion of mental health issues in municipal rehabilitation is important as patients need to cope both physical, practical, and mental aspects of a life with T2DM. The aim of this study was to assess whether T2DM management program influences mental health including diabetes distress and overall wellbeing. Methods: During 2018-2021, all patients referred for T2DM management programs were invited to the study. Included patients completed a series of validated questionnaires including WHO-5, PAID-1 and PAID-5 at baseline, at end of the program and at 6 months follow-up. A total of 131 completed all three questionnaires and were included in the study. Based on a person-centered and differentiated approach to diabetes management programs, the intervention consists of teaching, physical training, cooking and/or individual conversations. Results: The study population consist of 60% men, age range primarily from 55-79, 57% have a short education level. At baseline, mean WHO-5 score was 61.6 points (IQR: 48.0-80.0). At end of rehabilitation a statistically significant increase of 4.6 points (95%CI: 1.1-7.8, p=0.003) was observed. At 6 months follow-up the WHO-5 score was leveled and unchanged when compared to baseline. According to PAID-5, 47% of included patients had diabetes distress at baseline. This was reduced to 30% and 26% at end of the program and at 6 months follow-up, respectively. Conclusion: T2DM management programs has a positive effect on mental health including general well-being and diabetes distress. Nonetheless there is still room for improvement which is why we have now initiated a project in collaboration with a research institute, aiming to improve identification of individuals and develop interventions targeting patients with moderate to high degrees of diabetes distress.

Disclosure

C.Glümer: None. A.D.Hvidberg: None. L.A.Helgstrand: None.
57-LB: The Real-World Study of 2+N System Therapy in Remission of Type 2 Diabetes
Authors: ZENG KEJING , LI HEJUN , SONG YINGYING , YANG YIN , HUANG YALI , XU GUGEN
Published: June 2023

Background: Type 2 diabetes mellitus (T2DM) has been considered as a chronic disease which requires long-term treatment with hypoglycemic drugs. However, recent clinical studies have shown that comprehensive lifestyle intervention can effectively reduce body weight and alleviate T2DM, which become a new strategy and the latest clinical practice for the treatment of T2DM.

Objective: Our team has applied the first and exclusive "2+N system therapy", (Integrated traditional Chinese and Western medicine combined with nutrition, psychology and lifestyle comprehensive interventions) to obese and type 2 diabetes patients since 2015. This study aims to summarize the real-world efficacy of 2+N system therapy in alleviating type 2 diabetes.

Method: The clinical data of 1086 patients with T2DM who were treated with 2+N systematic therapy in the Second People's Hospital of Guangdong Province from 2015 to 2022 were analyzed by self-control method, and the clinical data of patients before and after treatment (3 and 6 month) were observed. Results: After 3 months of 2+N system therapy intervention, body weight, BMI, waist circumference, hip circumference, HbA1c, lipid indexes (TC, TG, LDL-c), uric acid, HOMA-IR, area under OGTT curve were all decreased (P<0.05). The area under the curve of HDL-c, HOMA-β were increased (P<0.05). After 6 months, the metabolic indexes were further improved, the body weight and BMI were decreased by (9.18±4.33)kg and (3.22±1.45)kg/m2, respectively, and T2DM remission rate reached to 88.4%. MR analysis further showed that the liver and pancrease fat deposit rate both were decreased. Conclusions: In T2DM patients, 2+N system therapy can effectively reduce body weight, improve metabolic indexes and β cell function, and finally achieve T2DM remission.

Disclosure

K. Zeng: None. H. Li: None. Y. Song: None. Y. Yang: None. Y. Huang: None. G. Xu: None.

Funding

National Natural Science Foundation of China (81902004, 52203206); Natural Science Foundation of Guangdong Province (2023.1.1-2025.12.31 to K.Z.)
572-P: Transition Survey of Adult Diabetes Education Centers in Ontario, Canada
Authors: VARGHESE AKSHAY , ALCAIDE AMANDA , LAPIER HEATHER V.M. , YANG SABRINA , SPAIC TAMARA
Published: June 2023

Young adults with type 1 diabetes face many physiological and psychological issues in adolescence, which negatively impact glycemic control and long-term health outcomes. Dedicated transition programs facilitating the transition from pediatric to adult care have shown favourable outcomes with regards to clinic follow-up, glycemic control, and diabetes-related complications. In Ontario, Canada, it is unclear how transition programs are implemented given the lack of formal processes. Our study surveyed adult diabetes education centers in Ontario with the goal of identifying current availability and characteristics of various transitional programs, while exploring perspectives on transitional practices, clinical experiences, and barriers. There were 53 (20.2%) diabetes education centers that participated in our survey. Majority respondents were females (n=50, 94%), between age 40-50 years (n=21, 40%), identifying as a nurse or dietitian (n=35, 66%), working in a community setting (n=43, 81%). Only 25% (n=13) of respondents identified a transition program in their center, however 30.2% (n=16) provided care to both pediatric and adult patients. Where no transition programs were available, the main reason was low perceived importance and/or need (n=22, 41.5%). A lack of guidelines on what program to adopt in addition to lack of personnel and financial resources were the main barriers reported. Where transition programs were available they included education materials (n=9, 17%) and a joint clinic between pediatric and adult care (n=5, 9.4%). Only 5.7% (n=3) respondents identified a designated transitional coordinator. Almost a third of respondents (n=15, 28.3%) noted that the most common referral method was from the emergency room or following a hospitalization, rather than from a pediatric-based program (n=9, 17%). Despite a greater awareness of transition issues over the last decade, the use of structured transition programs requires further improvement across the province of Ontario, Canada.

Disclosure

A.Varghese: None. A.Alcaide: None. H.V.M.Lapier: None. S.Yang: None. T.Spaic: Advisory Panel; Sanofi, Research Support; Novo Nordisk, Lilly, Speaker's Bureau; Dexcom, Inc.
574-P: A Ketogenic Diet Improves Aerobic Capacity in Hyperglycemic Mice by Sex-Dependent Mechanisms
Authors: PATTAMAPRAPANONT PATTARAWAN , FORMATO MIA , NOGUEIRA SOARES ROGERIO , LESSARD SARAH J.
Published: June 2023

Hyperglycemia is associated with lower aerobic exercise capacity (VO2peak) in humans and rodent models. We tested whether reducing blood glucose levels with a dietary intervention can restore VO2peak in hyperglycemic mice. Male and female CD-1 mice were injected with low dose streptozotocin (STZ) to induce moderate hyperglycemia (>200 mg/dL). Hyperglycemic mice were randomized to receive a standard diet (STZ-CHOW) or a ketogenic diet (STZ-KETO). KETO significantly reduced blood glucose in STZ-treated mice. Next, both groups underwent similar volumes of exercise training by voluntary wheel running, or remained sedentary for 8 wks. In males, VO2peak during maximal exercise testing was similar in sedentary mice, regardless of diet. However, with training, VO2peak was significantly improved in STZ-KETO, but not STZ-CHOW males (see Figure). In females, KETO significantly increased VO2peak in sedentary mice, with no additional increase in response to training. Improved VO2peak with KETO in females was associated with a 50% increase in skeletal muscle mitochondrial ATP synthase protein. In contrast, ATP synthase was not regulated by diet in males. Our data demonstrate that a ketogenic diet can improve VO2peak in mice with hyperglycemia. In males, improved VO2peak with KETO was exercise-dependent, while in females, the beneficial effects of KETO on VO2peak and mitochondrial content were exercise-independent.

Disclosure

P.Pattamaprapanont: None. M.Formato: None. R.Nogueira soares: None. S.J.Lessard: None.
586-P: Light Physical Activity Prevents the Progression of Diabetic Nephropathy in Patients with Type 2 Diabetes
Authors: OSAKA TAKAFUMI , OKADA HIROSHI , FUKUI MICHIAKI
Published: June 2023

Background and aim: Diabetic nephropathy is one of the most important complications of diabetes mellitus. In recent years, aerobic exercise has been reported to be potentially effective in preventing nephropathy. However, the relationship with light physical activity (LPA), activities of daily living, is not clear. In this study, we researched the effect of LPA assessed by tri-axial acceleration sensors on the progression of nephropathy in patients with type 2 diabetes

Materials and methods: We analyzed retrospectively the cohort study of type 2 diabetic patients (T2DM) with urinary albumin-to-creatinine ratio (UACR) under 300 mg/gCr who visited Ayabe City Hospital from April 2018 to March 2020 and were observed until May 2022. The progression of nephropathy was defined as an increase in the category of diabetic nephropathy. LPA time was measured using a tri-axial accelerometer ActiGraph GT3X-BT instructed to use the accelerometer for 7 days, except while bathing and sleeping. LPA was defined as 100-1,952 counts per min. Hazard ratio of LPA for the progression of nephropathy was calculated by Cox hazard model after adjusting by age, gender, BMI, hemoglobin A1c (HbA1c), smoking states, alcohol consumption, use of renin-angiotensin system inhibitor at baseline.

Results: 167 patients (109 men) including 132 with stage1 and 35 with stage 2, mean age, body mass index, HbA1c, UACR, LPA and median observation period were 72.1 ± 12.3 years, 23.4 ± 3.4 kg/m2, 7.6 ± 0.9 %, 56.8 ± 137.4 mg/gCr, 305.6 ± 85.5 minutes/day and 1246 (406-1283) days. During follow-up, progression of nephropathy was observed in 39.5 % (66/167). The adjusted hazard ratio of LPA per 1 hour of progression of nephropathy was 0.81 (95% confidence interval 0.67-0.98, P = 0.031).

Conclusion: Patients with T2DM with low LPA were shown to be at higher risk of developing diabetic nephropathy. This suggests that increasing activities of daily living in patients with T2DM is important in terms of preventing diabetic nephropathy.

Disclosure

T.Osaka: None. H.Okada: None. M.Fukui: None.
592-P: Exercise Training and a Chow Diet Improve High-Fat Diet (HFD)–Induced Metabolic Disorders via Different Pathways in Female Mice
Authors: ZHU LIN , AN JULIA , LITTS BRIDGET , ATZRODT CASSANDRA L. , STAFFORD JOHN M.
Published: June 2023

Understanding the mechanism by which healthy diet or exercise training improves metabolic outcomes is crucial to developing therapeutic targets for obesity-associated diseases. In this study, female mice were fed a high-fat diet (HFD) for 12 weeks and divided into 4 groups of lifestyle interventions that followed for 6 weeks: a. HFD; b. diet-change to chow; c. HFD+exercise; d. diet-change+exercise. Age-matched mice continuously fed a chow diet served as controls. An oral glucose tolerance test was performed 48 hours after the final exercise session. HFD induced obesity, dyslipidemia, fatty liver, and impaired glucose tolerance, which were completely reversed by diet-change. Exercise alone did not change obesity but partially improved glucose tolerance and fatty liver. The increased daily energy intake caused by HFD feeding was corrected by diet-change while exercise alone increased the energy expenditure and decreased RQ. Western blotting showed that HFD decreased pAKT, pAMPKβ, Glut4, and proteins involved in β-oxidation pathways in skeletal muscles compared to controls, which was reversed by diet-change alone. Exercise training alone partially reversed pAKT and Glut4 but significantly increased proteins in β-oxidation pathways compared to controls and the diet-change group. Exercise and diet-change in combination improved metabolic outcomes similarly to diet-change alone. RNAseq of visceral adipose tissue showed that HFD modified multiple canonical pathways. Among those pathways, 1) Ca+, G-protein coupled receptor, and hepatic fibrosis signaling were reversed by diet-change and exercise training alone; 2) cAMP-mediated and ILK signaling were reversed by diet-change alone; and 3) PKA signaling was reversed by exercise training alone. Further analysis of those pathways showed several genes that were modified by HFD and reversed by all three lifestyle interventions, which could be potentially targeted for improving metabolic diseases.

Disclosure

L.Zhu: None. J.An: None. B.Litts: None. C.L.Atzrodt: None. J.M.Stafford: None.

Funding

National Institutes of Health (DK109102, HL144846, AG077038); U.S. Department of Veterans Affairs (BX005459-01)
597-P: Effects of Exercise Interventions on Blood HbA1c and Lipid Concentrations in Healthy Pregnant Women—The FitMum RCT
Authors: JENSEN IDA K.B. , ROLAND CAROLINE B. , KNUDSEN SIGNE P. , JESSEN ANNE D. , ALOMAIRAH SAUD A. , MORTENSEN OLE H. , FRIIS-HANSEN LENNART J. , BENDIX JANE M. , MOLSTED STIG , STALLKNECHT BENTE , CLAUSEN TINE D. , LØKKEGAARD ELLEN
Published: June 2023

Concentrations of maternal glucose and lipid during pregnancy affect both fetal growth and the risk of pregnancy complications. The aim of this study was to investigate the effect of two different exercise interventions on maternal blood HbA1c and lipid concentrations. Healthy pregnant women (n=219) were enrolled in the study at gestational age ≤15+0 weeks and randomized 2:2:1 to supervised exercise sessions three times per week, to a motivational group having seven counselling sessions on physical activity, or to standard care. Venous blood samples were drawn at 6+4 to 15+0 weeks, at 28+0-6 weeks, at 34+0-6 weeks and at delivery. HbA1c, total cholesterol, LDL-C and triglyceride concentrations were measured by standard biochemical methods and compared within and between groups using constrained linear mixed models. No differences in HbA1c or lipid concentrations between the groups were detected (Figure 1). Overall, HbA1c decreased from ≤15+0 to 28+0-6 weeks (p<0.001) and increased from ≤15+0 to 34+0-6 weeks (p=0.032). Overall, total cholesterol, LDL-C and triglyceride concentrations increased throughout pregnancy (all p<0.001 for ≤15+0 weeks vs. 28+0-6 weeks, 34+0-6 weeks and delivery). Exercise interventions did not affect maternal HbA1c or lipid concentrations during pregnancy. The overall pattern of changes during pregnancy resembled findings from previous studies.

Disclosure

I.K.B.Jensen: None. B.Stallknecht: None. T.D.Clausen: None. E.Løkkegaard: None. C.B.Roland: None. S.P.Knudsen: None. A.D.Jessen: None. S.A.Alomairah: None. O.H.Mortensen: None. L.J.Friis-hansen: None. J.M.Bendix: None. S.Molsted: None.
60-LB: Social Media as a Last Resort—Barriers to Accessing Diabetes Medications and Supplies
Authors: HAREL SHIRAZ , WILCOX ANNABELLE , LUKASIK JAMES , SUTTIRATANA SAKINAH C. , LIPSKA KASIA J. , WEINZIMER STUART A. , GUJRAL JASMINE , NALLY LAURA M.
Published: June 2023

Introduction: To address the rising costs of insulin and diabetes supplies, many people with diabetes (PWD) have sought support from social media (SM). We describe the impact on and individual experiences of PWD who have reached out to SM for diabetes medications and supplies.

Methods: We conducted a qualitative cross-sectional descriptive study of PWD or their caregivers who have used SM to obtain diabetes medications and/or supplies. Participants (18+ yrs) were recruited through SM by self-reported use of SM to obtain diabetes support. Interviews were transcribed, coded, and emerging patterns were combined into descriptive content categories. Analyses were conducted using a consensus model approach.

Results: Thirty individuals (27+/- 8 yrs, 87% F, 63% NHW) were interviewed, including 5 caregivers of PWD. Five main themes emerged from the data (Table). Health insurance and affordability were the most commonly reported barriers. Most respondents changed their diabetes management (e.g. rationed) as a result, and financial and medical consequences were common.. All interviewees reported fear for their or their child’s health and safety.

Conclusion: This study describes broad barriers to accessing diabetes medications and supplies, leading to potentially harmful compensatory behaviors and psychological distress. Healthcare reform is needed to improve access to these lifesaving medications and supplies.

Disclosure

S. Harel: None. A. Wilcox: None. J. Lukasik: None. S. C. Suttiratana: None. K. J. Lipska: Other Relationship; UpToDate. S. A. Weinzimer: Consultant; Zealand Pharma A/S, Other Relationship; Abbott Diabetes, Zealand Pharma A/S, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc. J. Gujral: None. L. M. Nally: Research Support; Novo Nordisk, Medtronic, Dexcom, Inc.

Funding

None
604-P: Effects of the OPTIFAST (OP) Total and Partial Meal Replacement Program (MRP) on Weight and Glycemic Outcomes in Adults with Normoglycemia (NG) or Dysglycemia—Exploratory Analysis of the OPTIWIN Study
Authors: ROTHBERG AMY E. , ARD JAMY D. , DAR MOAHAD , LOPER JUDY , HAWKINSON ANDREA H. , COHEN SARAH S. , ERIK JOHANSEN ODD
Published: June 2023

Weight loss improves glycemia. We performed exploratory analysis of an RCT using the OP (n=135) MRP vs food-based (FB) diet (n=138), that showed significant weight loss at week (W) 26 (reduction phase) and W52 (maintenance), to evaluate potential differential glycemic/weight effects by glycemic status (NG: no type 2 diabetes [T2D], HbA1c < 5.7%, and FPG < 100 mg/dL, or dysglycemia: prediabetes or T2D). We assessed changes in anthropometrics and glycemia using a linear and logistic (Odds Ratio [OR]) mixed effects model. Baseline (BL) characteristics were similar within the OP/FB subgroups, but the NG (n=134) vs dysglycemia (n=139) group were slightly younger (mean age 44/50 yrs) and had a lower HbA1c (5.4/6.1%). FPG and HbA1c decreased at W26 within both groups (Table), with a differential effect for FPG favoring OP in those with NG. At W52, the pattern was similar, but with smaller reductions. Weight loss was numerically greater with OP vs FB in those with dysglycemia vs NG at both W26 and W52; ORweight loss ≥10% W26: 5.80 (2.62, 12.86), p<0.0001 vs NG: 3.36 (1.58, 7.15), p=0.002; ORweight loss ≥10% W52: 4.26 (1.85, 9.83), p=0.001 vs NG: 2.08 (0.97, 4.47), p=0.06). Although both groups significantly lost weight, those with dysglycemia at BL had greater weight loss and the higher protein content in the OP MRP may play a role.

Disclosure

A.E.Rothberg: None. J.D.Ard: Advisory Panel; Novo Nordisk, Consultant; Eli Lilly and Company, Intuitive Surgical, Regeneron, Other Relationship; Optum Labs, Weight Watchers International, Research Support; Nestlé Health Science, Boehringer Ingelheim Inc., Epitomee, KVK Tech. M.Dar: None. J.Loper: Advisory Panel; Nestlé Health Science. A.H.Hawkinson: Employee; Nestlé Health Science. S.S.Cohen: Consultant; Nestlé Health Science. O.Johansen: Employee; Nestlé Health Science.

Funding

Nestlé Health Science
609-P: Postprandial GLP-1 Response to Two Diabetes-Specific Formulas Compared with Instant Oatmeal in Adults With Type 2 Diabetes
Authors: THOMAS SARA , BESECKER BETH , CHOE YONG
Published: June 2023

Diabetes specific formulas (DSFs) are designed with an optimized macronutrient profile as a meal or snack replacement to meet the nutritional needs of people with diabetes while helping to manage blood glucose response. Macronutrients found in DSFs have been shown to promote glucagon-like peptide-1 (GLP-1) secretion, a key hormone involved in regulating incretin response to manage blood glucose levels during the postprandial period. We tested the postprandial GLP-1 response in two randomized, controlled crossover studies in adults with T2D with two DSFs (DSF-1; Study 1, DSF-2; Study 2) varying in macronutrient composition compared to isocaloric instant oatmeal (IOM). In each study, participants were randomly allocated to receive IOM or the study DSF on two test days separated by 4 - 14 days. Total GLP-1 concentration was measured at baseline, 15, 30, 45, 60, 90, 120, 180, and 240 minutes after consumption. Outcome parameters included adjusted peak GLP-1 concentration, and positive area under the curve (pAUC) over 0 - 240 minutes for each participant. Respectively, Study 1 and Study 2 included 26 (n = 15 males, n = 11 females; mean age = 63.6 ± 1.4 years; mean BMI = 30.0 ± 0.9) and 22 (n = 14 males, n = 8 females; mean age = 64.6 ± 2.0 years; BMI = 32.8 ± 0.9) completed participants. Median (1st and 3rd quartile) adjusted peak GLP-1 concentration was significantly higher for DSF-1 (9.2 (6.4, 16.5) pmol/L vs. 3.7 (2.5, 9.0) pmol/L; p = 0.012) and DSF-2 (10.8 (7.5, 20.0) pmol/L vs. 6.3 (4.3, 9.4) pmol/L; p < 0.001) compared to IOM. DSFs significantly increased pAUC for GLP-1 response (DSF-1: 901 (410, 1091) vs. IOM: 177 (47, 421); p <0.001 and DSF-2: 1122 (682, 1820) vs. IOM: 403 (183, 778); p < 0.001) by 410% and 178%, respectively. As part of a diabetes management plan, DSFs can serve as a convenient tool to meet nutritional needs while improving GLP-1 response to help manage blood glucose.

Disclosure

S.Thomas: Employee; Abbott Nutrition. B.Besecker: Employee; Abbott Nutrition, Stock/Shareholder; Abbott Nutrition. Y.Choe: Employee; Abbott Nutrition.
61-LB: Blood Pressure and Lipid-Lowering Medication Adherence in Young Adults with Youth-Onset Type 2 Diabetes and Hypertension or Dyslipidemia—The TODAY2 iCount Study
Authors: TRIEF PAULA M. , WEINSTOCK RUTH S. , BURKE BRIAN K. , WEN HUI , KALICHMAN SETH , BULGER JANE D. , ANDERSON-THOMAS BARBARA J.
Published: June 2023

Youth-onset type 2 diabetes (T2D) is associated with early development of vascular complications. Treatment of hypertension and dyslipidemia are critical to reduce morbidity. iCount examined adherence to blood pressure (BP) and lipid-lowering medications in young adults with youth-onset T2D (mean age 26 y, duration of T2D 12 y, BMI 37 kg/m2) and hypertension/nephropathy (n=196) or dyslipidemia (n=146) during the observational phase of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY)2 study (2017-2019). They were receiving diabetes care in their communities. Adherence was assessed with 3 monthly unannounced phone pill counts at 2 times 1 year apart. Percent low adherent (<80% pill-taking) and high-adherent (≥80% pill-taking) did not change over time. Of participants with hypertension and/or nephropathy, 80.1% were low adherent, 19.9% were high adherent. Those who were low adherent had fewer years of education (p=0.004), higher HbA1c (p=0.001) and shorter diabetes duration (p=0.031). Of those with dyslipidemia, 93.8% were low adherent, 6.2% high adherent. Those low adherent to BP (p<0.001) and lipid-lowering (p≤0.008) medications were also low adherent to oral hypoglycemic medications or insulin. Beliefs that medications are necessary were lower for those low adherent to BP and lipid-lowering medications (unadjusted analyses); concerns about medications also were lower for those low adherent to lipid-lowering medications. In adjusted multivariable analyses of participants with hypertension or nephropathy, having ≥1 material need insecurity predicted medication adherence 1 year later (p=0.010). Belief about medicines, diabetes distress, self-efficacy, depressive and anxiety symptoms, and self-management support were not 1 yr predictors of medication adherence. To prevent early vascular events, approaches that further identify and address unmet needs should be studied.

Disclosure

P. M. Trief: None. R. S. Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc. B. K. Burke: None. H. Wen: None. S. Kalichman: None. J. D. Bulger: None. B. J. Anderson-thomas: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110456)
611-P: Direct and Indirect Pathways between Food Insecurity and Glycemic Control in Adults with Diabetes
Authors: WALKER REBEKAH J. , AMJAD RABIA , EGEDE LEONARD E.
Published: June 2023

Background: Extensive research has identified food insecurity as a driver of poor glycemic control in adults with diabetes. The goal of this study was to investigate the direct and indirect relationships between food insecurity and glycemic control, focusing on three possible pathways: body composition, anthropometrics, and healthy eating.

Methods: Using national US data collected through the 2011-2018 National Health and Nutrition Examination Survey (NHANES), we created measures for body composition (total fat, total lean, fat mass index, lean mass index), anthropometrics (body mass index, waist circumference) and healthy eating index (food group component scores and overall HEI score). Food insecurity was scored based on the standard USDA scale, glycemic control was continuous HbA1c, and diabetes was based on self-report. Structural equation modeling using Stata v17 was used to investigate direct and indirect relationships in a sample of adults with diabetes. Total lean, waist circumference, and overall HEI score served as indicators for each of the three possible pathways based on preliminary correlations that found these as the strongest relationships for each category.

Results: The final model was well fit (RMSEA=0.00, CFI=1.0, pclose 1.0) and showed higher food insecurity was directly associated with higher HbA1c (B=0.09, p<0.001) and indirectly associated through waist circumference and HEI score (B=0.008, p<0.001) in adults with diabetes. Food insecurity was significantly associated with higher waist circumference (B=0.07, p<0.001) and lower healthy eating (B=−0.09, p<0.05). Higher waist circumference (B=0.03, p<0.001) and lower healthy eating (B=−.06, p<0.05) were significantly associated with higher HbA1c. Body composition was not a significant pathway.

Conclusions: Waist circumference and overall healthy eating index are significant pathways through which food insecurity is associated with worse glycemic control in adults with diabetes.

Disclosure

R.J.Walker: None. R.Amjad: None. L.E.Egede: None.

Funding

National Institutes of Health (R01DK118038, R01DK120861, R01MD013826)
616-P: Glucose Metabolism—Does Chronotype Matter?
Authors: DE AMICIS RAMONA , FOPPIANI ANDREA , LEONE ALESSANDRO , GALASSO LETIZIA , MONTARULI ANGELA , ROVEDA ELIANA , CASTELLI LUCIA , ESPOSITO FABIO , BERTOLI SIMONA , BATTEZZATI ALBERTO
Published: June 2023

Glucose and insulin follow circadian-mediated metabolic profiles. Accumulating evidence has demonstrated significant associations between circadian disruption-related lifestyles and an increased risk of type 2 diabetes typical of Evening-types (E-types), more active in the last part of the day, compared to Morning-types (M-types). However, few studies have examined the contribution of chronotype to abnormalities of glucose profile considering both lifestyle factors and body composition. We conducted a cross-sectional study on 575 adults (71% females, 48.5±12.8 years, BMI 29.3±6.0 kg/m2) with no endocrine diseases and no consumption of medications affecting endocrine function. Chronotype was assessed through the reduced Morningness-Eveningness Questionnaire (rMEQ), glycemia, insulinemia and HbA1c plasma levels HOMA-IR were estimated. Anthropometric parameters were collected and abdominal fat distribution was measured by ultrasonography. Smoking and physical activity habits were collected by a medical history and adherence to Mediterranean diet was assessed by MEDAS questionnaire. Logistic regression models were used to investigate the association between glycemia, insulinemia and chronotype. Sex, age, BMI, total body fat, visceral and subcutaneous fat, physical activity, smoking habits and MEDAS were included in all models. Insulin levels were significantly higher in the E-Types compared to M-Types. We did not find a significant interaction between chronotype, glycemia and HbA1c, however insulin and HOMA-IR decreased with increasing rMEQ score and morningness, indicating that E-Types have +5,6 and +1,4 points of insulinemia and HOMA-IR, respectively, compared to M-Types (β=−0.28 [−0.5; −0.1], p=0.003; β=−0.07 [−0,12; −0,02], p=0.005). Chronotype is independently associated with abnormalities in insulin profile, pointing to the importance of understanding the mechanisms underlying the impact of circadian disruption on glucose metabolism, which may contribute to improved glycemic control.

Disclosure

R.De amicis: None. A.Battezzati: None. A.Foppiani: None. A.Leone: None. L.Galasso: None. A.Montaruli: None. E.Roveda: None. L.Castelli: None. F.Esposito: None. S.Bertoli: None.

Funding

Italian National Recovery and Resilience Plan Mission 4 Component 2 Investment 1.3 - Call for Proposals (341) of 15 March 2022 of Italian Ministry of University and Research funded by the European Union - NextGenerationEU (PE00000003) Concession Decree (1550) of 11 October 2022 adopted by the Italian Ministry of University and Research (CUP D93C22000890001)
617-P: Time in Range following Mealtime Protein Supplementation Is Predicted by Liver Health and ß-Cell Function in Adults with Type 2 Diabetes
Authors: SMITH KIERAN , TAYLOR GUY , WALKER MARK , BOWDEN DAVIES KELLY A. , STEVENSON EMMA J. , WEST DANIEL J.
Published: June 2023

Background: Consuming mealtime whey protein supplementation increases daily time in euglycemic range [TIR] in adults with type 2 diabetes [T2D] with inter-individual responses. The present post-hoc analysis aimed to identify metabolic predictors to the effectiveness of pre-meal whey protein.

Methods: In a randomized-crossover design, 16 individuals with T2D [HbA1c 57±9 mmol/mol) underwent two 7d free-living periods where they consumed a whey protein (15g) or placebo beverage before each main meal. Glucose control was captured by blinded continuous glucose monitoring. Patient anthropometric and fasting markers of liver health and glucose metabolism were obtained at baseline. β-cell function was determined by the ratio of the incremental changes in insulin secretion to glucose during a feeding test. The relationship between TIR and clinical markers were analyzed by correlational analysis, and predictors of TIR were determined by multiple regression.

Results: β-cell function was a strong determinant to TIR during both the whey (rs=0.615; p=0.011) and placebo (rs=0.598; p=0.019) weeks. Around 76% of the variance in TIR during the whey week was accounted by β-cell function, and fasting insulin and alanine aminotransferase concentrations (adj R2=0.760; p<0.001). During the whey intervention, TIR was inversely associated with aspartate aminotransferase (rs=−0.506; p=0.046) and tended to be related to fasting glucagon (rs=−0.482; p=0.058), whereas there were no associations between liver health or fasting hormonal markers with TIR during placebo (p>0.05).

Conclusions: In a small cohort of people with T2D, our data indicates that those with compromised liver health and reduced β-cell function may experience a reduction in TIR when consuming mealtime protein supplementation. This is possibly due to disruptions in the liver-α-cell axis, which may be further aggravated by increasing plasma amino acid availability from protein supplementation.

Disclosure

K.Smith: None. G.Taylor: None. M.Walker: None. K.A.Bowden davies: None. E.J.Stevenson: None. D.J.West: None.

Funding

Francis James Bell Endowment Fund; County Durham Community Foundation
619-P: An Isocaloric High Saturated Fat Diet Increases Endogenous Cholesterol Production Which Is Reversed by a Protein-Enriched Diet in Normal-Weight Humans
Authors: KRUSE MICHAEL , MATYSIK SILKE , HOFFMANN DANIELA , FRAHNOW TURID , PFEIFFER ANDREAS F.
Published: June 2023

Lathosterol is a marker of endogenous cholesterol synthesis whereas plant sterols (e. g. campesterol) reflect cholesterol absorption. Obesity and type 2 diabetes mellitus are associated with increased endogenous cholesterol production and decreased cholesterol absorption. Only few studies evaluated cholesterol homeostasis under isocaloric nutritional conditions. This study investigated endogenous cholesterol production in healthy humans after consumption of isocaloric diets enriched with carbohydrates (KH) or saturated fat (HF) or protein (HP). 24 normal weight participants (women and men, age 18 - 70) were investigated for 18 weeks. An isocaloric diet rich in carbohydrates (55% carbohydrates, 30% fat, 15% protein, KH) was applied followed by an isocaloric diet rich in saturated fat (40% carbohydrates, 45% fat, 15% protein, HF) and finally followed by an isocaloric diet enriched with proteins (45% carbohydrates, 30% fat, 25% protein, HP); each for 6 weeks. Body weight (BW), serum total and LDL cholesterol and serum lathosterol and campesterol levels were analyzed after the KH period, after one week (HF1) and 6 weeks (HF6) of the HF and after the HP period. BW did not change during the study. Serum total and LDL cholesterol increased from 4.38±0.2 and 2.74±0.2 mmol/L, respectively at KH to 4.82±0.2 and 2.97±0.2 mmol/L, respectively at HF6 (both P<0.01) and were decreased back to KH levels at HP. Serum lathosterol levels increased 1.26-fold and 1.16-fold, respectively at HF1 and HF6 (P<0.05 compared to LF), however decreased by 10.1% at HP (compared to KH levels, P<0.05). Serum campesterol levels moderately decreased at HF1 and HF6 and were restored to KH levels at HP (P<0.01 compared to HF6). These data show that composition of macronutrients are responsible for diet induced elevation of serum cholesterol levels due to an increased endogenous cholesterol production in normal weight humans regardless of the energy content of the diet.

Disclosure

M.Kruse: None. S.Matysik: None. D.Hoffmann: None. T.Frahnow: None. A.F.Pfeiffer: Advisory Panel; Abbott Diabetes, Speaker's Bureau; Novo Nordisk, Sanofi-Aventis Deutschland GmbH.

Funding

German Federal Ministry of Education and Research (0315424)
62-OR: Six Months Experience on Meal Announcement with Three Personalized Presets of Carbohydrates vs. Precise Carbohydrate Counting in Adolescents with Type 1 Diabetes Using the MiniMed 780G System
Authors: PETROVSKI GORAN , CAMPBELL JUDITH , HUSSAIN KHALID , PASHA MAHEEN F. , DIABETES GROUP SIDRA
Published: June 2023

Objective: To compare six months glycemic control in adolescents with Type 1 Diabetes (T1D) on MiniMed 780G system that used simplified meal announcement to those that used precise carbohydrate counting.

Research Design and Methods: 34 participants (12-18 years) with T1D that initiated MiniMed 780G system were randomly assigned to the Fix group (simplified meal announcement by preset of 3 personalized fixed carbohydrate amounts) or the Flex group (precise carbohydrate counting). After 3 months, participants in Fix group could choose to continue with the same regimen, or to switch to precise carbohydrate counting. HbA1c, Time in Ranges, insulin and sensor data were analyzed after 3 and 6 months.

Results: TIR was 73.5±6.7% in the Fix and 80.3±7.4% in the Flex group (p=0.043) at 3 months. 88% of participants (n=15) in Fix group continued to use same regime for the additional 3 months (TIR of 72.7±7.8% in Fix group and 79.4±6.9 in Flex group, p=0.006). HbA1c below 7% was achieved in both groups, without a group difference during the study.

Conclusion: Adolescents on the MiniMed 780G system using simplified meal announcement can reach and maintain international targets of glycemic control. This method may be a valuable alternative to precise carbohydrate counting in users, challenged by precise carbohydrate counting.

Disclosure

G.Petrovski: None. J.Campbell: None. K.Hussain: None. M.F.Pasha: None. Sidra diabetes group: n/a.
621-P: Subphenotyping of Type 2 Diabetes Based on Pathophysiology and Its Association with Diabetes Remission in Urban Indians
Authors: TRIPATHI PRAMOD , VYAWAHARE ANAGHA R. , KADAM NIDHI S. , SHARMA BABY , GANLA MALHAR H. , DAS BISWAS MAYURIKA , SABOO BANSHI D.
Published: June 2023

Background and Aim: Sub-classification of type 2 diabetes (T2D) based on pathophysiological abnormalities is documented to facilitate better T2D management. Aim of the study was to classify 270 Indian patients with recently diagnosed T2D based on phenotype and the impact of each phenotype on the rate of remission, after a structured diabetes remission program.

Methods: We retrospectively extracted and analyzed baseline data of patients with T2D (diagnosed as per WHO criteria) enrolled for a one-year diabetes management program at the Freedom from Diabetes Clinic, India. Inclusion criteria included a recent diagnosis of T2D (<2 years). Using the homeostatic assessment model, patients were categorized into 3 sub-phenotypes: insulinopenic (high insulin sensitivity (IS) and low beta cell function (BCF)), classical (low IS and low BCF), and hyperinsulinemic (low IS and high BCF) T2D. Post-intervention, remission was defined as maintaining HbA1c<48 mmol/mol without the use of glucose-lowering medications for at least 3 months.

Results: Of the 270 patients, the majority were hyperinsulinemic (35.9%) followed by insulinopenic 17.4% and classical (13.3%) T2D. Additionally, a novel category of patients with both high IS and high BCF was observed (labeled ‘Unclassified’-33%). Hyperinsulinemic patients had the highest BMI (median 28 kg/m2), dyslipidemia, hypertension, and history of heart disease with the lowest remission rate (14.4%). One in four classical patients was on oral hypoglycemic agents and showed poor glycemic control but 25% remission. Unclassified patients showed the highest remission (28.1%).

Conclusion: Pathophysiological sub-phenotyping could assist caregivers in better management of T2D through targeted treatment options. Remission rates were observed to be better in classical and unclassified (high insulin sensitivity and beta function) T2D. Further large-scale studies to understand the unclassified group are warranted.

Disclosure

P.Tripathi: Board Member; Freedom from Diabetes Clinic. A.R.Vyawahare: Research Support; Freedom From Diabetes. N.S.Kadam: Research Support; Freedom from Diabetes Clinic. B.Sharma: Research Support; Freedom From Diabetes clinic. M.H.Ganla: Employee; Freedom from Diabetes Clinic. M.Das biswas: Employee; Freedom from Diabetes Clinic. B.D.Saboo: None.