bluuebunny/crossref_metadata_2025 huggingface dataset:
45-PUB: Persistent Performance Improvement Using Interdisciplinary Resources and Continuous Glucose Monitoring in Patients with Poorly Controlled Type 2 Diabetes
Authors: BEHNKE ANDREW , REDDY VARSHA , LUCAS KARA , ORLOWSKI MICHELLE
Published: June 2024

Aims: The purpose of this study was to examine the effects of a pharmacist managed monitoring and interaction program using continuous glucose monitoring in a population of poorly controlled (A1C >10 %) patients with type 2 diabetes.

Methods: This study was conducted in the outpatient clinical setting and examined levels of Time in Range and A1C for 12 patients with poorly controlled type 2 diabetes as indicated by an A1C level of greater than 10%. The intervention included use of a continuous glucose monitor (CGM) and weekly interactions either virtually or by telephone by one of the team members.

Results: After 13 weeks, the average A1C levels reduced from 11.47% to 7.7% (p<001). Over 90% of the subjects achieved an A1C of less than 10%. After 26 weeks, the average A1C was 8.18% (p =0.01). Time in Range increased from 36.5 % initially to 60% at three months and 56% at six months. There were no significant changes in the amount of insulin dose.

Conclusions: The combination of continuous glucose monitoring and frequent interaction in a brief (three months) time frame may be a significant tool to improve glucose control up to 6 months in this high-risk population.

Disclosure

A. Behnke: Research Support; Abbott. V. Reddy: None. K. Lucas: None. M. Orlowski: None.

Funding

Abbott (15130167v1)
452-P: Folic Acid on Homocysteine Levels in Type 2 Diabetes Patients—Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: MOKGALABONI KABELO O.S. , PHOSWA WENDY N. , MASHABA RENEILWE G.
Published: June 2024

Introduction and objectives: The beneficial effect of folate has been observed in various conditions; however, the available evidence on homocysteine and reduction of cardiovascular disease (CVD) in type 2 diabetes (T2D) is limited. This study aims to quantitatively assess the effects of folate on homocysteine levels and the risk of CVDs in individuals with T2D.

Methods: We comprehensively searched clinical trials from PubMed, Cochrane, and Scopus. The trials that focused on adult T2D using folate were included, while those with different interventions, T1D, and animal models of T2D were excluded. A random effect model was used due to heterogeneity. The data was analyzed using Jamovi 2.4.8. Results were presented as standardized mean differences (SMD) and 95% confidence intervals using forest plot.

Results: Evidence retrieved from 9 studies with a sample size of 426 T2D patients was analyzed. Folate supplementation led to a significant reduction in homocysteine (SMD = -1.26 µmol/L, 95% CI: -1.74 to -0.78, p < 0.05) (Figure 1). The subgroup of the sample below 50 revealed no heterogeneity compared to a sample over 50.

Conclusion: Our findings suggest that folate in T2D patients may reduce homocysteine and consequently mitigate CVD. Future trials should explore the effects of folate on homocysteine, especially using a large enough sample size.

Disclosure

K.O.S. Mokgalaboni: None. W.N. Phoswa: None. R.G. Mashaba: None.
519-P: Association of Circulating Sphingolipids with Glycemia in People without Diabetes
Authors: ASUZU PEACE , ALIYE FETO NASER , STENTZ FRANKIE B. , WAN JIM Y. , MANDAL NAWAJES , DAGOGO-JACK SAMUEL
Published: June 2024

Objective: Sphingolipids (SPL) are involved in the pathogenesis of diabetes. We examined plasma SPL levels in relation to glycemic markers in people without diabetes.

Methods: Plasma SPL levels{ceramides (Cer), monohexosylceramides (MHC), sphingomyelin (SM) and sphingosine (So)} were assayed using LC-MS/MS in healthy adults free of diabetes. Using OGTT, subjects were classified into those with normal fasting (FPG) and 2hPG (NFG-NGT), IFG, IGT, and IFG-IGT.

Results: The participants (N=520, 63% female; 48% Black, 52% White) had a mean age of 45.5 + 9.84 yr, BMI 32.4 + 7.24 kg/m2 and waist 101 + 17.0 cm; FPG was 99.8 + 10.5 mg/dl mg/dl, 2hPG 145+ 29.4 mg/dl, and HbA1c 5.80 + 0.53%. FPG and 2hPG correlated inversely with MHC and positively with other circulating SPL levels (Fig. 1), adjusted for age, sex, race, BMI and waist. Weaker correlations were seen with HbA1c (r 0.04-0.19, P=0.43-<0.001). Compared with NFG-NGT, subjects with IFG-IGT had lower MHC and 4-fold higher Cer C16:0/C18:0 (P<0.0001).

Conclusion: Higher levels of major SPL species, and lower MHC, are associated with upward glycemic drift within the nondiabetic range, suggesting a link between SPL metabolism and glucoregulation.

Disclosure

P. Asuzu: None. N. Feto: None. F.B. Stentz: None. J.Y. Wan: None. N. Mandal: None. S. Dagogo-Jack: Consultant; Merck Sharp & Dohme Corp., Medtronic, Bayer Inc. Stock/Shareholder; Aerami.

Funding

National Institute of Health (DK128129)
545-P: Ethnic Variations in Willingness to Participate in Diabetes-Related Health Research
Authors: ROMERO RYAN L. , CRIST SHAUN M. , VACCARO JOAN A. , WEBB FERN , NEFF DONNA F. , GAILLARD TRUDY R.
Published: June 2024

Introduction & Objective: In the US, there is a clear disparity in ethnically diverse participation in health research due to historical and social contexts. Our objective was to analyze the willingness of ethnically diverse adults to participate in health research within the Florida Statewide Register for Aging Studies (FSRAS).

Methods: A structured survey of 164 ethnically diverse adults who listed diabetes as a top three health concern, drawn from the FSRAS, captured the degree of willingness to engage in various health research modalities. The survey stratified responses by ethnicity, including Black Hispanic, Black Non-Hispanic, Caribbean, and White Hispanic groups. Statistical measures of central tendency and dispersion characterized the level of interest in participation.

Results: The study uncovered a complex landscape of willingness to participate in diabetes-related research. Caribbean adults demonstrated the most robust engagement, with nearly 59% indicating "Definitely" or "Maybe" to participating (n=197 for both responses). White Hispanic individuals showed a similar trend (n=187 for "Definitely" or "Maybe"). In contrast, Black Non-Hispanic adults exhibited the highest levels of reluctance, with 63% choosing "Maybe Not" or "Definitely Not" (n=199 for both responses). Black Hispanics mirrored this hesitancy (n=198 for "Maybe Not" or "Definitely Not").

Conclusion: Willingness to participate in diabetes-related research varied by ethnicity within the Black race with Caribbean adults being most willing and Black non-Hispanic adults the least willing. White Hispanics were more likely than Black Hispanics to participate. The study underscores the necessity for multifaceted, culturally competent engagement strategies that are grounded in the understanding of ethnicity-specific concerns and historical contexts. Enhancing trust and participation through such tailored approaches could lead to more inclusive health research engagement.

Disclosure

R.L. Romero: None. S.M. Crist: None. J.A. Vaccaro: None. F. Webb: None. D.F. Neff: None. T.R. Gaillard: None.

Funding

NIAR24AG067951
561-P: Advancing Clinical Proficiency in Insulin Management through Case-Based Education
Authors: TAMAS MARGERY J. , BEYER MICHAEL , NOVAK LUCIA M. , O'BRIEN SARAH , DREW HEATHER N.
Published: June 2024

Objectives: Advances in mealtime insulin therapy and delivery technology can improve postprandial glucose, yet many healthcare professionals (HCPs) have significant knowledge and skills deficits regarding the fundamentals of prandial insulin therapy. This accredited educational activity sought to improve HCPs' ability to use newer types of prandial insulin, engage in patient-centered discussions, and adjust insulin doses.

Methods: The online activity emphasized case-based teaching using standardized patient-provider videos to simulate telehealth visits. HCPs applied the latest evidence (via case scenarios) to real-life management of patients with insulin-treated diabetes. Interpretation of ambulatory blood glucose records and insulin dosing was emphasized. Point-of-care practice aids were provided to reinforce and enhance translation into clinical practice.

Results: Participation: 3,013 US-based HCPs - 30% endocrinologists, 40% PCPs, 27% NPs/PAs, 3% other HCPs

Assessment - Pre- (N=602) and post- (N=460)

Skills Enhancement:54% absolute gain in ability to incorporate newer options and advances in mealtime insulin (25% to 78%)50% absolute gain in ability to engage in patient-centered discussions (29% to 79%)Impact on Practice:28% absolute gain in intention to frequently or always assess time in range (TIR) as a measure of glycemic control (63% to 91%)41% absolute gain in intention to frequently or always use continuous glucose monitoring to assess blood glucose patterns (47% to 88%)18% absolute gain in willingness to ask patients frequently or always about their preferences for monitoring and insulin delivery devices (78% to 96%)Conclusion: Simulated telehealth visits with case-based teaching improved HCPs’ insulin administration skills and patient-centered practices. The substantial participation from diverse HCP backgrounds and the demonstrated improvements in key competencies underscore the initiative's relevance and effectiveness.

Disclosure

M.J. Tamas: None. M. Beyer: None. L.M. Novak: Speaker's Bureau; Abbott. Consultant; Abbott. Advisory Panel; Ascensia Diabetes Care, Boehringer-Ingelheim. Speaker's Bureau; BI Lilly Aliance. Advisory Panel; Medtronic, Novo Nordisk. Consultant; Novo Nordisk. Speaker's Bureau; Novo Nordisk, Sanofi, Xeris Pharmaceuticals, Inc. S. O'Brien: None. H.N. Drew: None.

Funding

Lilly (A-30576)
573-P: Survey-Based Analysis of Type 1 Diabetes Mellitus Patient Training Experience with Omnipod 5 Pump
Authors: BHARGAVA KAVERI , BASINA MARINA
Published: June 2024

Introduction & Objective: Given the recent FDA-approval of Omnipod 5 pump system (OP5), there is little information regarding its best pump training practices. We conducted a patient survey to evaluate educational needs, training satisfaction, and need for additional pump training sessions.

Methods: Following IRB approval, an online REDCap survey was sent via email to patients of an outpatient endocrinology clinic. Patients over 18 years with Type 1 Diabetes who were prescribed OP5 were included. Formal in person or virtual pump training was offered and conducted by the same certified clinic pump trainer for those who opted for it.

Results: Out of 181 invitations sent, 33 survey responses were received (18.2% response rate). Patients were analyzed in two groups: formally trained (FT) (16/33; 48.5%) and self-trained (ST) using online resources (17/33; 51.5%). Results shown in Table 1.

Conclusions: Our survey demonstrated similar patients’ satisfaction with ST and FT methods. Both groups preferred at least 1-2 additional training sessions. Patients’ satisfaction with ST has not been previously evaluated. Considering individual variability in learning needs, different assimilation of new information, availability of the online materials, allocation of the resources, and time constraints, ST can be a viable option for some patients with additional follow up or ongoing training sessions. Larger and longer studies are needed.

Disclosure

K. Bhargava: None. M. Basina: None.
594-P: Exercise Timing Has Limited Effect on Glycemic Profile in a Cluster of Well-Controlled Youth with Type 1 Diabetes
Authors: CODELLA ROBERTO , DELLA GUARDIA LUCIO , BASSI MARTA , MINUTO NICOLA , BISIO AMBRA , RUGGERI PIERO , FAELLI EMANUELA , MAGGI DAVIDE
Published: June 2024

Identifying the best exercise timing to mitigate hypoglycemia is critical for patients with type 1 diabetes (T1D). Despite the established health benefits, concerns persist regarding post-exercise glucose stabilization in this population. In a cross-sectional design of one hundred well-compensated individuals from Northwest Italy (55% female, 45% male; age: 16 ± 6 years; HbA1c: 6.8 ± 1%), physical activity (PA), glycemic profiles, and psychometric traits were monitored. The timing, duration, intensity, and volume of PA were derived from a 7-day training log. Glycemic control was assessed through continuous glucose monitoring, including time in range (TIR; 70-180 mg/dL), time below range (TBR; <70 mg/dL), time below the extreme hypoglycemia range (TBER; <54 mg/dL), time above range (TAR; 180-250 mg/dL), time >250 mg/dL, mean glycemia (MGLU), and total daily insulin dose. Subjects were categorized based on the prevalent timing of exercise into three groups: morning (6am - 12pm), afternoon (12pm - 6pm), and night (6pm - 12 am). Non-exercising days (NO-activity) for each subject were also considered. The mixed model analysis for fixed effects revealed that TIR, TAR, TBER, and MGLU were significantly influenced by the timing of exercise. However, post-hoc analysis indicated that this difference was observed only when comparing NO-activity vs afternoon exercise. Pairwise comparisons showed no significant differences in TIR, TAR, TBER, and MGLU when comparing exercise timing (morning vs afternoon vs night). Additionally, active participants exhibited better quality of life, reduced fear of hypoglycemia, and improved diabetes management self-efficacy compared to their less active counterparts. The findings suggest that exercise timing may be secondary to the overarching goal of helping individuals with T1D develop a consistent and adherent exercise routine. This insight is valuable in guiding recommendations for managing glycemic control in T1D.

Disclosure

R. Codella: None. L. Della Guardia: None. M. Bassi: Speaker's Bureau; Movi spa. N. Minuto: Consultant; Novo Nordisk A/S. A. Bisio: None. P. Ruggeri: None. E. Faelli: None. D. Maggi: Consultant; Bayer Inc.
6-OR: Renal Cell Type—Associated Therapeutic Effects of Semaglutide in a Mouse Model of Hypertension-Accelerated Diabetic Kidney Disease
Authors: TOZZI MARCO , HANSEN HENRIK H. , CHRISTENSEN MICHAEL
Published: June 2024

Introduction & Objective: Emerging evidence suggests that glucagon-like peptide-1 receptor (GLP-1R) agonists improve cardiovascular and renal outcomes in type 2 diabetes patients, however, their mode of action at the kidney level is presently unclear. Using paired bulk and single-nucleus RNA sequencing (RNAseq), we profiled renal transcriptome signatures of the long-acting GLP-1R agonist semaglutide alone and in combination with an ACE inhibitor in a state-of-the-art mouse model of hypertension-accelerated advanced DKD.

Methods: Female db/db mice received a single i.v. injection of renin-encoding adeno-associated virus (ReninAAV) followed by uninephrectomy (UNx) one week later. Six weeks post-UNx, db/db UNx-ReninAAV mice were administered (q.d.) vehicle, semaglutide (30 nmol/kg, s.c.) or semaglutide (30 nmol/kg, s.c.) + lisinopril (30 mg/kg, p.o.) for 11 weeks. Endpoints included blood pressure, urine biochemistry, kidney histology and paired bulk and single-nucleus RNAseq.

Results: Semaglutide improved hyperglycemia, hypertension and albuminuria concurrent with reduction in glomerulosclerosis severity in db/db ReninAAV-UNx mice. Co-administration of lisinopril further reduced hypertension and glomerulosclerosis. Renal transcriptome changes induced by semaglutide mono- and combination treatment were primarily linked to the immune system and extracellular matrix remodeling. Combined semaglutide and lisinopril administration resulted in more widespread transcriptome changes in several renal cell types, including macrophages, mesangial cells, podocytes and proximal tubule cells.

Conclusion: Semaglutide improves disease hallmarks in the db/db ReninAAV-UNx mouse model of advanced DKD associated with modulation of several renal cell types. Therapeutic outcomes and renal transcriptome signatures were further improved by combined antihypertensive standard-of-care.

Disclosure

M. Tozzi: None. H.H. Hansen: Employee; Gubra. M. Christensen: Employee; Gubra.
614-P: Effects of Umami Stimulation on Oral Environment of Type 2 Diabetes Mellitus Patients
Authors: SAKAI CHIEKO , HORIKOSHI YOSUKE , MIZUTA EINOSUKE , MATSURA TATSUYA , HANAKI KEIICHI
Published: June 2024

Objectives: Patients with type 2 diabetes (T2D) are at high risk for reduced saliva volume as well as periodontal diseases, and often have dysgeusia. This study investigated whether umami stimulation could effectively ameliorate these conditions in T2D by improving the oral environment and reducing the preference for sweet taste.

Methods: Participants were 21 patients (18 men, 3 women) with T2D who were not receiving pharmacotherapy. The mean age was 61.6 ± 12.6 years (range, 34-79), mean body mass index (BMI) was 26.9 ± 5.8 kg/m2, and mean hemoglobin A1c (HbA1c) was 6.9 ± 0.7%. After patients ingested umami substances for 3 months, we evaluated recognition thresholds for sweet taste, changes in the oral environment, and clinical indices. Measurements before and after diet therapy were compared.

Results: Thresholds for sweet taste did not change significantly (before diet therapy, 4.2 ± 1.1 vs. after diet therapy, 3.2 ±1.1), but sensitivity (perception) to sweet taste showed a tendency to become stronger. The oral environment showed increased saliva volume (2.68 ± 0.9 vs. 3.24 ± 1.7 mL), decreased salivary hemoglobin (3.02 ± 2.1 vs. 2.1 ± 1.1 μg/mL), and decreased salivary lactate dehydrogenase (156.5 ± 95.5 vs. 152.5 ± 61.5 U/L). Clinical indices showed the significant reduction of body weight (71.5 ± 13.5 vs. 70.9 ± 13.4 kg; p < 0.05) and BMI (26.9 ± 5.8 vs. 26.6 ± 5.7 kg/m2; p < 0.05). HbA1c values decreased (6.9 ± 0.7 vs. 6.8 ± 0.6%). Fasting blood glucose (139.3 ± 24.2 vs. 122.3 ± 16.8 mg/dL; p < 0.05) and tumor necrosis factor-α (0.85 ± 0.4 vs. 0.71 ± 0.3 pg/mL; p < 0.05) decreased significantly.

Conclusion: These results suggest that umami stimulation effectively alters oral environment, reduces sweet taste preference, and improves type 2 diabetic condition.

Disclosure

C. Sakai: None. Y. Horikoshi: None. E. Mizuta: None. T. Matsura: None. K. Hanaki: None.

Funding

Japan Society for the Promotion of Science (JSPS) KAKENHI Grant Numbers 19K10851 (C.S.) and 22K10781 (C.S.).
62-OR: Continuous Glucose Monitoring in Pregnancies with Type 1 Diabetes—A Retrospective Study
Authors: FISHER STEPHANIE A. , VILLA TAMAYO MARIA F. , PAVAN JACOPO , MOSCOSO-VASQUEZ MARCELA , FABRIS CHIARA , CONBOY NATALIE , NIZNIK CHARLOTTE M. , YEE LYNN D. , KOHN MICHAEL A. , KOBAYASHI EMILY , MAJITHIA AMIT R. , HUANG JINGTONG , TIAN TIFFANY , AARON RACHEL , KLONOFF DAVID C.
Published: June 2024

Introduction & Objective: Prior studies do not identify if continuous glucose monitor (CGM) metrics at a critical gestational age (GA) can distinguish risk of adverse pregnancy outcomes (APOs). We evaluated 3rd trimester CGM metrics by GA and APO status in gravidas with type 1 diabetes (T1D).

Methods: Dexcom G6 CGM data from singleton pregnancies with T1D (2018-2022) were retrospectively analyzed. Time in, above, and below range 63-140 mg/dL (TIR, TAR, TBR) and glycemic variability (CV) were computed in 2-week CGM intervals from 28°-396 weeksdays. APOs were hypertensive disorders of pregnancy (HDP), large for gestational age (LGA), NICU admission, neonatal hypoglycemia (NH), and respiratory distress syndrome (RDS). Linear mixed-effects models were fitted on CGM metrics with GA, APO status, and their interaction as fixed effects.

Results: In 86 pregnancies (1st trimester mean HbA1c 6.1%, BMI 25 kg/m2), 71% had at least 1 APO. At 28° weeks, pregnancies with HDP, NICU, or RDS, had higher TAR (p<0.01) and lower TIR (p<0.05). TIR evolution across the 3rd trimester differed in the presence vs. absence of HDP (p<0.05; Figure), with greatest interaction at 28°-316 weeks. Evolution of all metrics differed in the presence vs. absence of RDS (p<0.05), with greatest interaction at 28°-336 weeks.

Conclusion: The early 3rd trimester, a period of peak insulin resistance, is a critical window to optimize CGM metrics to mitigate APO risk.

Disclosure

S.A. Fisher: None. M.F. Villa Tamayo: Research Support; Dexcom, Inc. J. Pavan: Other Relationship; Dexcom, Inc. M. Moscoso-Vasquez: Research Support; Dexcom, Inc. Other Relationship; Dexcom, Inc. C. Fabris: Research Support; Novo Nordisk A/S. Other Relationship; Novo Nordisk A/S, Dexcom, Inc. N. Conboy: None. C.M. Niznik: None. L.D. Yee: None. M.A. Kohn: None. E. Kobayashi: None. A.R. Majithia: None. J. Huang: None. T. Tian: None. R. Aaron: None. D.C. Klonoff: Consultant; Afon Technology Ltd, Better Therapeutics, Inc, Glucotrack, LIfecare, Nevro Corp., Novo Nordisk, Samsung, Thirdwayv Inc.
635-P: Impact of Vitamin D Supplementation on Insulin Resistance amongst People with Type 2 Diabetes in India
Authors: MAHESHWARI ANUJ , TEWARI AJOY , CHAVDA VIPUL
Published: June 2024

Introduction & Objective: Vitamin D appears to play a crucial role in regulating various events responsible for normal insulin sensitivity and pancreatic β-cell function. Deficiency in Vitamin D has been associated with increased Insulin Resistance (IR) and an elevated risk of developing T2D. This study aims to evaluate the impact of treating Vitamin D (Vit D) deficiency on IR in T2DM patients.

Methods: This prospective, observational, multicentric, real-world study conducted across 34 sites in India enrolled T2d patients meeting the inclusion criteria (Age: 18-60 yrs, Vit D (25-OH) Insufficiency <30 ng/ml, HbA1C: 6.5% - 9%, ). Vit D 60k units of softgel capsules, once a week for 12 weeks. Vit D3 levels and HOMA-IR were reassessed. The baseline sample consisted of 402 patients, with 313 after 12 weeks follow-up.

Results: The mean duration of T2DM is 5.0 yrs, with 53% of the patients being male. Patient’s average age is 48 yrs and mean BMI is 27.6 kg/m­­2. Baseline HOMA-IR and vit D levels exhibit a poor correlation (r2=0.03%, p=0.75). 35.8% have High HOMA IR level (>=2.0), 32.3% between 1 and 1.99 and 31.9% have HOMA IR <1.0.After 12 weeks, the impact was assessed based on medication compliance (through patient feedback and change in Vit D levels). In the compliant group (147, 47%), vitamin levels increased from 16.7ng/mL to 40.4ng/mL. In contrast, for the non-compliant group (166, 53%), Vit D levels remained the same (19.7ng/mL Vs 20.1ng/mL). HOMA-IR change is not significant: compliant group - 2.5 to 2.3, p=0.32 and non-compliant group: 1.9 to 2.0, p=0.53. The correlation (r2=0.6%) between change in HOMA IR and Change in Vit D is also poor.

Conclusion: The null hypothesis, positing no direct clinical correlation between the increase in Vit D levels and HOMA-IR, is accepted. The poor correlations underscore the multifaceted nature of the association between Vit D supplementation, IR and T2DM, prompting further research to unravel the indirect correlations and implications for clinical practice.

Disclosure

A. Maheshwari: None. A. Tewari: None. V. Chavda: None.
688-P: Psychosocial Protective and Risk Factors and Transition Readiness in Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: ESHTEHARDI SAHAR S. , MINARD CHARLES G. , CARREON SAMANTHA A. , LYONS SARAH , MCKAY SIRIPOOM , STREISAND RANDI , ANDERSON-THOMAS BARBARA J. , TANG TRICIA S. , HILLIARD MARISA E.
Published: June 2024

Introduction & Objective: Transition readiness is how prepared a YA is to move from pediatric to adult care and is linked to self-management and diabetes outcomes. Though barriers to transition are documented, less is known about psychosocial factors associated with transition readiness. We evaluated diabetes strengths and diabetes distress in relation to diabetes-specific transition readiness in YAs nearing transfer to adult care.

Methods: At baseline of an intervention RCT, 100 YA with T1D (Mean age=19.9±1.3, 42% male, HbA1c=8.8±2.0%, 52% pump, 76% CGM) self-reported on demographics, clinical variables, and measures of diabetes strengths, diabetes distress, and 3 domains of transition readiness (health behaviors, knowledge, navigation). After identifying significant covariates via ANOVAs, separate regression models tested diabetes strengths and diabetes distress in relation to transition readiness (each domain separately and summed).

Results: Models explained 12-18.5% of the variance in scores (Table). Greater diabetes strengths and female gender were independently associated with higher transition readiness scores.

Conclusion: Diabetes strengths may play a protective role in the context of transition-related challenges. Supporting YA strengths as part of a comprehensive preparation program may support transition readiness as YAs prepare to leave pediatric T1D care.

Disclosure

S.S. Eshtehardi: None. C.G. Minard: None. S.A. Carreon: None. S. Lyons: None. S. Mckay: None. R. Streisand: None. B.J. Anderson-Thomas: None. T.S. Tang: None. M.E. Hilliard: None.

Funding

National Institute of Diabetes and Digestive and Kidney Disease (1R01DK119246); National Institute of Diabetes and Digestive and Kidney Disease (K26 DK138332)
692-P: Work or Wellness? Examining Challenges of Low Wage Workers with Type 2 Diabetes
Authors: SCHLESINGER PENELOPE , ASANTE PRINCESS , LIPSKA KASIA J. , KEENE DANYA
Published: June 2024

Introduction & Objective: There is a preponderance of evidence regarding the impact of social determinants of health (SDOH) on diabetes management and outcomes. However, absent from this literature is attention to employment and workplace conditions as determinants of health. Responding to this gap, this study examines whether and how employment experiences and work environments impact diabetes self-management for people in low wage jobs.

Methods: We conducted qualitative interviews (N=115) with 41 participants who are enrolled in a study about housing and diabetes outcomes. Initial interviews focused on broad experiences of diabetes management, economic precarity, and housing. Work and employment emerged as important topics and we conducted an additional 15 interviews to explore these topics in-depth. We analyzed the data using inductive coding and memo writing techniques.

Results: The average age of participants was 51 with a range from 24 to 70. 70% (29) of participants identify as African American, 15% (6) as white and 15% (6) as other. 63% (26) identified as female and 37% (15) as male. Interview participants described work schedules and environments that were not conducive to diabetes management. Participants revealed that they often struggled to balance demands of work with diabetes self-management and often felt like they were failing to successfully manage their nutrition, consistent medication and insulin intake, exercise, stress, and sleep which all factor into diabetes outcomes.

Conclusion: Our findings suggest the need for improved support systems for low wage workers with diabetes to help mitigate disparities in diabetes outcomes.

Disclosure

P. Schlesinger: None. P. Asante: None. K.J. Lipska: None. D. Keene: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK124500)
693-P: Association of Resilience with Hemoglobin A1c and Mental Health Symptoms in Youth and Young Adults with Diabetes
Authors: JULCEUS EMMANUEL F. , MENDOZA JASON A. , FLORY KATE , FRONGILLO EDWARD A. , MERCHANT ANWAR , MALIK FAISAL , COOPER DANIEL K. , REBOUSSIN BETH A. , SAUDER KATHERINE A. , BELLATORRE ANNA , LIESE ANGELA D.
Published: June 2024

Introduction & Objective: Studies on resilience in youth and young adults (YYA) with diabetes are scarce. We assessed if resilience was associated with hemoglobin A1c (HbA1c), depressive symptoms, anxiety, and disordered eating behaviors in YYA with type 1 (T1D) and type 2 diabetes (T2D).

Methods: A cross-sectional analysis of the multicenter SEARCH Food Security Cohort study follow-up 2 (2019-2021) was conducted including 762 YYA with T1D and 103 YYA with T2D. Resilience was assessed with the Connor-Davidson Resilience scale; depressive symptoms, anxiety and disordered eating behaviors were assessed with the Center for Epidemiological Studies-Depression scale (clinical cutoff of ≥24 for youth and ≥16 for young adults), the Generalized Anxiety Disorder screener (≥10), and the Diabetes Eating Problem Survey-Revised (≥20). Logistic regression models were performed to examine associations between resilience and the above diabetes-related outcomes, adjusting for sociodemographic and clinical factors.

Results: YYA were on average 25.1 years old, 60.0% female, 71.2% Non-Hispanic White, and classified by tertiles of resilience into low (n=276), intermediate (n=316) and high (n=273) resilience. Among YYA with T1D, compared to those with high resilience, those with low resilience had elevated odds of HbA1c >9% (OR 2.3, 95% CI 1.3-4.1), depressive symptoms (OR 16.5, 95% CI 10.0-27.2), anxiety (OR 7.9, 95% CI 4.8-12.9) and disordered eating behaviors (OR 8.7, 95% CI 4.5-16.6), likewise for those with intermediate resilience. Among YYA with T2D, those with low resilience had higher odds of depressive symptoms (OR 6.5, 95% CI 1.4-29.1) than those with high resilience, but no difference in odds of HbA1c >9%, anxiety or disordered eating behaviors.

Conclusion: Given the potentially cross-cutting impact of resilience on quality of life, mental health, and diabetes self-management in YYA with diabetes, strategies to enhance resilience should be explored.

Disclosure

E.F. Julceus: None. J.A. Mendoza: None. K. Flory: None. E.A. Frongillo: None. A. Merchant: None. F. Malik: None. D.K. Cooper: None. B.A. Reboussin: None. K.A. Sauder: None. A. Bellatorre: None. A.D. Liese: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases (R01DK117461)
694-P: Engaging Family and Health Care Provider Stakeholders to Refine a Type 1 Diabetes Peer Mentoring Program for Equitable CGM Use
Authors: ENLOW PAUL , THOMAS COURTNEY , COLLINS D A. , LESTER MARIA , SIMPSON KEVIN L. , MAYSONET ABIGAIL , MAYSONET ASHLEY , LIPMAN TERRI H. , GANNON ANTHONY , ALDERFER MELISSA A.
Published: June 2024

Introduction & Objective: Racial disparities in the use of CGM are persistent and contribute to racial disparities in health outcomes among youth with type 1 diabetes (T1D). Here we describe the process and outcomes of partnering with families of youth of color with T1D and healthcare providers to refine Type 1 Together, an intervention combining peer mentoring, educational resources, community health worker access to promote equitable use of CGM.

Methods: Monthly meetings were held with 5 Black and 5 Hispanic caregiver-youth dyads and 4 diabetes care providers via a video-conferencing platform. We also sent post-meeting summaries outlining plans to address issues identified during meetings. The quality of stakeholder engagement was assessed by meeting attendance rates and stakeholder ratings on the synergy subscale of the Community Engagement Survey (range 1-6, higher scores indicate better engagement).

Results: We achieved attendance rates of 99% and 95% for family and healthcare provider stakeholders, respectively. Community Engagement Survey responses revealed high levels of engagement for family (M=5.3, SD=0.8) and healthcare provider (M=5.5, SD = 0.7) stakeholders. Family stakeholders renamed the program and outlined processes for discussing and addressing social determinants of health. Feedback from family and healthcare provider stakeholders was incorporated into the measurement strategy and peer mentor training curriculum. Healthcare provider stakeholders refined mentor recruitment strategies and clinical processes to facilitate communication between the study community health worker and other members of the diabetes care team.

Conclusion: Partnering with family and healthcare provider stakeholders helped refine Type 1 Together. Lessons learned when co-developing health equity interventions and utilizing evidence-based community engagement practices to enhance the quality of these partnerships will be discussed.

Disclosure

P. Enlow: None. C. Thomas: None. D.A. Collins: None. M. Lester: None. K.L. Simpson: None. A. Maysonet: None. A. Maysonet: None. T.H. Lipman: None. A. Gannon: None. M.A. Alderfer: None.

Funding

National Institute of General Medical Sciences (P20GM144270-01)
703-P: The Association of Environmental Mastery and Diabetes Distress among Young Adults with Type 1 Diabetes
Authors: NAGEL KATHRYN , DEARTH-WESLEY TRACY , HERMAN ALLISON N. , WHITAKER ROBERT C.
Published: June 2024

Objective: Although diabetes distress (DD) is common among young adults with type 1 diabetes (T1D), little is known about how to prevent DD. We determined whether greater environmental mastery is associated with a lower prevalence of DD.

Methods: In 2017, an online survey was completed by 423 of 743 (56.9%) young adults (19-31 years) with T1D receiving care at a specialty clinic in New York City. The prevalence of DD (score >3) was measured with the 17-item Diabetes Distress Scale, and environmental mastery scores were measured with the 7-item subscale from Ryff’s Psychological Well-Being Scale. Logistic regression was used to adjust for sociodemographic and clinical covariates.

Results: Of the 416 respondents with complete DD and environmental mastery data, 59.1% were female, 62.7% used an insulin pump, and 47.6% used continuous glucose monitoring. Mean (SD) HbA1c was 8.0 (1.7)%, and 24.3% had DD. The covariate-adjusted prevalence (95% CI) of DD decreased across tertiles (sample-defined) of increasing environmental mastery: 49.6% (41.2%, 58.0%), 19.1% (12.8%, 25.3%), 6.5% (2.5%, 10.6%). This graded association was present across levels of HbA1c (Figure).

Conclusion: Greater environmental mastery was associated with lower DD and may protect young adults with T1D from developing DD.

Disclosure

K. Nagel: None. T. Dearth-Wesley: None. A.N. Herman: None. R.C. Whitaker: None.

Funding

National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (T32DK007028)
707-P: Advanced Glycation End Products and Executive Functions in Elderly People with Type 2 Diabetes
Authors: ALVES ANNE
Published: June 2024

Advanced glycation end products (AGE) is one of the major pathways involved in the progression of diabetic complications. Also, diabetes increases risk for cognitive impairment and dementia. The aim of this study was to correlate AGE with executive functions in elderly people with type 2 diabetes (DM2). The sample consisted of 34 elderly DM2. A questionnaire was used to evaluate the AGE consumption score, AGE reader was used to measure skin autofluorescence and two tasks from the Brief Neuropsychological Assessment (NEUPSILIN) to assess executive functions. The Spearman and Mann-Whitney tests were used (mean+SD). AGE consumption (7.77+ 3.48) was considered adequate and the skin autofluorescence value was higher for age (3.03+0.67). There was no relationship between AGE measures and executive functions (p=0.253; p=0.481). It was observed that the better the performance in verbal fluency, the lower the medication amount (p<0.001; r=-0.555) used by the elderly and the higher the income (p=0.033; r=0.366). Women (-0.025+1.03) had a higher problem-solving Z score than men ( -0.93+1.03; p=0.011). Elderly non-smokers (1.01+2.12) obtained a higher Z score on this same task than elderly smokers (-0.17+1.36; p=0.034).

In conclusion, an adequate consumption of AGE was noted, but elderly DM2 had higher skin autofluorescence. AGE measures were not predictors of executive functions, but gender, smoking, income and polymarcy influenced this performance.

Disclosure

A. Alves: None.

Funding

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.
717-P: National DPP—Best Practices for Program Implementation and Participant Retention in a Primarily Hispanic Population
Authors: WALLACE CHARLENE , MANCILLAS ELI , SHATTUCK TERESA D.
Published: June 2024

To date, 585,000+ at-risk US adults have taken part in the National Diabetes Prevention Program (National DPP). While the National DPP is effective, challenges exist for building successful programs that support participant retention, particularly for high-risk populations such as Hispanic/Latino (H/L). The aim of this evaluation was to identify factors that influence successful Lifestyle Change Program (LCP) implementation to facilitate participant retention.

Utilizing an implementation research model, researchers analyzed surveys, focus groups and program delivery data from 8 LCPs (4 in predominately Hispanic communities) serving 5226 participants (74% Hispanic). Retention analysis focused on program completion (attended 8+ classes over a 9-month period).

Non-H/L v. H/L (p<.001; 40.5% v 32.4%), and Whites v. Non-Whites (p<.001; 31.6% v 22.3%) were more likely to complete an LCP. Additionally, participants attending through in- person/online or in-person/distance learning were more likely to complete (p<.001; 70.4% and 69.4%, respectively). Themes emerged regarding successful program implementation: 1) address sustainability initially and allow time for the LCP to develop; 2) organizational leadership support and appropriate staffing plans are critical; 3) be prepared to adapt to challenges that may arise and the needs of participants (i.e., adapting schedules, delivery modes, personalization). LCPs attributed retention success to providing optional virtual sessions, flexible scheduling, innovative retention strategies, and frequent communication. Participants attributed retention success to coaches creating a nurturing environment; finding common ground; group sharing; staff follow up; accountability; and experiencing improved health.

This project provided a unique opportunity to identify important and practical considerations for National DPP LCPs across the US in developing programs to support participant retention.

Disclosure

C. Wallace: Employee; American Diabetes Association. E. Mancillas: None. T.D. Shattuck: None.

Funding

Centers for Disease Control and Prevention (NU58DP006364-03-00)
727-P: A New HbA1c Test Based on a Cellular Stiffness Measurement of Red Blood Cells
Authors: PARK EUNYOUNG , KANG SEUNGJIN , KO UNGHYEON
Published: June 2024

Objective: Diabetic red blood cells (RBCs) exhibit increased stiffness compared to their healthy counterparts. In our prior work, we successfully developed a microfluidic device for measuring cellular stiffness at the single-cell level. This study investigates the potential of utilizing RBC stiffness measurements to predict HbA1c levels.

Methods: The study adhered to the approved protocol of the Public Institutional Review Board designated by the Ministry of Health and Welfare of Korea. Blood samples were collected from fingertip punctures and diluted in Dulbecco's Phosphate Buffered Saline solution. All experiments were completed within 30 minutes of blood collection. Individual RBCs traversed a micro-sized fluidic channel, with their transit times serving as a representation of cellular stiffness.

Results: Stiffness analysis was conducted on over 500 RBCs from each participant. Histogram analysis revealed a diverse stiffness distribution with a wide range. Notably, the stiffness distribution of RBCs varied between HbA1c groups, with the higher HbA1c group exhibiting a greater proportion of stiffer RBCs compared to the group with lower HbA1c levels.

Conclusion: Our result is the first to report the proportionality between HbA1c level and cellular stiffness of RBCs. We believe that cellular stiffness measurements would be a groundbreaking metric for A1c testing, free from conventional protein quantification.

Disclosure

E. Park: None. S. Kang: None. U. Ko: None.
735-P: Association between Glucagon-Like Peptide 1 Receptor Agonists and Risk of Depression in U.S. Older Adults with Type 2 Diabetes—A Population-Based Cohort Study
Authors: LU YING , TANG HUILIN , DONAHOO WILLIAM T. , BIAN JIANG , GUO JINGCHUAN
Published: June 2024

Background: Literature evidence suggests that glucagon-like peptide-1 receptor agonists (GLP-1RAs) may have anti-depressant effects. However, population studies assessing the association between GLP-1RAs and depression risk are limited and have yielded mixed results.

Methods: Older adults with type 2 diabetes (T2D) who were newly prescribed either a GLP-1RA or a dipeptidyl peptidase 4 inhibitor (DPP4i) were identified from 2016-2020 national Medicare Claims data. We employed 1:1 propensity score matching to control for potential confounding at baseline and a Cox proportional hazards regression to estimate hazard ratio (HR) and 95% confidence intervals (CI) for incident depression.

Results: We included 25,824 Medicare beneficiaries with T2D. Figure 1 presents the Kaplan-Meier plots showing the cumulative incidence of depression over time between matched groups. The incidence rate of depression among GLP-1RA users was lower than that among DPP4i users (46.3 cases vs. 57.1 cases per 1,000 person-years). In the Cox model, GLP-1RAs were significantly associated with a decreased risk of incident depression compared to DPP4i (HR, 0.81; 95%CI, 0.71-0.85).

Conclusion: Among older people with T2D, GLP-1RAs were associated with a significant decrease in the risk of depression compared to DPP4i.

Disclosure

Y. Lu: None. H. Tang: None. W.T. Donahoo: None. J. Bian: None. J. Guo: None.
741-P: Circulating Follistatin Predicts Tirzepatide Treatment Outcomes on Type 2 Diabetes
Authors: ZOU QI , ENGSTRÖM GUNNAR , PAN JINGXUE , ZHANG JIALIN , PERISHO ESTHER J. , LIN YANZHU , WIESE RUSSELL , WILSON JONATHAN M. , PAVO IMRE , GAO RUI , DUFFIN KEVIN L. , DE MARINIS YANG
Published: June 2024

Elevated circulating hepatokine follistatin (FST) is associated with increased risk of type 2 diabetes (T2D) by inducing adipose tissue insulin resistance and adipocyte lipolysis. In this post-hoc analysis, we explored effects of the GIP/GLP-1 receptor agonist tirzepatide (TZP 5, 10, and 15 mg) and insulin glargine on plasma FST levels at weeks 24 and 52 in adults with T2D and high cardiovascular risk (SURPASS-4, n=1624). At baseline, higher concentration of FST was correlated with higher HbA1c and reduced HOMA-B. The adjusted hazard ratio (HR) for achieving HbA1c<5.7% by 15 mg TZP in the highest quartile of baseline plasma FST (Q4) vs. the lowest quartile (Q1) was 2.39 (CI: 1.14-5.03, p<0.05) in 24 weeks and 2.03 (CI: 1.12-3.70, p<0.05) in 52 weeks. TZP dose dependently reduced FST at 52 weeks (4.69; 4.49; 4.11 ng/ml for 5, 10, 15 mg TZP, p<0.001); and 15 mg TZP reduced FST at 24 and 52 weeks (baseline 5.14; 24 week 4.03; 52 week 4.11 ng/ml, p<0.001). Change from baseline FST correlated with HbA1c and BMI reduction and HOMA-B increase, with stronger associations on higher TZP dose. These post-hoc data show that TZP treatment reduces plasma FST, and TZP is more effective for reaching HbA1c<5.7% in T2D individuals with higher baseline FST levels. Further understanding of link between TZP outcomes and FST, including related role of FST in β-cell, hepatocyte and/or adipocyte function associated with TZP treatment, remain to be elucidated.

Disclosure

Q. Zou: None. G. Engström: Stock/Shareholder; AstraZeneca. J. Pan: None. J. Zhang: None. E.J. Perisho: Research Support; Eli Lilly and Company. Y. Lin: Stock/Shareholder; Eli Lilly and Company, Pfizer Inc., AstraZeneca. R. Wiese: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. J.M. Wilson: Employee; Eli Lilly and Company. I. Pavo: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. R. Gao: None. K.L. Duffin: Employee; Eli Lilly and Company. Y. De Marinis: None.

Funding

Crafoord Foundation (Crafoordska stiftelsen) grant to Y.D.M.
746-P: GLP-1 RA and Risk of Malignancy in Patients with Type 2 Diabetes
Authors: ISHOLA FAIDAT A. , WILLIAM PIKE C. , KIM SUN H.
Published: June 2024

Introduction and Objective: Glucagon-like peptide 1 receptor agonists (GLP-1 RA) have been associated with both increased (Bezin 2023) and decreased risk (Wang 2023) of certain cancers in patients with type 2 diabetes (T2DM). We investigated the risk of developing 13 obesity-associated malignancies in patients with T2DM who received GLP-1RA compared with other anti-hyperglycemic agents except insulin.

Methods: We conducted a real-world retrospective cohort study on 130 million US adults using deidentified electronic health records from Eversana Life Sciences. The study included patients with new diagnosis of T2DM and no history of malignancy who were prescribed GLP-1RA (n=30,196) within 12 months of T2DM diagnosis and propensity matched to patients on other anti-hyperglycemic agents (n=30,196) between 2010 to 2023. Outcome was incidence of 13 obesity-associated malignancies. Time-varying Cox proportional hazard model was used to compare time to event rates.

Results: In patients with T2DM (56 years, 53% female, 53% White), there was a total of 1219 malignancies after a mean follow up of 2.9 years. Most common cancers were breast (388), prostate (328), and colorectal (148). GLP-1RA users had higher risk for prostate cancer (HR 1.28, 95% CI 1.03, 1.6) compared with those on other anti-hyperglycemic agents. However, E-value was small (1.2), indicating unmeasured confounders affecting outcomes. There was no increased rate of other or overall malignancies (HR 1.04, 95% CI 0.93, 1.17).

Conclusion: Despite a noted increased risk for prostate cancer with GLP-1RA use, non-visible confounders limit the results. Other cancers showed no significant association with GLP-1RA use.

Disclosure

F.A. Ishola: None. C. Pike: None. S.H. Kim: Consultant; ALIGOS Therapeutics. Advisory Panel; GI Dynamics. Research Support; Fractyl Health, Inc. Consultant; Nutrisense.