bluuebunny/crossref_metadata_2025 huggingface dataset:
48-PUB: Implementation of a Student-Tailored Version of the Diabetes Prevention Program
Authors: WISK LAUREN E. , SOETENGA SAMANTHA , DIAZ ROLDAN KATE , BHAGAT MEERA , KRYGER VALERIE , VU AMANDA V. , MOIN TANNAZ
Published: June 2024

One-in-four young adults have prediabetes in the US so there is a need to adapt evidence-based programming, such as the National Diabetes Prevention Program (DPP). To address this important public health concern, we are testing a student-tailored DPP in a pilot RCT during the 2023-24 academic year.Undergraduates at a major university were recruited in the first three weeks of the academic year using a self-administered eligibility form assessing type 2 diabetes risk. Survey responses and feasibility outcomes are described.

Among 875 completed surveys, 315 students (36.0%) met DPP eligibility criteria. Of eligible students, 28 (8.9%) disclosed a diagnosis of prediabetes, 309 (98.1%) met BMI-based eligibility criteria, and 15 (4.8%) had a qualifying score on the CDC risk test; 29 (9.2%) students met more than one criteria. Compared to ineligible students, eligible students were statistically (p<0.05) more likely to be Hispanic/Latinx (36.2% vs 23.9%), have a family history of diabetes (41.0% vs 27.9%), physically inactive (23.5% vs 15.4%), food insecure (35.2% vs 23.4%), financially vulnerable (30.8% vs 21.8%), and report high levels of personal stress (54.0% vs 43.4%); groups were similar with regard to sex (74.5% female overall). We successfully enrolled our target of 80 participants into the trial. Enrolled participants were similar to eligible participants except for being younger (mean age 19.7±1.4 vs 20.9±4.2) and more likely to be Hispanic/Latinx (48.8% vs 36.2%). Sixty invited students declined participation, the most commonly cited reason was the time commitment (29, 48.3%).

Both the demand and need for diabetes prevention among university students was high. We were successful in reaching socioeconomically vulnerable and diverse students, who stand to benefit the most from targeted diabetes prevention.

Disclosure

L.E. Wisk: None. S. Soetenga: None. K. Diaz Roldan: None. M. Bhagat: None. V. Kryger: None. A.V. Vu: None. T. Moin: None.

Funding

American Diabetes Association (7-23-ICTST2DY-11); NIDDK (5R01DK124503)
484-P: Patient-Reported Burden of Disease in Diabetic Peripheral Neuropathic Pain—Learnings from In-depth Patient Interviews—Substudy of RELIEF-DPN 1
Authors: GAUDIANI LINDA M. , SIKIRICA SLAVEN , HARDIN MARQUETTE B. , ERVIN CLAIRE M. , GOSS DIANA S. , KOSA KATHERINE M. , GOPINATHAN SUMA
Published: June 2024

Background and Aims: Diabetic peripheral neuropathy often results in diabetic peripheral neuropathic pain (DPNP) which is difficult to manage effectively with the current standards of care. RELIEF-DPN 1, a Phase 2 study in adult patients with Type 1 or 2 diabetes and moderate to severe established DPNP, evaluated the safety and efficacy of LX9211, a potent non-opioid inhibitor of AP2-associated protein kinase 1 (AAK1). A sub-study of RELIEF-DPN 1, employed patient interviews with the objectives of characterizing pre-trial patient-reported disease burden and assessing unmet need in DPNP management.

Methods: Sixty-two telephone interviews were conducted across 31 US clinical sites following a semi-structured interview guide to ensure consistent data capture. Data were analyzed using thematic qualitative data analysis. Dominant trends were compared across interviews to describe themes and relative importance of symptoms observed. Demographic and clinical information were summarized with descriptive statistics.

Results: Of 62 patients interviewed, 39 (63%) were male. The average age was 59.7 years. Analyses revealed the most commonly reported symptoms were numbness (89%), tingling (84%), and burning (71%). The symptoms reported as “most bothersome” were burning (30%), numbness (26%), and tingling (26%). The aspects of daily living most impacted by patient’s DPNP were sleep (81%), mood (66%), and mobility (66%). Over 40% of patients were “not at all satisfied” with prior treatments for DPNP, while 18% reported being “very satisfied.” DPNP was at least “moderately difficult” to manage for 82% of patients; 37% reported it “very difficult.”

Conclusion: This sub-study demonstrates that, from patients’ perspectives, symptoms and aspects of daily living impacted by DPNP are considerably burdensome to patients. This study highlights a pressing need for improved therapy and innovation in DPNP management.

Disclosure

L.M. Gaudiani: Consultant; Biomea Fusion, Inc., Lexicon Pharmaceuticals, Inc. Employee; LifeScan Diabetes Institute. Advisory Panel; Lilly Diabetes. Stock/Shareholder; Dexcom, Inc., Lilly Diabetes, Insulet Corporation, Omnipod, Tandem Diabetes Care, Inc. Research Support; Lilly Diabetes. S. Sikirica: Employee; Lexicon Pharmaceuticals, Inc. M.B. Hardin: Employee; Lexicon Pharmaceuticals, Inc. C.M. Ervin: Other Relationship; Lexicon Pharmaceuticals, Inc. D.S. Goss: Other Relationship; RTI International. K.M. Kosa: None. S. Gopinathan: Employee; Lexicon Pharmaceuticals, Inc.

Funding

Lexicon Pharmaceuticals, Inc. The Woodlands, TX USA
49-OR: GPSM1 Regulates Atherosclerosis Progression by Controlling Macrophage Chemotaxis through PKA/KLF4/PMP22-MAPK Pathway
Authors: ZHANG YUEMEI , HU CHENG
Published: June 2024

Introduction & Objective: The infiltration of macrophages into the vessel walls are the central part of atherosclerosis-one kind of macrovascular complication of diabetes. However, the detailed mechanisms remain unclear. We aim to determine whether myeloid cell G-protein-signaling modulator 1 (GPSM1) regulates atherosclerosis and macrophage chemotaxis.

Methods: We used myeloid-specific GPSM1 ablation mice on Apoe-/- background, and GPSM1 overexpression/deficient mice with an AAV-PCSK9 injection to explore function of GPSM1 in atherosclerosis. BMDMs and THP-1 cells were used to access mechanism of GPSM1 in regulating macrophage chemotaxis. Apoe-/- mice were injected with a small-molecule compound, AN-465 that countered GPSM1 function to evaluate potential therapeutic effects of GPSM1 on atherogenesis.

Results: Myeloid-specific GPSM1 ablation protects mice against atherosclerosis and reduces atherosclerotic plaque formation and aortic inflammation, both in Apoe-/- double knockout mice and an AAV-PCSK9 injection model. In contrast, myeloid-restricted overexpression of GPSM1 induces promotes atherosclerosis development in mice. Particularly, GPSM1 deficiency suppresses oxidized low-density lipoprotein (oxLDL)-burdened monocytes priming and macrophages chemotaxis and migration, thereby alleviating pro-inflammatory responses within atherosclerotic plaque. Mechanistically, GPSM1 loss inhibits P38/ERK MAPK pathway through cAMP/PKA/KLF4/PMP22 axis in macrophages, ultimately resulting in impaired macrophage chemotaxis and migration. Finally, pharmacological inhibition of GPSM1 with AN-465 reduces plaque formation and macrophage infiltration, suggesting that targeting GPSM1 would be an approach for the treatment of macrovascular complication of diabetes.

Conclusion: Our findings establish that GPSM1 is a new regulator of atherosclerosis and suggest GPSM1 as a potential therapeutic target for atherosclerosis.

Disclosure

Y. Zhang: None. C. Hu: None.
493-P: Cerebral Spinal Fluid Supports Calvaria Bone Marrow to Sustain Hematopoiesis and Protect the Retina following Acute Ischemia/Reperfusion Injury and in Diabetic Retinopathy
Authors: GRANT MARIA B. , ASARE-BEDIAKO BRIGHT , LI CALZI SERGIO , ROSENCRANS ROBERT F. , PRASAD RAM , BOULTON MICHAEL , BUSIK JULIA V.
Published: June 2024

Introduction and Objectives: Hematopoietic cells emanate from multiple bone marrow (BM) compartments and support microvascular repair. Calvaria BM has a unique exposure to cerebrospinal fluid (CSF) which may modulate hematopoiesis, whereas this exposure does not occur for long bones. We asked if hematopoiesis differed between calvaria and long bones and if so, how this impacted diabetic retinopathy (DR) or the response to ischemia/reperfusion (I/R) injury. Because oxysterols and hematopoiesis have been linked, oxysterol content of paired plasma and CSF were compared.

Methods: In 12-month db/db mice, flow cytometry, micro CT, mass spectrometry (MS) and IHC were used to investigate the impact of type 2 diabetes (T2D) on distinct BM compartments and on DR. Recruitment of BM-derived cells into retina after I/R injury was assessed using in vivo cell labelling of each BM compartment in Kikume Green-Red photoconvertible fluorescent protein (KIKGR) reporter mice.

Results: In db/db mice, calvaria in contrast to tibia underwent slower bone deterioration and less vascular degeneration while sustaining physiological hematopoiesis as evident by elevated levels of myeloid angiogenic cells (MACs), a key vascular reparative BM population. Calvaria was the source of reparative MACs following I/R injury, whereas long bones provided pro-inflammatory monocytes to the retina. MS demonstrated that CSF of db/db mice, but not serum, contained high levels of the neurotropic and anti-inflammatory oxysterols, 22-hydroxycholesterol and 27-hydroxycholesterol.

Conclusion: CSF-derived oxysterols, selectively accessible to the calvaria BM compartment but not long bones, preserves physiological hematopoiesis despite chronic T2D. Calvaria provides a source of reparative cells to the retina following acute injury and retards DR, whereas the long bones primarily provide pro-inflammatory monocytes.

Disclosure

M.B. Grant: None. B. Asare-Bediako: None. S. Li Calzi: None. R.F. Rosencrans: None. R. Prasad: None. M. Boulton: None. J.V. Busik: Consultant; Ceramedix, Inc.

Funding

NEIR01EY012601
494-P: Plasma Metabolomic Profiling of Diabetic Macular Edema
Authors: ZHU XIAO-RONG , LU JING , ZHANG LIN
Published: June 2024

Background: Diabetic macular edema (DME), a sight-threatening retinopathy, is a leading cause of vision loss in persons with diabetes mellitus. Despite strict control of systemic risk factors, a fraction of patients with diabetes develop DME, suggesting the existence of other potential pathogenic factors underlying DME. This study aimed to investigate the plasma metabotype of patients with DME and to identify novel metabolite markers for DME. Biomarkers identified from this study will provide scientific insight and new strategies for the early diagnosis and intervention of DME.

Methods: To match clinical parameters between case and control subjects, patients with DME (DME, n=30) or those with diabetes but without DME (Control, n=30) were assigned to the present case-control study. Distinct metabolite profiles of serum were examined using liquid chromatography-mass spectrometry (LC-MS).

Results: A total of 190 distinct metabolites between DME and Control groups were identified (VIP > 1, Fold Change > 1.5 or < 0.667, and P < 0.05). The distinct metabolites between DME and Control groups were enriched in 4 KEGG pathways, namely, Glutamate Metabolism, Carnitine Synthesis, Oxidation of Branched Chain Fatty Acids, and Phytanic Acid Peroxisomal Oxidation. Finally, 4 metabolites were selected as candidate biomarkers for DME, namely, 5-Phospho-beta-D-ribosylamine, Succinic acid, Ascorbyl glucoside, and Glutathione disulfide. The area under the curve for these biomarkers were 0.693, 0.772, 0.762, and 0.771, respectively.

Conclusions: This study suggested that impairment in the metabolism and 4 potential metabolites were identified as metabolic dysregulation associated with DME, which might provide insights into potential new pathogenic pathways for DME.

Disclosure

X. Zhu: None. J. Lu: None. L. Zhang: None.

Funding

This work was supported by the National Natural Science Foundation of China (No.82000733)
500-P: Disruption of REDD1 Protein Allostery as a Therapeutic for Diabetic Retinopathy
Authors: DENNIS MICHAEL D. , SUNILKUMAR SIDDHARTH , MILLER WILLIAM P. , SHA CONGZHOU M. , DOKHOLYAN NIKOLAY V.
Published: June 2024

Introduction & Objective: Increased abundance of the protein Regulated in Development and DNA damage 1 (REDD1, also known as RTP801/DDIT4) in cells of the retina is required for retinal pathology and visual function deficits in diabetic mice. Indeed, an RNA-based therapeutic designed to reduce REDD1 modestly improved visual acuity in patients with diabetic macular edema. Studies here investigated the cause of REDD1 upregulation in the context of diabetes.

Methods: Mice were administered low dose streptozotocin (STZ) to model diabetes and treated with either the SGLT-2 inhibitor dapagliflozin or the antioxidant N-acetyl cysteine. Complementary studies were performed in human MIO-M1 cells exposed to hyperglycemic conditions. Discrete molecular dynamics (DMD) and an artificial intelligence (AI) neural network were used to examine REDD1 structure and ligand binding.

Results: Hyperglycemia and an increase in reactive oxygen species were required for increased REDD1 protein abundance in the retina of diabetic mice, which was observed without a change in REDD1 mRNA expression. Hyperglycemic conditions promoted formation of a cross-strand disulfide bond in REDD1 at C150/C157 that suppressed its normally rapid degradation. DMD revealed allosteric regulation of residues upon formation of the redox-sensitive disulfide bridge that controlled REDD1 proteolysis. Genetic disruption of REDD1 allostery prevented the suppressive effect of disulfide bond formation on REDD1 degradation. Ligands with high bioavailability and cell permeability that bind REDD1 at the site of allosteric regulation were identified.

Conclusions: The results reveal a new molecular switch in the REDD1 protein that is activated by diabetes and suggest that the prior clinical trials designed to reduce REDD1 synthesis were undermined by diabetes-induced blockade of REDD1 degradation. Genetic or small molecule inhibition of REDD1 protein allostery may represent a new clinically translatable therapeutic intervention.

Disclosure

M.D. Dennis: None. S. Sunilkumar: None. W.P. Miller: None. C.M. Sha: None. N.V. Dokholyan: None.

Funding

R01 EY032879
509-P: The Nuclear Receptor Nr5a1 Promotes Adipogenesis as a Novel Transcriptional Regulator of PPARgamma
Authors: CHENG YANGLEI , GUO YAN , LI YANBING
Published: June 2024

Introduction & Objective: The nuclear receptor subfamily 5 group A member 1 (Nr5a1) recognized as a transcription factor in adrenal and gonadal organs is also found to regulate lipid metabolism in the islets. However, its involvement in the development of white adipose tissue (WAT) in which peroxisome proliferator activated receptor gamma (PPARgamma) plays a key role remains to be elucidated. Herein, we aim to study the roles and effects of Nr5a1 in adipogenesis.

Methods: Human and mice subcutaneous and visceral adipose tissue were harvested and primary adipose-derived preadipocytes were isolated and cultured in vitro. The expression of Nr5a1 in WAT and preadipocytes was validated by qPCR, western blot and immunofluorescence. RNA-seq and qPCR were conducted to discern downstream target genes. Oil-red O staining detected the lipid accumulation and western blot tested the expression of key factors in adipogenesis. The transcriptional regulation of Nr5a1 on the target gene was tested by CUT&tag and qPCR and luciferase reporter assays.

Results: Nr5a1 levels were elevated in WAT of ob/ob and db/db and diet-induced-obese mice compared to their lean controls. In primary preadipocytes of human and mice, Nr5a1 expressed at a low-level while was dramatically upregulated during adipogenesis both in mRNA and protein level. GO analysis showed that overexpression of Nr5a1 in preadipocytes upregulated adipogenesis marker genes and lipid biosynthetic process. And it was demonstrated that adipogenesis was suppressed by knockdown of Nr5a1 while overexpression of Nr5a1 promoted it. In the process of adipogenesis, Nr5a1 promoted the transcription of PPARgamma by binding to its promoter.

Conclusion: Nr5a1 promotes adipogenesis in WAT by upregulating the transcription of PPARgamma. Our findings highlight the roles of Nr5a1 in the adipocyte differentiation and lipid metabolism in WAT, positioning it as a potential target for obesity treatment.

Disclosure

Y. Cheng: None. Y. Guo: None. Y. Li: Consultant; Sanofi, Novo Nordisk, AstraZeneca.
510-P: Remnant Cholesterol and Triglyceride-Rich Lipoproteins Are Associated with Insulin Resistance and Subclinical Inflammation in Youth and Young Adults
Authors: CHOWDHURY ARUBA , GLAROS SOPHIA B. , SAMPSON MAUREEN , DAVIS FAITH , DIXON SYDNEY A. , KRENEK ANDREA , MALANDRINO NOEMI , MABUNDO LILIAN , LIGHTBOURNE MARISSA , BROWN REBECCA , MAGGE SHEELA N. , CHUNG STEPHANIE T.
Published: June 2024

Introduction: Remnant cholesterol (Rem-C) and triglyceride-rich lipoproteins (Rem-TRLp) increase risk for atherogenesis in adults but the concentrations and relationship with insulin resistance (IR) and subclinical inflammation in youth and young adults (YYA) is unclear.

Methods: We measured fasting lipoprotein particle size and number, GlycA (composite marker of inflammation), and lipoprotein insulin resistance index (LPIR) using NMR LipoProfile® in a pooled cohort analysis of 379 YYA: 64 healthy lean (HL), 163 healthy with BMI≥85th percentile (OWOB), 104 youth-type 2 diabetes (YT2D), and 48 lipodystrophy (LD). Rem-TRLp was calculated as small + very small TRLp and Rem-C as totalC — HDLC — LDLC). Regression models compared groups and determined relationships with LPIR and GlycA, adjusting for age, sex, and race/ethnicity.

Results: YYA were aged 17.1±4.3y (mean±SD), 62% female, 66% Black, BMI 31.7 ± 9.2 kg/m2. LPIR and GlycA were higher in LD and Y-T2D vs. OWOB and HL (Table). TRLp, Rem-C, and Rem-TRLp were highest in LD. Y-T2D had higher TRLp and Rem-TRLp vs. HL. Rem-C was related to LPIR and GlycA (both adjR2=0.5, P<0.01) and Rem-TRLP (both adjR2=0.2, P<0.01).

Conclusion: In YYA, Rem-C and Rem-TRLp associate with severe IR and inflammation. Their contribution to atherogenesis in high risk YYA with Y-T2D and LD requires further study.

Disclosure

A. Chowdhury: None. S.B. Glaros: None. M. Sampson: None. F. Davis: None. S.A. Dixon: None. A. Krenek: None. N. Malandrino: None. L. Mabundo: None. M. Lightbourne: None. R. Brown: Research Support; Regeneron Pharmaceuticals Inc., Pfizer Inc., Amryt Pharma Plc. S.N. Magge: None. S.T. Chung: None.

Funding

Intramural Research Program of the National Institute of Diabetes & Digestive & Kidney Diseases
523-P: Proteomic Predictors of Diabetic Foot Ulcer Healing Time
Authors: SINGH AHLUWALIA TARUNVEER , JAIN SIDDHI , PETKOVIC MARIJA , RAGUZ JANA A. , KAUR GURJEET , JERSIE-CHRISTENSEN ROSA R. , KIRKETERP-MØLLER KLAUS , ANDERSEN JONAS H. , PEDERSEN ANDERS G. , VEVES ARISTIDIS , RASMUSSEN ANNE , DALGAARD LOUISE T. , ROSSING PETER
Published: June 2024

Background and Aims: Longer diabetic foot ulcer (DFU) healing time is associated with a 10 to 20 times higher risk of foot amputations in people with diabetes than in nondiabetic subjects, however no biomarkers for DFU healing exist. We investigated foot ulcer swap proteins associated with DFU healing time.

Material and Methods: Untargeted proteomics profiling of DFU surface swaps was conducted on 112 diabetic individuals at the Steno Diabetes Center Copenhagen outpatient clinic with follow-up of 6 months. Proteomics was performed using Liquid Chromatography Mass Spectrometry workflow with quantification (MaxQuant), and annotation (Perseus). Two data preprocessing workflows (WFs) were compared, WF1: Missing values were either imputed from normal distribution after filtering 30% non-missing data, and WF2: Compositionality-based Bayesian multiplicative replacement was applied. Longitudinal analysis was conducted using cox proportional hazards regression adjusting for covariates (age, gender, BMI, diabetes type and duration, HbA1c, and triglyceride levels) with false detection rate (FDR) applied, with significance PFDR<0.1 in R Studio. A lower hazards ratio (HR) indicated longer healing time.

Results: Study participants had a mean (± SD) age 50.7(11.9), and diabetes duration 26.9(14.6) years, HbA1c 64.8(15.3) mmol/mol, BMI 29.9(5.5) kg/m2, TBI 0.48 (0.22), 83.9% had neuropathy and 62.5% had type 2 diabetes. Of 256 (WF1) and 1092 (WF2) unique proteins remaining post preprocessing, 6 and 46 proteins remained significantly associated (PFDR<0.1) with ulcer healing time. Top proteins included S100A8 (HR: 0.81), and Myeloblastin (HR: 0.74) associating with longer healing and IL16 and MMP1 (HR:1.28) with faster healing. Both WFs were highly correlated (R=0.7).

Conclusions: We identify tissue proteomic signatures for DFU wound healing time particularly proteins indicating increased inflammation and granulocyte infiltration in DFU wound bed and poor healing.

Disclosure

T. Ahluwalia: None. S. Jain: None. M. Petkovic: None. J.A. Raguz: None. G. Kaur: None. R.R. Jersie-Christensen: None. K. Kirketerp-Møller: None. J.H. Andersen: None. A.G. Pedersen: None. A. Veves: None. A. Rasmussen: None. L.T. Dalgaard: None. P. Rossing: Other Relationship; AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Gilead Sciences, Inc., Novo Nordisk, Eli Lilly and Company, Novartis AG, Abbott Diagnostics.

Funding

Novo Nordisk Foundation (NNF 23OC0084081)
525-P: Use of a Remote Thermovisual Monitoring System in High-Risk Patients—A Pilot Study
Authors: ABBOTT CAROLINE , FRANKLYN KERRYN , STUART DAVID , KIRWAN ELLEN , FLYNN SINEAD , MCINTOSH CAROLINE D. , BOULTON ANDREW J.
Published: June 2024

Introduction: Diabetic foot ulcer (DFU) recurrence rates are high, at 40% in 12 months. We investigated patient adherence to, and effects of, a remote thermovisual monitoring system (Bluedrop Medical) in high-risk diabetic patients. We hypothesized that at-home thermovisual monitoring is easy, used consistently by patients, and may assist podiatry care

Methods: In this single arm, open-label, 12-week pilot study in 2 countries, 27 patients with a DFU history were recruited to remote monitoring alongside routine podiatry care. Users were asked to stand on the investigational device (in the form of a home weight scale) for 30s per day at home. Plantar thermal and visual data were captured and transmitted to a cloud-based server for daily review. Scans with abnormalities were reported to patients’ healthcare provider (HCP) who determined best course of intervention. Primary endpoint was mean patient adherence across the study. Likert scales assessed a) HCP reported utility of data to perform remote assessment, b) patient reported device usability

Results: Sixteen patients completed 12 study weeks, 11 were withdrawn early (new DFU (7), technical issues) after 59.2 ± 22.3 days. 1,547 daily scans were taken during 1,940 active study days. Mean patient adherence to daily device use was 80% (±19) and 91% had high adherence (≥3 scans/wk). From 73 reported scans: in 62% of cases HCPs did remote interventions (25%) or continued to monitor (37%); in 39% of cases HCPs scheduled in-person care. HCPs strongly agreed/agreed that they could use these data to remotely assess patients’ foot health (96% reports) and help identify issues earlier than standard care (82% reports). HCPs found temperature data useful in 12% of reports vs. 90% for visual data. All patients agreed they were satisfied with the device and found it easy to use

Conclusions: Remote monitoring of vulnerable patients was achieved with good adherence, clinical utility and patient satisfaction. Future studies are warranted to assess the impact on DFU prevention

Disclosure

C. Abbott: Research Support; Bluedrop Medical. K. Franklyn: Research Support; Bluedrop Medical. D. Stuart: Research Support; Bluedrop Medical. E. Kirwan: Research Support; Bluedrop Medical. S. Flynn: Research Support; Bluedrop Medical. C.D. McIntosh: None. A.J. Boulton: None.
526-P: Risk Factor for Prolonged Hospital Stay in Patient with Diabetes-Related Foot Infection Admitted to a Specialized Unit—A Retrospective Cohort Study
Authors: LOPEZ-HUAMANRAYME EDDY , PASQUEL FRANCISCO J. , CAYCHO ANGELICA , ROQUE-QUICO KEVIN R. , CORDOVA-HUANCAS CLAUDIA C. , ALFEREZ CONDORI JHANIRA B. , FLORES FIDEL , TAMAYO CARLOS W.
Published: June 2024

Introduction: Diabetes-related foot infections (DFI) demand high costs for health systems due prolonged hospital stay (PHS). We evaluated factors associated with PHS in patients hospitalized with DFI.

Methods: We conducted a retrospective cohort study of patient>18 years hospitalized in a Peruvian hospital, during 2020 and 2021. Characteristic of patients and wounds were collected, such as the wound treatment (conservative care, minor/major amputation, and surgical debridement) and we evaluated its association with PHS, >10 days, using Poisson regression, to calculate adjusted relative risks (aRR) with their 95% confidence interval.

Results: Data from 228 patients were analyzed, 76.3% were men, the mean age was 66 years, 56.6% had previous atherosclerotic cardiovascular disease (ASCVD). The median wound length was 3.5 cm, 59.5% pf patients had peripheral arterial disease, 50.5% received conservative wound care, and 49.6% had a prolonged hospital stay. Prolonged hospital stay was associated to wound length > 5 cm (aRR=1.63, 95%CI: 1.17 to 2.26), major amputation/surgical debridement (aRR=2.04, 95%CI: 1.4 to 2.97), minor amputation (aRR=1.79, 95%CI: 1.22 to 2.63), and previous ASCVD (aRR=1.4, 95%CI: 0.8 to 1.84).

Conclusion: About half of the patients had a PHS, which was associated with longer wound length, type of wound treatment, and history of ASCVD.

Disclosure

E. Lopez-Huamanrayme: None. F.J. Pasquel: Research Support; Tandem Diabetes Care, Inc., Insulet Corporation, Dexcom, Inc., Ideal Medical Technologies, Novo Nordisk. Consultant; Dexcom, Inc., Medscape. A. Caycho: None. K.R. Roque-Quico: None. C.C. Cordova-Huancas: None. J.B. Alferez Condori: None. F. Flores: None. C.W. Tamayo: None.

Funding

Oficina de Docencia e Investigación, Hospital Nacional Alberto Sabogal Sologuren
530-P: Self- and Family-Management Experiences of Barriers and Facilitators in the People Living with Diabetic Foot Ulcers and Comorbidity—A Qualitative Study
Authors: SHI SHUPENG
Published: June 2024

Objective: Diabetic foot ulcers are the leading cause of lower extremity amputations and require foot care for healing and prevention of recurrence, especially in family care settings. Patients’ high prevalence of co-morbidity is directly to risks of adverse outcomes including poor functional status and low quality of life, which needs self- and family management (SFM) beyond foot care for better prognosis. This qualitative study aimed to identify factors that impact patients and their families to manage patients’ health and meet health-related goals after discharge.

Methods: Semi-structured in-depth interviews were conducted with 15 patients and 6 informal caregivers based in China. Patients were eligible if they had completed primary diabetic foot treatment and had at least one other chronic condition. The SFM framework was used to inform the interview outline and data analysis.

Results: Twenty-six themes were mapped onto the 5 domains of SFM as barriers and facilitators. These themes include (1) health status: high symptom burden and impaired cognitive function were prominent barriers, as well as (2) personal/lifestyle: emotional factors including fear and lack of knowledge. “Maintaining whole body” in the Chinese culture motivated patients and their families to perform SFM. (3) resources: financial and equipment constraints also hindered SFM. (4) environment: social network shaped attitude and involvement in SFM. (5) health care system: service access and relationship with health providers also shaped SFM’s effect.

Conclusion: Elucidating the impact factors identified in this study allows for a more systematic selection of strategies that may improve the design of effective interventions for diabetic foot patients with co-morbidity. Adding symptom management and dementia-friendly interventions to the current foot care program may improve accessibility and quality of care.

Disclosure

S. Shi: None.

Funding

Guangdong Provincial Fundamental and Applied Fundamental Research Regional Joint Fund-Key Project (2020B1515120076)
531-P: Role of Social and Family Status in Long-Term Follow-up of Patients with Diabetic Foot
Authors: GOROBEIKO MAKSYM , DINETS ANDRII , MARCHENKO OLGA , PRYSTUPIUK MAKSYM
Published: June 2024

Patients and Methods: 396 patients were identified from 3 diabetic foot (DF) clinics with follow-up for 1 year (2019-2022). Patients constituted study groups according to their social status: living in family (Group 1, n=154), periodical care (Group 2, n=132), living alone (Group 3, n=110). We estimated quantity of patients with ulcers at time of primary visit, after 6 and 12 months.

Results: 202 (51%) patients were females, 194 (49%) males. Mean age was 59.2±2.7 years. Mean HbA1c was 8.7±1.7%. 56 (14%) patients had HbA1c < 7.0%, whereas 179 (45%) patients had HbA1c > 8.2%. We provided a “fear management strategy” to patients and relatives. However, emotional reaction of single patient was weak and sceptic. Reaction of patients’ relatives was productive with multiple questions. From Group2 on 2nd visit 28 relatives out of 35 came for the first time. At follow-up of 1 year, we detected decreasing of DF ulcers in Group1 from 16% to 10%. In Group2 increasing of ulcers frequency was increased up to 12% (13 patients with new ulcers, of which 11 patients admitted DF clinic alone). In Group3 was increasing ulcers frequency from 20% to 28.5%. 7 patients underwent amputations (5 low-amputations, 2 high-amputation): one patients in Group 1, 6 patients in Group3. Patients who were accompanied by relatives support at time of visit to DFclinic had decreasing of ulcers frequency (baseline-6 months-1 year) 17.4-36.2-18.8%, as compared to patients not-accompanied with relatives for 8-34-31%, respectively. After beginning of Russian aggression against Ukraine 2 DFclinic were closed, but 49 patients were still under the follow-up.

Conclusions: Living in family even under partial care is associated with better benefit for patients. Visit relatives together with patient to DF clinic scientifically improves effect of treatment. Alone patients have higher level of amputation and complications. War is associated with significant and negative impact on DF medical centers and quantity of patients who can possibility to admit clinic.

Disclosure

M. Gorobeiko: None. A. Dinets: None. O. Marchenko: None. M. Prystupiuk: None.
548-P: Multidisciplinary Team Education Has an Effect on Prevention of Renal Function Decline in Subjects with Diabetes and Macroalbuminuria
Authors: HITOMI MAMIKO , MORIYA TATSUMI , MIYATSUKA TAKESHI , HIKI NAOKI
Published: June 2024

It had been well known that the multidisciplinary team approach (MTA) contributes to remission of microalbuminuria in persons with type 2 diabetes, whereas it remains unclear as to whether MTA improves macroalbuminuria, a risk factor of progressive kidney failure. To investigate the effect of MTA on progression of diabetic kidney diseases (DKD) in the subjects with diabetes and macroalbuminuria, 24 subjects were managed by MTA (n=11), or by dietitian approach alone (DA, n=13) during January 2012 and December 2022. The team, which consists of physicians, nurses, and dietitians, provided support and education for DKD subjects: [1] pathophysiology and stages of DKD, [2] medications, [3] daily measurements of blood pressure, blood glucose, and body weight, [4] how to check edema, and [5] medical diet therapy based on estimated protein and salt intake from 24-hour urine collection. There was no significant difference between MTA and DA in types of diabetes, gender, age, frequencies of interventions, and the initial eGFR. HbA1c levels in MTA group (7.5±1.5) was significantly lower than those in DA group (9.7±2.8 %)(p=0.021). During the intervention period, there was a numerical decrease in albuminuria levels in MTA group (906.7 to 349.6 mg/gCr, p=0.511), whereas a numerical increase in DA group (785.1 to 1841.5 (p=0.064). Five subjects were initiated hemodialysis in the DA group, but not in MTA group. DKD stage was improved (A3 to A2) in four MTA subjects during the intervention period. The annual rate of eGFR decline during 4-year observation was significantly better in MTA group than in DA group (-2.78±4.42 vs, -8.18±6.9 mL/min/1.73m2/y, p=0.031). Thus, MTA is likely to prevent deterioration of DKD, compared with DA alone, in DKD subjects with macroalbuminuria. Further studies would be needed to uncover the effects of MTA in the prevention of other diabetic complications.

Disclosure

M. Hitomi: None. T. Moriya: None. T. Miyatsuka: None. N. Hiki: None.
553-P: Digital Storytelling Intervention for Type 2 Diabetes Self-Management among Hispanic Adults—A Randomized Clinical Trial
Authors: WIELAND MARK , VICKERY KATHERINE , GONZALEZ CRYSTAL R. , GOODSON MIRIAM L.P. , NJERU JANE W. , FORD BECKY , O'BYRNE THOMAS J. , SIA IRENE G.
Published: June 2024

Background: Digital storytelling interventions are narrative-based videos elicited through a community-based participatory research (CBPR) approach to surface the voices of participants overcoming obstacles to healthful behaviors that perpetuate health inequities. A digital storytelling intervention for type 2 diabetes (T2D) self-management was developed by a CBPR partnership. Assessment in primary care settings demonstrated feasibility and acceptability of the intervention. This study assessed the intervention impact on glycemic control among Hispanic patients with poorly controlled T2D.

Methods: A randomized controlled trial was conducted at two primary care networks in Minnesota and Arizona among Hispanic adults with poorly controlled T2D (hemoglobin A1c≥8%). Patients were randomly assigned to receive the intervention by viewing the video at the clinical facility plus access to the intervention on a software application or to no intervention. Both groups received usual diabetes care. The 12-minute intervention included an introduction, four stories with transitions, and a closing educational message re-enforcing diabetes self-management goals. The primary outcome was the mean change from baseline of hemoglobin A1c at 3 months. Secondary outcomes included blood pressure, LDL cholesterol, body mass index, and self-reported diabetes self-management behaviors.

Results: There was a small improvement in hemoglobin A1c in the intervention group compared with the control group after adjusting for baseline A1c, age, sex, education, and income (9% to 8.3% in the intervention group compared with 9.4% to 8.8% in the control group, p=0.04). There were no statistically significant changes in secondary outcomes.

Conclusion: A digital storytelling intervention developed with and for Hispanic adults with T2D was highly acceptable and feasibly implemented within primary care settings and resulted in a modest improvement of glycemic control.

Disclosure

M. Wieland: None. K. Vickery: Research Support; National Institute of Diabetes and Digestive and Kidney Diseases. Other Relationship; National Institutes of Health, UnitedHealth Group. C.R. Gonzalez: None. M.L.P. Goodson: None. J.W. Njeru: None. B. Ford: None. T.J. O'Byrne: None. I.G. Sia: None.

Funding

National Institutes of Health (DK113999)
557-P: User Engagement and Usage Patterns in a Mobile Application for Adults with Type 2 Diabetes
Authors: BERLOT ASHLEY , WILSON SCOTT M. , KIM VIVIAN , JARIWALA SUNIT
Published: June 2024

Introduction & Objective: Mobile applications (apps) are effective tools for improving patients’ self-management of chronic health conditions. However, there is a scarcity of published data on how patient-level characteristics are linked to app usage patterns, which could provide insight into factors influencing app engagement and health outcomes. Our study aimed to evaluate the app-usage patterns and participant characteristics of users of the DiabetesXcel mobile app, a diabetes-focused educational mobile app that has been previously shown to improve diabetes-related quality of life and clinical outcomes.

Methods: DiabetesXcel was implemented in the Bronx, NY among adult participants with Type 2 Diabetes. Logistic regression was used to determine the association of baseline characteristics with user logins and app questions answered (AQA) at 6 months. Logins and AQA were dichotomized above and below the mean.

Results: Participants (N=46) were, on average, 47 + 9 years-old, mostly women (71.7%), with half identifying as Black or African American (50.0%) and having public insurance of Medicaid or Medicare (50.0%). The average number of logins was 11 + 24 and AQA was 34 + 40. There were trends of older participants having greater odds of answering more than the mean AQA (OR=1.09 [95% CI 0.99, 1.21], p=0.07) months. Those of non-Black/African American race or ethnicity trended towards lower odds of answering more than the mean AQA (OR=0.14 [95% CI 0.02, 1.30], p=0.08) compared to those who were Black/African American, as did those with non-private insurance (OR=0.14 [95% CI 0.02, 1.30], p=0.08) than those with private insurance.

Conclusion: Our study showed trends towards older participants engaging with the app more, while those identifying as non-Black/African American and with non-private insurance engaged with the app less. Additional studies are needed to further understand this relationship, and potentially tailoring the application to these groups may improve application usage.

Disclosure

A. Berlot: None. S.M. Wilson: None. V. Kim: None. S. Jariwala: None.
559-P: Evaluating the Feasibility and Preliminary Effectiveness of a Tailored Diabetes Education Program for Rural Residents
Authors: SMALLS BRITTANY L. , SETSER BETHANY M. , GONZABATO NELSON
Published: June 2024

Background: Limited access to healthy foods, exercise facilities, and behavior modification skills in rural-dwelling individuals may impact the ability to appropriately manage type 2 diabetes (T2D). We tailored a 6-week diabetes education for a diverse rural Appalachia Kentucky population to determine the effects of the intervention on diabetes knowledge, self-care, and glycemic control.

Methods: A culturally tailored diabetes education was administered to study participants (N=18) with three- and six-month follow-up. The diabetes self-management questionnaire (DSMQ) and the Diabetes Knowledge Questionnaire (DKQ) were used to assess diabetes self-management and knowledge. DKQ scores were expressed as a sum of all 24 items, scaled to 10. A linear mixed effects model was used to measure DSMQ, DKQ, and A1c associations.

Results: Participants were majority white (72%). Mean A1c values decreased from 7.68 to 7.28 at follow-up. Mean DKQ scores increased from 10.50 to 11.25. There was a 0.06 difference between baseline and follow-up mean sum-scale DSMQ). Sum-scale DSMQ was negatively associated with A1c (β=-0.098; 95% CI: -0.356 to 0.161). DKQ scores were positively associated with A1c (β=0.009; 95% CI: -0.054 to 0.071). Six months of the intervention was negatively associated with A1c (β=-0.112, 95% CI: -0.462 to 0.237).

Conclusion: Findings from this pilot and feasibility study suggest that the tailored diabetes education improved diabetes knowledge and glycemic control in rural Appalachia residents living with T2D. A larger study using the tailored education is needed to provide further insight into the intervention's effectiveness.

Disclosure

B.L. Smalls: None. B.M. Setser: None. N. Gonzabato: None.

Funding

National Institutes of Diabetes and Digestion and Kidney Disease (P30 DK020579)
560-P: Optimizing Vision Care for Diabetes Patients—Interprofessional Initiatives to Combat Clinical Inertia in the Management of Diabetic Retinopathy and Diabetic Macular Edema
Authors: TAMAS MARGERY J. , BEYER MICHAEL , BEASER RICHARD S. , FONSECA VIVIAN , MOSHFEGHI ANDREW A. , DREW HEATHER N.
Published: June 2024

Introduction and Objectives: Diabetes specialists (DSs) and primary care professionals (PCPs) play pivotal roles in the screening and referral process for diabetic retinopathy (DR) and diabetic macular edema (DME). Timely screenings and referrals to eye care specialists (ECSs) are critical in preventing vision-threatening complications for patients with diabetes (PWD). Two related activities sought to educate DSs and PCPs on appropriate ECS referrals to directly benefit and improve outcomes for PWD with, or at risk for, DR/DME.

Methods: The activities focused on interprofessional and multidisciplinary strategies to overcome referral barriers. Realistic patient cases with varying degrees of urgency were presented to engage learners and demonstrate the impact of decisions made by DSs/PCPs on patient outcomes. Multiple choice questions pre- and post-activity and intent to change questions post-activity measured the effect of the education.

Results: Total learners: 3,847, including 661 Endocrinologists and 1,726 PCPs

30% absolute improvement in knowledge of their role in the screening and referral process for DR/DME (51% to 81%)27% absolute improvement in skills coordinating timely and appropriate referrals to eye care specialists (59% to 86%)When learners return to practice, most intend to:Refer PWD to ECSs for comprehensive annual exams (89%) and follow up to ensure the exam is performed (92%)Incorporate strategies to overcome barriers to timely and appropriate referral to ECSs (90%)Conclusion: The activities resulted in significant gains in participants' knowledge related to their role in the screening and referral process for DR/DME and their ability to make referrals consistent with current guidelines. As confidence is a key component for effective clinical performance, these and similar initiatives may directly benefit and improve outcomes for PWD with, or at risk for, DR/DME.

Disclosure

M.J. Tamas: None. M. Beyer: None. R.S. Beaser: None. V. Fonseca: Consultant; Abbott, Bayer Inc. Stock/Shareholder; BRAVO4HEALTH, LLC. Consultant; Corcept Therapeutics. Speaker's Bureau; Eli Lilly and Company. Research Support; Fractyl Health, Inc. Consultant; Sun Pharmaceutical Industries Ltd. Stock/Shareholder; Amgen Inc. A.A. Moshfeghi: Research Support; Novartis Pharmaceuticals Corporation. Consultant; Alimera Sciences, Genentech, Inc. Research Support; Genentech, Inc. Consultant; Regeneron Pharmaceuticals Inc. Research Support; Regeneron Pharmaceuticals Inc. Consultant; Ocular Therapeutix. Stock/Shareholder; Ocular Therapeutix. H.N. Drew: None.

Funding

Regeneron (MED-OPT-7842, MED-OPT-7846)
569-P: A CME Webcast Series’ Impact on Clinicians’ Knowledge and Competence of Long-Term Obesity Management in Patients with Type 2 Diabetes Mellitus
Authors: AGARWAL NEHA , CAMPANO JENNY
Published: June 2024

Obesity is one of the main modifiable risk factors for diabetes and adverse cardiovascular events, the latter being the leading cause of mortality in patients with T2D. However, clinicians who treat T2D patients often inadequately address obesity in terms of suboptimal selection of antiglycemic therapies that promote weight loss and fail to recommend comprehensive treatment strategies for long-term obesity management. They also may be unaware of advances in obesity management in high-risk patients. These gaps posed a need for developing activities to educate clinicians regarding the significance of addressing obesity in T2D patients. To address these gaps, we developed and launched a 6-part CME webcast series to assess knowledge/competence changes using pre-/post assessment questions. The series launched in Nov. 2023 with the participation of 7,867 healthcare professionals and 3,538 learners (MD/DO, PAs, RNs, NPs, PharmDs). A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p <0.05). There was a significant increase in knowledge regarding the mechanism of action of novel weight management therapies and key aspects of glycemic management (57% and 59% relative increase in knowledge compared to baseline, p <0.0001). Additionally, a significant increase in competency regarding selecting appropriate treatment for long-term obesity management (52% relative increased to baseline, p<0.0001) was noted. At the post-activity evaluation, an average of 75% of learners indicated that they plan to make changes based on information received, including utilizing patient-first language, encouraging lifestyle modifications, and utilizing weight-neutral /lowering medications to manage glycemic control in their patients.

Disclosure

N. Agarwal: None. J. Campano: None.

Funding

Lilly USA, LLC.Grant ID A-31055
574-P: Intersectional Effects of Language and Education on Prediabetes Inequities in U.S. Latinos
Authors: CAMACHO EUGENIA , ECHEVERRIA SANDRA
Published: June 2024

Introduction: Prediabetes presents a unique opportunity to identify risk factors that can delay or prevent the development of diabetes. Latinos experience a high prevalence of prediabetes and identifying the combined risk of multiple, interconnected sources of social disadvantage can lead to more effective prevention strategies.

Objective: Examine the joint effect/ intersection of language spoken and educational attainment on prediabetes prevalence in US Latinos.

Methods: We combined data from the 2011-2018 National Health and Nutrition Examination Survey restricting the sample to those 18+ years of age, Latino ethnicity, and no diabetes diagnosis (n=4,294). We created a four-level variable measuring the language spoken at home (English only/mostly vs Spanish only/mostly) and educational attainment (<high school="" vs.="" high="" school+),="" with="" english="" only="" and="" education="" as="" the="" referent.="" prediabetes="" was="" based="" on="" laboratory="" confirmed="" a1c="" levels="" of="" 5.7-6.4.="" we="" generated="" weighted="" odds="" ratios="" (or)="" 95%="" confidence="" intervals="" (ci)="" adjusting="" for="" age,="" sex,="" poverty="" income="" ratio="" body="" mass="" index.="" all="" models="" accounted="" complex="" sampling="" design="" significance="" set="" to="" (p <.05) using SAS v9.4.

Results: The prevalence of prediabetes among Latinos was 24.4%. The odds of prediabetes among Spanish only and low education was 1.8 (95% CI: 1.5,2.2) compared to the referent group in fully adjusted models. All other combinations of exposure had significant odds ratios of 1.33-1.38.

Conclusion: This study highlights the added disadvantage of limited English proficiency and education on prediabetes prevalence and suggests the need for more complex interventions addressing multiple sources of disadvantage in Latino adults.

Disclosure

E. Camacho: None. S. Echeverria: None.