bluuebunny/crossref_metadata_2025_split huggingface dataset:
637-P: Factors Related to Recruitment and Retention of Patients into Diabetes Group Visits
Authors: NAIK AADITI G. , STAAB ERIN M. , LI JEFFERINE , WAN WEN , SCHAEFER CYNTHIA T. , CAMPBELL AMANDA , QUINN MICHAEL T. , BAIG ARSHIYA A. 
Published: June 2020

Background: Diabetes is a chronic disease requiring medical treatment and self-management. Group visits (GVs) are one way to deliver care and provide self-management education to patients with diabetes. While studies have examined the impact of GVs on clinical outcomes, no study to date has examined factors related to recruitment and retention of patients in diabetes GVs.
Methods: We examined the association between patient characteristics and GV attendance of 83 patients enrolled in a GV intervention in six Midwestern FQHCs in an ongoing cluster randomized trial. Patients with uncontrolled type 2 diabetes (A1C &gt;8%) who were seen in clinic in the past year were eligible. Linear mixed models were used to evaluate associations between retention of patients and race, language, comorbidities burden, diabetes empowerment score, diabetes distress score, diabetes social support, and duration of diagnosis. A Chi-squared analysis was performed to compare enrolled and unenrolled patients and test for association with patient recruitment method.
Results: Of 280 eligible patients reached by FQHCs, 44% (24/55) of patients contacted in person were recruited into the study, compared to 25% (56/225) of those contacted by telephone and/or mail (P=0.006). In the multivariate analysis, patients with more GV attendance were associated with higher diabetes empowerment score (P=0.03) and likely heavier comorbidities burden (P=0.08).
Conclusion: In-person recruitment for group visits was more effective than recruitment by telephone or mail. Patients with more comorbidities and those who felt less empowered to manage their diabetes at baseline were most motivated to attend GVs, suggesting that patients with multiple chronic conditions who need more support in disease management may be most interested in receiving care in a group setting. This finding may be especially important for FQHC providers taking care of underserved populations who face greater barriers to self-management in traditional care settings.

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

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

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

Disclosure
A.L. Fortmann: None. A. Philis-Tsimikas: Advisory Panel; Self; Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. S.R.S. Bagsic: None. D.G. Vital: None. J.A. Jones: None. H. Sandoval: None. K.L. Savin: None. T. Clark: None. K. Luu: None. J.G. Godino: None. L. Gallo: None.

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

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

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

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

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

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

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

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

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

Purpose: To characterize Latina experiences of a Spanish-language DSME program delivered in the VW versus a F2F format.
Methods: Qualitative analysis of transcripts from three semi-structured focus groups conducted with 22 randomly selected Latina women enrolled in the Women in Control (WIC) DSME comparative effectiveness study. Two researchers coded the data and conducted a qualitative thematic analysis. Audio recordings were transcribed verbatim.
Results: A total of 73 Latinas living with uncontrolled type 2 diabetes enrolled in the WIC study with an average age of 52yo, ∼75% had less than a high school diploma and more than 40% reported low health literacy. Four overarching themes were identified and applied to both VW and F2F formats, including (1) the impact of depression on diabetes self-care, (2) strong desire for actionable education (3) high value on peer coaching and positive group culture. One additional theme was identified among VW participants - (4) Positive Technological Development (PTD) - the sense of agency developed through learning to use technology for DSME.
Conclusion: Latina women with diabetes with low health and computer literacy were positively impacted by the Women in Control DSME program both in F2F and in a VW. The VW platform facilitated PTD even among those with very low literacy and computer experience.

Disclosure
K. Melo: None. A. Bragg: None. L.D. Laird: None. P. Gardiner: None. J.M. Howard: None. S. Mitchell: Speaker’s Bureau; Self; Merck Sharp & Dohme Corp. Stock/Shareholder; Self; See Yourself Health, LLC.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK106531-05S1)
68-LB: Use of Real-Time CGM Is Associated with Fewer Hospitalizations Compared with SMBG in the Insulin-Treated Medicare Population
Authors: PUCKREIN GARY , MARRERO DAVID G. , PARKIN CHRISTOPHER , NORMAN GREGORY J. , XU LIOU , LYNCH PETER M. , TAYLOR BRUCE T. 
Published: June 2020

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

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

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

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

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

Background and Aims: Moderate-to-vigorous physical activity (MVPA) could reduce both the incidences of type 2 diabetes in the general population and of cardiovascular events in patients with type 2 diabetes. Several guidelines have indicated that patients with diabetes were advised to perform MVPA for &gt;150 min per week. Recent studies have not shown apparent harmful effects of physical activity in patients with diabetic nephropathy. However, the association between physical activity and microalbuminuria remains unknown. Thus, MVPA time was evaluated using an accelerometer, and its association with microalbuminuria was investigated in the present cross-sectional study.
Materials and Methods: MVPA time was measured using a tri-axial accelerometer ActiGraph (ActiGraph Corp., Pensacola, Florida). Patients with diabetes were instructed to use the accelerometer for 7 days, except while bathing and sleeping. MVPA was defined as &gt;1,952 counts per min. The association between MVPA and log urine albumin-to-creatinine ratio (UACR) was assessed using the linear regression model. In the multivariate model, age, gender, height, body weight, grip strength, blood pressure, sedentary time, hemoglobin A1c, estimated glomerular filtration rate, total cholesterol, insulin use, and ACE/ARB inhibitor use were used as covariates.
Results: Among 236 patients (157 men, 66.5%), the mean age, body mass index, hemoglobin A1c, daily MVPA, and median UACR were 65.5 ± 9.3 years, 23.3 ± 3.4 kg/m2, 7.4% ± 1.0%, 27.2 ± 24.5 min, and 11.8 mg/gCr, respectively. Approximately 7.7% of patients had microalbuminuria of &gt;300 mg/gCr. Log UACR was associated with daily MVPA in the univariate (r = −0.17, P = 0.010) and multivariate models (ß = −0.14, P = 0.046).
Conclusion: MVPA time was associated with UACR in Japanese patients with type 2 diabetes. Although patients with severe diabetic nephropathy have low physical activity levels, patients included in this study had no or mild nephropathy.

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

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

Disclosure
J.E. Layne: Employee; Self; Onduo. H. Zisser: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. R.M. Bergenstal: Consultant; Self; Ascensia Diabetes Care, Johnson & Johnson. Other Relationship; Self; Abbott, Dexcom, Inc., Hygieia, Lilly Diabetes, Medtronic, Novo Nordisk A/S, Onduo, Roche Diabetes Care, Sanofi, UnitedHealth Group. R.A. Gabbay: Advisory Panel; Self; FormHealth, Health Reveal, Lark, Onduo, Vida Health. N.A. Barleen: Employee; Self; Onduo. D.P. Miller: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. R.F. Dixon: Employee; Self; Onduo.