bluuebunny/crossref_metadata_2025_split huggingface dataset:
654-P: Detection of Insulin-Derived Amyloid Deposits and the Management of Insulin Injection Site Using CGM and Abdominal Wall CT Examination
Authors: NISHIHARA HARUMI , SUDO TOMIKO , SASAKI JUNKO , HASEGAWA NORIKO , ISHII MASUMI , KOIZUMI CHIAKI , HIRAOKA MEGUMI , IKEJIMA SHIN , HIRAI AIZAN , SUZUKI MIKA 
Published: June 2020

Repetitive injection of insulin causes subcutaneous amyloid deposits leading to impaired blood glucose control due to delayed absorption of the drugs. Amyloid deposits in abdominal wall is detected by CT examinations. Proper selection of the injection site avoiding amyloid deposits is essential. The present study was conducted to establish a novel method for the management of injection site avoiding amyloid deposits.
The present study included 50 diabetic patients who were treated with insulin over 5 years. Two weeks CGM was performed using Free Style Libre Pro. In the case of significant day to day variation in blood glucose control, abdominal wall CT examination was performed. In front abdominal wall, 36 small circular zones were set to identify the site of injection, named “no-injection zone” which caused impaired blood glucose control due to delayed absorption of insulin by amyloid deposits. Site rotation seat was developed for the management of insulin injection site.
Among 50 patients, 33 patients were shown to have “no-injection zone” (average; 8.5 zones). In the patients whose HbA1c is over 8% (n=15), a significant improvement in HbA1c from 9.0% to 7.8% was observed without any changes in daily dose of long-acting insulins by the management of injection site.
The management of injection site using CGM, abdominal CT and site rotation seat improves blood glucose control.

Disclosure
H. Nishihara: None. T. Sudo: None. J. Sasaki: None. N. Hasegawa: None. M. Ishii: None. C. Koizumi: None. M. Hiraoka: None. S. Ikejima: None. A. Hirai: None. M. Suzuki: None.
656-P: Multidisciplinary Predialysis Team Education for Patients with Diabetic Nephropathy Produced Not Only Good Effects on the Hemodialysis Course, but Also Prolonged the Survival
Authors: HITOMI MAMIKO , SATO TERUKO , MORIYA TATSUMI 
Published: June 2020

To determine whether or not a multidisciplinary individual team approach (MTA) benefited the hemodialysis (HD) course and prognosis after HD induction in patients with diabetic nephropathy (DN), we compared the effect of an MTA on the HD course of 42 DN patients with that of 33 DN patients managed by a dietitian approach alone (DA) (n=75 total; 50 men, 62±12 years old; 73 with type 2 diabetes mellitus). In all cases, HD was initiated between January 2010 and June 2016. There were no significant differences in the HbA1c or age between the groups when serum creatinine (S-Cr) was 2.0 mg/dL at the study start. MTA staff members were doctors, dietitians, nurses, laboratory technologists, and pharmacists. The team provided broad education, including advice on nutrition, medication, medical exams, and foot care. The duration from S-Cr 2.0 mg/dL to HD induction was significantly longer in the MTA group (3.3±2.2 yrs) than the DA group (2.3±1.8 yrs; p=0.021). The MTA group had a shorter hospitalization for HD induction and lower cost per admission than the DA group (44±33 days vs. 32±20 days, p=0.035; $20,506 ±14,219 vs. $14,554 ± 826, p=0.019). Urine collection (24-h) was more frequent in the MTA group than the DA group (likelihood ratio 5.05; p=0.025). Patients with urine collection tended to live longer than those without it (8.2±3.1 yrs vs. 6.9±2.6 yrs, p=0.075). The CTR at the HD induction tended to be smaller in the MTA group than in the DA group (53.0±5.7% vs. 55.6±7.3%, p=0.057). The hematocrit value in the MTA group (29.2±4.6%) was significantly better than in the DA group (26.5±4.0%, p=0.004). A Kaplan-Meier survival analysis showed that the MTA group had a better survival than the DA group (log rank 4.430, p=0.035). An MTA provided multiple effects that postpone HD induction, better clinical HD course, cost reduction, and prolonged survival compared with a DA, even when observation was started at the same S-Cr level.

Disclosure
M. Hitomi: None. T. Sato: None. T. Moriya: None.
658-P: Regular Diabetes Ward Round Is Associated with Better Infection Control and Lower Mortality Rate in Inpatients Younger than 80 Years Old
Authors: CHOU SHENGPU , HARAGUCHI MIKIKO , IMAI MIEKO , ISHIBASHI MIDORI , MASANO MIKA , IWATA YOSHIE , ODA YUKO , MOTOGAMI TOMOKO , NAKAMURA SUNAO 
Published: June 2020

Background: While good glycemic control during hospitalization has been reported to have better outcomes and reduced complications, achieving this is difficult in hospitals where diabetes specialists are not present or understaffed. Diabetes ward round by an independent and specialized team (DMWR) is one of the solutions for regular monitoring of glycemic control in inpatients, few studies existed to assess its effectiveness.
Material and Methods: A team composed of two diabetes specialists, one specialized nurse, one dietician, one pharmacist, and one assistant conducted DMWR from May 2017. Hospital inpatients who were at risk of poorly controlled glycemia were given adequate advice to prevent hyperglycemia and hypoglycemia. A total of 384,422 capillary blood glucose measurements were taken from all hospitalized patients from April 2015 to March 2019 and the changes in frequency of hyperglycemic and hypoglycemic episodes were analyzed. Infection control was evaluated by episodes of blood cultures. The mortality rate at discharge and within 90 days of discharge were also calculated.
Results: The odds ratio (OR) for the frequency of pre-prandial hyperglycemia before and after DMWR was 0.430 (95% confidence interval (CI): 0.407, 0.454). The OR for that of severe hypoglycemia was 0.371 (95% CI: 0.265, 0.520). The number of blood cultures was significantly reduced by 26% after DMWR. The mortality rate within 90 days of discharge was also significantly decreased in patients aged less than 65 (OR 0.363, 95%CI: 0.216, 0.609) and from 65 to 79 (OR 0.689, 95%CI: 0.541, 0.856), respectively.
Conclusion: DMWR resulted in improved glycemic control and reduced staff burden for managing severe hypoglycemia and preventable infection events. Moreover, the mortality rate of patients less than 80 years of age was also reduced over the same period, suggesting that stabilizing blood sugar was beneficial for lowering mortality rate in the younger patient population.

Disclosure
S. Chou: None. M. Haraguchi: None. M. Imai: None. M. Ishibashi: None. M. Masano: None. Y. Iwata: None. Y. Oda: None. T. Motogami: None. S. Nakamura: None.
663-P: Medication Adherence (MA) Is an Independent Predictor for Glycemic Control Even after Adjustment for Lifestyle Confounders in Japanese Patients with Type 2 Diabetes
Authors: YAGUCHI YUTA , FUJIHARA KAZUYA , YAMADA MAYUKO H. , SATO TAKAAKI , KITAZAWA MASARU , YAMAMOTO MASAHIKO , SEIDA HIROYASU , YAMANAKA NAUTA , MATSUBAYASHI YASUHIRO , SONE HIROHITO 
Published: June 2020

The impact of MA on glycemic control may be affected by lifestyle confounders but little is known on this topic. We investigated clinical variables significantly associated with MA for OHA and the association between MA and glycemic control considering the effects of smoking, drinking alcohol, exercise and dietary habits in Japanese with DM using a large claims database. Analyzed were 6651 DM patients with medication records for OHA for at least 1 y (mean age 54 y, HbA1c 7.2%). MA was evaluated by the proportion of days covered (PDC), and PDC &lt;80% was defined as non-adherence. Mean PDC was 80.7% and 31.8% of patients were non-adherent. Logistic analysis indicated that older age and taking ≥2 concomitant medications were significantly associated with adherence (odds ratio (OR) 1.34 (95% CI 1.24-1.44) and 1.19 (1.01-1.40), respectively) while smoking and skipping breakfast were significantly associated with non-adherence (OR 0.88 (0.78-0.99) and 0.60 (0.51-0.71), respectively). Multiple regression analysis showed that PDC was negatively correlated with HbA1c after adjusting for lifestyle factors. HbA1c decreased by 0.2% with a 25% increase in PDC. MA was significantly associated with glycemic control even after adjustment for lifestyle factors, suggesting the importance of improving MA in parallel with lifestyle education.

Disclosure
Y. Yaguchi: None. K. Fujihara: None. M.H. Yamada: None. T. Sato: None. M. Kitazawa: None. M. Yamamoto: None. H. Seida: None. N. Yamanaka: None. Y. Matsubayashi: None. H. Sone: Research Support; Self; Kyowa Hakko Kirin Co., Ltd., Novartis AG, Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Co.
664-P: The Case for Targeted Diabetes Medication and Device CME for PCPs
Authors: LEVINE BRIAN J. , MCDERMOTT JAMES M. , LACKNER JOHANNA B. , SHOGER ERIK , STONER KEATON C. , BEASER RICHARD S. , CLOSE KELLY L. 
Published: June 2020

Objective: This study aimed to evaluate primary care physicians’ (PCPs) perceptions of and desired improvements to diabetes continuing medical education (CME).
Methods: In March-April 2019, 306 U.S.-based PCPs who treat people with diabetes and earn diabetes CME credits completed an online survey.
Results: On average, respondents regularly see 391 people with diabetes (38% on insulin) for checkups and allot 16% of annual CME credit hours to diabetes. More than 75% of PCPs believe that improved PCP education could enhance care for people with diabetes and 82% believe that new diabetes technologies and therapies will change their practice significantly over the next five years. Respondents commonly reported that CME does not adequately cover diabetes drugs/devices, cost/insurance, or behavioral health. More than 80% of surveyed PCPs currently initiate and manage diabetes medications, though &gt;55% would prefer to outsource to a diabetes specialist. The trend is reversed for diabetes devices: 34% of PCPs in this study currently initiate and manage CGM, whereas 54% would like to, and 24% currently initiate and manage insulin pumps, whereas 53% would like to. Respondents most commonly used journal articles and online courses—used by 79% and 65%, respectively—to obtain diabetes CME credits, though academic/medical conferences were regarded as the most useful. Nearly all PCPs also believe improved patient education would improve diabetes care.
Discussion: PCPs in this study believe both online and live CME, alongside improved patient education, can help them adapt to the rapidly evolving diabetes management landscape. More PCPs would prefer to outsource diabetes medication management than do currently, suggesting discomfort with managing these medications. Conversely, PCPs would like to take a more active role in diabetes device management. CME could help close both gaps in order to enhance PCPs’ comfort and efficacy in managing diabetes. CGM should be emphasized given its dual applications in diagnostics and therapy.

Disclosure
B.J. Levine: Employee; Self; Onduo. J.M. McDermott: Other Relationship; Self; Various. J.B. Lackner: None. E. Shoger: None. K.C. Stoner: Other Relationship; Self; Various companies and organizations. R.S. Beaser: None. K.L. Close: Other Relationship; Self; Abbott, Air Liquide, American Diabetes Association, AstraZeneca, Dexcom, Inc., Janssen Pharmaceuticals, Inc., JDRF, Leona M. and Harry B. Helmsley Charitable Trust, Lilly Diabetes, Merck & Co., Inc.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
668-P: Experiencing a New Role for the Diabetes Educators Recruiting for Longitudinal Studies, Kuwaiti Experience
Authors: RAHME ZAHRA , TAHA NEHAD A. , MESBAH NAGLAA 
Published: June 2020

Background: Kuwait is the second highest country in the incidence of T1D globally. Familial study of this disease may disclose certain causative agents responsible for passing the disease through families. The recruitment of T1D patients and their family members to participate in a Kuwaiti autoimmune diabetes (KADS) Study was challenging. It is a longitudinal study, it required taking blood samples every 6 months for 3 years duration for all family members of a person with diabetes. It is important to note that, in Kuwait, convincing families to participate in researches were an extremely difficult task which needs a highly skilled personal to persuade family participations.
Aim: This abstract aimed to examine different recruitment approaches which were used and highlights the role of diabetes educators (DE) in the recruitment process.
Method: Three recruitment approaches were examined.1-Physician-approach; recruitment took place through their physicians follow up visit.2-Research coordinator (RC) approach recruitment took place in the clinic area. While patient is waiting for his medical appointment the research coordinator offers participating in the research.3-DE approach Recruitment took place through their educator follow up visit.
Results: Physicians were able to recruit 22 participants, but none of them completed the process of participation. While the RC could not recruit any participants. However, the DEs were able to recruit 274 participants.
Conclusion: Although the Kuwaiti families are generally obedient to their doctors, the physician were not able to recruit only few participants for this study. In contrast, the prolonged pre-established good relationship between the patient, family and the DE resulted in mutual trust and facilitated the process of recruitment. Hence, more subjects were recruited compare to the physician and the RC approaches. Thus, the DE approach was proved to be a successful approach to recruit people for researches.

Disclosure
Z. Rahme: None. N.A. Taha: None. N. Mesbah: None.
671-P: Recruitment and Retention of Minority Women for Women in Control 2.0: A Virtual Diabetes Self-Management Education Study
Authors: BRAGG ALEXA , GARDINER PAULA , WOODS SHAKIYLA B. , HOWARD JESSICA M. , MITCHELL SUZANNE 
Published: June 2020

Background: Research is needed to improve diabetes care of minority women who are disproportionately affected by type 2 diabetes. Yet, barriers exist that hinder efforts to include minority women in research. Evidence suggests that successful study enrollment requires multiple recruitment strategies. Little is known about the correlation between recruitment strategy and retention. We aim to examine the relationship between Women in Control (WIC) recruitment strategies, enrollment rates, and retention.
Methods: We utilized multiple strategies to recruit minority women, including culturally-tailored invitation letters and phone calls to targeted Boston Medical Center patients, referrals from clinicians and WIC participants, word of mouth, social media, and posted flyers. We analyzed WIC recruitment data to determine the proportion of participants recruited by each method. We then assessed the proportion of WIC participants who adhered to the Diabetes Self-Management Education (DSME) study protocol by recruitment method.
Results: Overall, targeted recruitment methods (letters and phone calls) yielded the highest number of screens and enrollments with a total of 975 screened, 207 found eligible, 195 enrolled - with 75% of those enrolled, attending 5 out 8 DSME medical group visits (MGV). Recruitment flyers generated the second most potential participants with a total of 73 screened, 18 found eligible and enrolled - with 83% attending 5 out of 8 MGV. All other recruitment methods (clinician or participant referral, word of mouth, social media and unknown source) combined yielded a total of 85 screened, 23 found eligible, 23 enrolled - with 78% attending 5 out of 8 MGV.
Conclusion: Although we used multiple methods to recruit minority women, our data shows that targeted recruitment - using culturally tailored messaging - was the most effective recruitment method. There was no relationship between recruitment method and retention in the intervention.

Disclosure
A. Bragg: None. P. Gardiner: None. S.B. Woods: 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)
675-P: Diabetes Care and Education Specialists: Opportunities to Improve Glycemia in Disadvantaged Communities
Authors: MON SANN , MEHROTRA NEHA , REN DIANXU , DEJESUS CARLA , SIMINERIO LINDA M. 
Published: June 2020

The number of people with DM continues to increase, with an inverse proportion of providers and specialists available to provide comprehensive care and support. This is especially troublesome for those at highest risk in underserved areas. Diabetes self-management education and support (DSMES) are critical to achieving quality outcomes. Yet reports show that patients are not participating in traditional DSMES approaches, subsequently DSMES programs are at risk of closure. In response, diabetes educators (DEs), now referred to as Diabetes Care and Education Specialists, are seeking new opportunities to provide services that include attention to behavioral and psychosocial issues. A coordinated care (CC) model was organized to address complex needs of those with DM in a disadvantaged community. The local endocrinologist sought assistance from a hospital-based program to provide coordinated care and DSMES on established clinic days. The DE was available for ongoing follow up and liaising to community services. Overarching goal was to lower mean A1C &lt;8%. Of 80 patients who received care in the DM clinic, majority with type 2 DM (80%) 52.5% F, mean age 57.1±14.1 years, BMI of 34.1 49±10.4 kg/m2 and A1C 9.2%, 49 patients agreed to participate in the CC program while 31 patients received usual care (UC) (traditional visit with endocrinologist only). No statistical differences were found in age, sex, BMI, or mean A1C between groups at baseline. Percent of patients with A1C &lt;8% in CC as compared to UC was 26.5% vs. 29% at baseline (p=0.8); 65% vs. 61.5% at 3 months (p&gt;0.99), 59.3% vs27.8% at 6months(p=0.07); 66.7% vs. 35% at 12 months (p=0.03). The majority of patients in the CC group, maintained lower A1C levels, meeting the immediate target of &lt;8%, while the UC group experienced a consistent rise in A1C over the course of the intervention. A provider-DE model offers a framework for providers and DEs to help a population of patients with complex needs to reach and sustain improved glycemia.

Disclosure
S. Mon: None. N. Mehrotra: None. D. Ren: None. C. DeJesus: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company.
677-P: Use of a Hybrid Closed-Loop System Lowers CHO Requirements during Prolonged Exercise
Authors: MUELLER-KORBSCH MICHAEL , FRUEHWALD LISA , HEER MICHAEL , FANGMEYER-BINDER MARIA , REINHART-MIKOCKI DAVID , FASCHING PETER 
Published: June 2020

Some individuals with type 1 diabetes (T1D) use the DIY Kit RileyLink Loop System (Loop) during exercise to avoid hypoglycemia and maintain optimal glucose levels; however, the system has no regulatory approval. This exploratory retrospective analysis assessed carbohydrate (CHO) requirements for maintaining glucose in target range (70-180 mg/dL) during and after 2 days of prolonged cycling, comparing the Loop with rtCGM plus insulin pump (rtCGM+P). Seven T1D adults (2 female/5 male, age 41±11 years, 6.1±0.8% A1C) were enrolled. Cycling was divided into two parts each day (Part 1, 28 miles; Part 2, 17 miles) with an hour lunch between parts. CHO intake was lower in the Loop group vs. rtCGM+P on Day1. (Table 1) More CHOs were required on Day2 than Day1 with Loop use (rtCGM+P users did not cycle on Day2). Prandial insulin doses were notably lower at the Day2 lunch meal vs. Day1 44 g CHO/IU vs. 6 g CHO/IU. Loop users vs. rtCGM+P users spent notably less time &lt;70 mg/dL on Day 1 (5.4 ± 4.4% vs. 12 ± 17%, respectively) and Post Exercise Day (3.8 ± 2.8% vs. 0.5 ± 0.7%, respectively). Time spent within 70 - 180 mg/dL were comparable on Day1 (84 ± 16% vs. 82 ± 17%, respectively) and Post Exercise Day (88 ± 10% vs. 91 ± 11%, respectively. Use of the Loop was associated with lower CHO requirements during prolonged exercise. Loop settings must be adjusted before and after exercise to maintain glucose levels &lt;220 mg/dL.

Disclosure
M. Mueller-Korbsch: Research Support; Self; Dexcom, Inc., Menarini Group, Novo Nordisk A/S. L. Fruehwald: None. M. Heer: None. M. Fangmeyer-Binder: None. D. Reinhart-Mikocki: None. P. Fasching: None.
679-P: Endothelial and Hematopoietic Progenitor Cells Are Reduced at Rest and Have an Attenuated Mobilization Response to Exercise in People with Type 1 Diabetes
Authors: TAYLOR GUY S. , SMITH KIERAN , SCRAGG JADINE , BASHIR AYAT , FLATT ANNELIESE , STEVENSON EMMA J. , SHAW JAMES A. , ROSS MARK D. , WEST DANIEL J. 
Published: June 2020

Aims: Endothelial and Hematopoietic Progenitor Cells (EPCs and HPCs) promote vascular health through secreting proangiogenic factors and replacing damaged cells. Exercise has been shown to be a mobiliser of these rare cells in healthy individuals, however, the response in chronic diseases such as type 1 diabetes (T1D) is unclear. We compared EPC and HPC counts at rest and after acute exercise in people with and without T1D.
Methods: Thirty T1D participants (38±12 years, HbA1c 58.5±9.3 mmol/mol-1, diabetes duration 20±13 years) and 30 age, sex, BMI and fitness matched non diabetes controls were recruited. After a maximal exercise test, participants attended a second visit to complete 45mins of walking at 60%VO2peak. Blood samples were taken at rest, immediately and 1 hour post exercise. Circulating levels of two HPCs and five EPC phenotypes were enumerated by flow cytometry. Data (mean±SD) were analysed by mixed model ANOVA and t-test with significance accepted at p≤0.05.
Results: The T1D group had significantly lower rest count of HPCs and EPCs, ranging from 21 to 41% lower across all samples compared to the control. Exercise mobilized all cell phenotypes in both groups, with significant increases from rest to post exercise, while HPCs and CD34+CD31+ EPCs remained elevated 1hr post exercise. However, the change (Δ) in HPCs and EPCs from rest to post exercise was greater in the control versus T1D group, with higher CD34+CD45dim HPCs (p=0.03, Δ 48±65 vs. 24±33 cells/ml), as well as CD34+CD31+ (p=0.04, Δ 23±19 vs. 15±25 cells/ml) and CD34+VEGFR2+ EPCs (p=0.02, Δ 24 ±24 vs. 15±31 cells/ml).
Conclusion: People with T1D have reduced numbers of HPCs and EPCs at rest and also display a blunted exercise induced increase in these rare blood vessel protecting cells. Further research is needed to understand the clinical significance of an attenuated exercise mobilization of these EPCs and HPCs phenotypes in predicting future cardiovascular complications in T1D.

Disclosure
G.S. Taylor: None. K. Smith: None. J. Scragg: None. A. Bashir: None. A. Flatt: None. E.J. Stevenson: None. J.A. Shaw: Advisory Panel; Self; Medtronic. Speaker’s Bureau; Self; Novo Nordisk A/S. M.D. Ross: None. D.J. West: None.

Funding
Diabetes Research & Wellness Foundation (to D.J.W.)