bluuebunny/crossref_metadata_2025_split huggingface dataset:
1300-P: Empowering Youth with Diabetes (DM): Characteristics and Initial Outcomes of a Novel Diabetes Transition Program (DTP)
Authors: LIBMAN INGRID , KRALL JODI T. , FISCHL ANDREA F. , FINNEY JESSICA , DIAZ ANA M. , SIMINERIO LINDA M. , CHARRON-PROCHOWNIK DENISE , BECKER DOROTHY J. 
Published: June 2020

Adolescents and young adults (AYA) with DM have increased risk of poor outcomes. The DTP was created to equip AYA with knowledge, support, and skills to foster successful lifelong DM self-management. This 1-year (4 visits) program pairs clinical care with peer-group discussions led by a multidisciplinary team focused on informed decision making of issues relevant to AYA with DM. The purpose of this study was to characterize the population referred to DTP and evaluate concerns, program adherence and outcomes. Medical records were reviewed and surveys administered. To date 153 AYA were referred (51% females, 99% T1DM, age at 1st visit 18.8±1.4 yrs, age at onset 9.7±4.7 yrs, HbA1c 9±2%). In ranking concerns of 5 complications (retinopathy, neuropathy, reproductive health complications, nephropathy and hypertension) at the 1st DTP visit, 60% of males and 57% of females who completed the survey rated retinopathy as their number 1 or 2 concern. Reproductive health and hypertension were listed as their least concern by 43% of males and 42% of females respectively. In terms of program adherence, the majority (60%, n=92) completed DTP on schedule (1 year). Of these, 42% transferred to adult care, 52% continued care at the institution and 6% were lost to follow up. Of those who did not complete DTP over 1 year (40%), 25% transferred to adult care before DTP completion, 60% are completing DTP in more than 1 year, and 15% were lost to follow up. Those who transferred to adult care (irrespective of program completion time), versus those who did not, had lower HbA1c at all DTP visits (e.g., 1st visit: 8.1 ± 1.4% vs. 9.4 ± 1.7%, p=0.01). In terms of outcomes for those that completed the program, no differences were found in HbA1c from the 1st to 4th visit.
In conclusion, AYA referred to DTP appear to be a high-risk population based on their HbA1c and suboptimal program adherence. This highlights the need for methods (e.g., telehealth) to continue to engage this population and ongoing self-management support.

Disclosure
I. Libman: Consultant; Self; Novo Nordisk A/S. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. A.F. Fischl: None. J. Finney: None. A.M. Diaz: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. D. Charron-Prochownik: None. D.J. Becker: None.

Funding
David Paul Diabetes Transition Care Research Initiative Fund
1301-P: Factors Predicting Diabetes Distress over 18 Months in Teens with Type 1 Diabetes (T1D)
Authors: MCGILL DAYNA E. , VOLKENING LISA K. , COMMISSARIAT PERSIS V. , WASSERMAN RACHEL M. , ANDERSON BARBARA , LAFFEL LORI M. 
Published: June 2020

Background: Teens with T1D are burdened by physical, social, and emotional challenges that can lead to diabetes distress, impacting self-care and health outcomes. We assessed diabetes distress and associated factors in teens with T1D over 18 months.
Methods: At baseline, 6, 12, and 18 months, teens (N=301), ages 13-17 years, completed the Problem Areas in Diabetes Survey - Pediatric version (PAID-Peds), a validated 20-item survey measuring diabetes distress over the past month. Higher scores (range 0-100) indicate more distress; ≥41 = high distress. Mixed linear models assessed factors associated with changing diabetes distress over time.
Results: At baseline, teens (49% male, 78% white) were 15.0±1.3 (M±SD) years old with T1D duration 6.5±3.7 years; 84% were from 2-parent families. Youth checked BG 4.5±1.9 x/day; 59% were pump-treated; A1c was 8.5±1.1%. At baseline, 45% of teens endorsed high diabetes distress and females were disproportionately affected (54% vs. 36% of males, p&lt;.01). In follow-up, 75% of teens with high baseline distress and 24% of teens with low baseline distress endorsed high distress at ≥50% of follow-up time points. High baseline distress strongly predicted subsequent distress (OR 9.6 [95% CI: 5.6, 16.5], p&lt;.0001). Female sex and increasing A1c predicted increasing distress. In teens with high baseline distress, decreasing BG monitoring predicted increasing distress. In those without high baseline distress, only increasing A1c predicted increasing distress. Factors such as zBMI, race, family structure, household income, parental education, pump use, or use of continuous glucose monitors did not predict distress over time.
Discussion: A substantial proportion of teens with T1D experience high diabetes distress. Rising A1c is a major factor associated with worsening diabetes distress over time. Interventions targeting teens with diabetes distress and/or increasing A1c may positively impact self-care and simultaneously help to manage distress and improve A1c.

Disclosure
D.E. McGill: None. L.K. Volkening: None. P.V. Commissariat: None. R.M. Wasserman: None. B. Anderson: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.

Funding
National Institutes of Health (R01DK095273, K12DK094721, P30DK036836), JDRF (2-SRA-2014-253-M-B)
1302-P: Shared Decision Making in Type 1 Diabetes (T1D) Care: Insights from the CoYoT1 to California (CTC) Study
Authors: FLORES GARCIA JAQUELIN J. , PYATAK ELIZABETH , REID MARK W. , FOGEL JENNIFER L. , DIAZ JESUS , RAYMOND JENNIFER 
Published: June 2020

Introduction: CTC is a 15-month intervention study evaluating a patient-centered, home telehealth care model for young adults (YA) ages 16-25 with T1D. The patient-centered CoYoT1 Care arm includes a shared decision-making tool completed by providers (n=3) and patients (n=47) prior to each visit. The present analysis examines how patients and providers collaborated to shape initial visit agendas. Methods: Six potential topics were each rated on a 1-5 scale, where higher values indicate greater importance. Patient and provider ratings within each topic were compared using paired t-tests. Next, ratings were compared between visits where a topic was discussed or not discussed using independent t-tests; patient and provider data were evaluated separately.
Results: Blood sugar ranges and supply/medication issues were discussed most frequently. Providers assigned higher overall importance to emotional well-being than their patients (p=0.005), but this topic was only discussed when patients assigned higher importance (p=0.001). Also, despite higher provider ratings, blood sugar ranges were only discussed when patients assigned higher importance (p=0.003). Discussion: Consistent with the CoYoT1 Care model, patients and providers collaborated to shape visit agendas, slightly favoring the patient perspective. Topics discussed were those assigned higher importance by patients and providers.

Disclosure
J.J. Flores Garcia: None. E. Pyatak: None. M.W. Reid: None. J.L. Fogel: None. J. Diaz: None. J. Raymond: None.
1304-P: Glycemic Trends in a Hockey Camp for Youth with Type 1 Diabetes (T1D)
Authors: RIDDELL MICHAEL , LI ZHAOMIAN , GAL ROBIN L. , MAZZUOCCOLO ANNA , GREENE ELLIS , CALHOUN PETER , BEAULIEU LINDSEY C. , CLEMENTS MARK A. , SHERR JENNIFER , PATTON SUSANA R. , BECK ROY 
Published: June 2020

Understanding glucodynamics in youth with T1D during a variety of physical activities (PA) may help guide management customized to type of activity. The present study profiled PA, heart rate (HR) and glycemia in youth participating in 5-day hockey camp. Youth attending the Dskate hockey camp, which includes daily hockey drills (D), a tournament (T), mixed martial arts (MMA) and off-ice activities (O), were invited to participate. Data were collected from wrist-based HR (Garmin vívosmart® 3) and Dexcom G5. Thirty-one youth (age 13±2 yrs; 94% on CSII and all using CGM; BMI percentile 69±21%; insulin dose 42±18U/d; HbA1c 7.7±0.8%; duration of T1D 6±3yrs) participated in this observational study. During the day camp, time in range (70-180mg/dL) was 57±15% (mean±SD), time &gt;180mg/dL was 41±16%, and the median time &lt;70mg/dL was 1.7% (IQR: 1.0-3.6%). Mean glucose levels during the activity fell from onset in D (from 183±79 to 170±74 mg/dL) and MMA (201±77 to 194±67 mg/dL), but rose in T (174±53 to 188±50 mg/dL) and O (172±63 to 178±60 mg/dL). HR was similar across activities (110±12 bpm). In a cohort of motivated youth attending a hockey camp, glucose levels tend to drop during practice and MMA but tend to rise in tournaments and in off-ice activities. Future studies will use similar wearable technologies to examine glucodynamics in a larger observational study of a more diverse sample of youth living with T1D.

Disclosure
M. Riddell: Advisory Panel; Self; Zucara Therapeutics Inc. Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc., Insulet Corporation. Speaker’s Bureau; Self; Medtronic, Novo Nordisk A/S. Z. Li: None. R.L. Gal: None. A. Mazzuoccolo: None. E. Greene: None. P. Calhoun: Stock/Shareholder; Self; Dexcom, Inc. L.C. Beaulieu: None. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc. J. Sherr: Advisory Panel; Self; Bigfoot Biomedical, Cecelia Health. Consultant; Self; Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Medtronic, Sanofi, T1D Exchange. S.R. Patton: None. R. Beck: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
1307-P: Do Youth Want Psychosocial Screenings in Diabetes Clinic? Profiles of Acceptability
Authors: WONG JESSIE J. , HANES SARAH , LANNING MONICA S. , TANENBAUM MOLLY L. , NARANJO DIANA , HOOD KOREY K. 
Published: June 2020

Background: Psychosocial screening is recommended and increasingly common, but little is known about youths’ perspectives on screenings.
Methods: One hundred and twenty-four adolescents (57.7% female) ages 12-21 years (M=16.2±2.3) completed routine, clinic-integrated screenings. K-means clustering derived profiles and ANOVA assessed correlates profiles.
Results: Four distinct profiles emerged (Table 1). Profiles varied by depression (F=3.54, p=0.017), diabetes distress (F=3.27, p=0.036), and A1c values (F=4.03, p=0.009). Majority (72.6%) placed high importance on diabetes teams awareness about their emotions and reported no difficulties/discomfort (Embracers). Those uncomfortable with screening (Avoiders) were most depressed and had lowest A1C. Youth who endorsed difficulties with tablet and placed low importance about team awareness about their emotions (Skeptics) had relatively high depression but least diabetes distress. A small fourth group (Strugglers; n=3) must be interpreted with caution due to size. No differences were found for age, gender, diabetes duration/type, race/ethnicity, self-rated global health, or anxiety.
Conclusions: Most youth responded favorably to in-clinic psychosocial screenings. Those less satisfied may have increased mental health risk and may benefit from technical support and an emphasized rationale for screenings.

Disclosure
J.J. Wong: None. S. Hanes: None. M.S. Lanning: None. M.L. Tanenbaum: None. D. Naranjo: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ.
1315-P: Application of Multiplex ECL Assay in Mass Screening for Presymptomatic Type 1 Diabetes
Authors: JIA XIAOFAN , HE LING , MIAO DONGMEI , WAUGH KATHLEEN , FROHNERT BRIGITTE I. , STECK ANDREA , REWERS MARIAN , YU LIPING , GENO RASMUSSEN CRISTY R. 
Published: June 2020

Islet autoantibody (IAb) assays for a general population screening should ideally be high-troughput, low-cost, and offer high-sensitivity and high positive predictive value in a low-risk population. The Autoimmunity Screening for Kids (ASK) study has compared the performance of the ’gold standard’ radiobinding assays (RBAs) and a multiplex electrochemiluminesence assay (ECL) in a large unselected pediatric population. Single IAb by RBA but negative by ECL have been previously shown to be low-affinity and of low predictive value for progression to clinical diabetes. From 2017-2019, ASK screened for IAbs 23,400 Colorado children ages 1-17 y. A high-throughput multiplex ECL assay combining IAbs to insulin, GAD and IA-2 in one single well was used in parallel with standard non-multiplex RBAs. At the initial screening with RBA, 3.0% (697/23400) of children were positive for at least one IAb, including 0.4% (98/23400) for multiple IAbs and 2.6% (599/23400) for a single IAb. Among children with ≥2 IAbs, ECL assay results were 89.8% congruent with RBA. In contrast, only 21.5% (129/599 p&lt;0.0001) of children with single IAb by RBA were ECL positive (i.e., high-affinity). During a median follow-up of 0.5 y (range 0.1-2.5 y), 90% (98/109) of children with a single IAb by both RBA and ECL remained persistently positive and 9.2% of those progressed to ≥2 IAbs. In contrast, 74% (242/328, p=0.0003) of children with a single IAb by RBA but ECL negative remained persistently positive; only 1.8% (p=0.001) of those converted to ≥2 IAbs (half became ECL positive). ASK results suggest that applying the ECL assay as the confirmation test may help to remove nearly 80% of subjects with single IAb from further follow-up and monitoring, with little loss of sensitivity. Alternatively, the multiplex ECL could be used as the primary screening tool to leverage its high throughput and low cost, compared to RBAs.

Disclosure
X. Jia: None. L. He: None. D. Miao: None. K. Waugh: None. B.I. Frohnert: None. A. Steck: None. M. Rewers: None. L. Yu: None. C.R. Geno Rasmussen: None.
1316-P: Celiac Disease in Youth with Type 1 Diabetes: Association with Age at Diabetes Diagnosis
Authors: ALVING ERIN , CARLIN KRISTEN , LEE DALE , ROBERTS ALISSA J. , DICKERSON JANE , GORBOUNOVA IRINA , LAW HELENE 
Published: June 2020

Background: Children with type 1 diabetes mellitus (T1D) are at increased risk for celiac disease (CD) (4-6% prevalence) and ADA clinical practice guidelines recommend screening all children with T1D for CD annually. A prior study suggests that diagnosis with T1D under age nine years correlates with increased risk for CD.
Aim: Assess the risk of CD by patient age at T1D diagnosis.
Methods: We collected data, including TTG IgA serology and ICD9 codes for T1D and CD from the electronic medical records of patients diagnosed at a single pediatric hospital with T1D between January 1, 2009 and July 31 2017. An unadjusted Cox proportional hazards model was used to assess the risk of celiac disease in patients in two groups: those diagnosed with T1D &lt;9 years of age and those diagnosed with T1D&gt; 9 years of age. Subjects were censored at either: diagnosis with CD, last CD screen if lost-to-follow-up, or December 29, 2017. We determined CD diagnosis by ICD9 code.
Results: In the study period, 2263 patients were diagnosed with T1D with mean (SD) age at diagnosis 10.3 years (4.4). CD was diagnosed in 111 (5%). Mean age of T1D diagnosis for those who also developed CD was 8.6 years (4.5) and for those without CD was 10.3 years (4.3). In patients diagnosed with T1D &lt;9 years 57 (6.7%) developed CD vs. 54 (4.7%) in &gt;9 years. Within one year after T1D diagnosis 58 patients had been diagnosed with CD and the relative risk of CD in patients ≤ 9 years was 1.52 compared to patients &gt; 9 years at T1DM diagnosis (95% CI 0.91, 2.54, p=0.111). Within 2 years of T1D diagnosis, 78 had been diagnosed with CD and the relative risk in patients ≤ 9 years was 1.83 vs. patients &gt; 9 years at T1D diagnosis (95% CI 1.17, 2.86, p=0.008).
Conclusion: Patients &lt;9 years at time of T1DM diagnosis have increased risk of CD within 2 years of initial T1D diagnosis compared to patients &gt;9 years at T1D diagnosis.

Disclosure
E. Alving: None. K. Carlin: None. D. Lee: None. A.J. Roberts: None. J. Dickerson: None. I. Gorbounova: None. H. Law: None.

Funding
Seattle Children’s Hospital
1317-P: Improving Access and Communication through Telehealth for Pediatric Type 1 Diabetes
Authors: RASBACH LISA E. , FREEMARK MICHAEL , PURRINGTON VIRGINIA , GRIFFIS MONA , ANNAS ANGELA , PAGE LAURA C. , HALL RACHEL , BENJAMIN ROBERT 
Published: June 2020

Telehealth may positively impact diabetes self-management by increasing contact between patients and providers.
Our diabetes team developed a telehealth intervention to provide insulin adjustments and establish diabetes goals. Eligible youth had T1D, Medicaid insurance, and A1c 9-12%. Participants set goals at quarterly visits. Monthly, participants communicated glucose data with the healthcare team through EMR portal or via phone calls. Youth &gt;10 years completed Diabetes Distress Scale (scores 1-6; higher=greater distress) and Diabetes Empowerment Scale (scores 1-5; higher=greater self-efficacy) at baseline, 6 mo, and 12 mo, while caregivers completed Diabetes Distress Scale for Parents (scores 1-5; higher=greater distress). Satisfaction surveys done at 3 and 12 mo (scores 1-5; higher=greater satisfaction). Baseline and 3 mo data presented. Youth (N=32, 56% male, 53% AA), aged 5-22 (12.4±3.9), with T1D for 5.1±3.5 years had baseline mean A1c 10.7±1.5%; 19% CSII and 34% CGM. At baseline, participants endorsed low levels of diabetes distress (mean score 1.9±0.9 youth and 2.1±0.6 parents). Youth endorsed high diabetes self-efficacy at baseline (mean score 4.2±0.6). There was no difference between mean A1c at baseline and 3 months (10.7% to 10.9%, N=26). Baseline A1c did not correlate with age, T1D duration, diabetes distress or empowerment for youth but correlated negatively with parental frustration [“I am the only one who takes responsibility for helping my teen manage diabetes” (r=-0.458; p=0.048) and “my teen ignores my suggestions about diabetes” (r=-0.842; p&lt;0.009)]. Participants reported high satisfaction with the intervention (mean score 4.3±0.49).
Correlation between A1c and parental frustration suggests need to improve communication between T1D teens and caretakers and enhance mental health support. Although A1c did not decline short term, families reported high satisfaction. Further research needs to assess the long-term impact of telehealth interventions.

Disclosure
L.E. Rasbach: None. M. Freemark: None. V. Purrington: None. M. Griffis: None. A. Annas: None. L.C. Page: None. R. Hall: None. R. Benjamin: None.

Funding
Duke University School of Medicine (3993054)
132-OR: Peripheral Serotonin Regulates Dietary Fat Absorption and Intestinal Chylomicron Production
Authors: RAKA FITORE , ADELI KHOSROW 
Published: June 2020

Introduction: Diabetic dyslipidemia is a key feature of insulin resistance and is characterized by overproduction of chylomicron particles by the intestine. Chylomicron output can be regulated by hormones secreted from the intestine. Enterochromaffin cells are specialized enteroendocrine cells that secrete serotonin (5-HT). Gut-derived 5-HT is emerging as a regulator of systemic energy homeostasis by regulating adipose and liver lipid metabolism. Currently, the role of 5-HT on intestinal fat absorption and chylomicron production remains unknown. We hypothesize that 5-HT regulates postprandial intestinal fat absorption and chylomicron production.
Methods/Results: Syrian golden hamsters underwent jugular cannulation surgery. The next day, hamsters received an oral fat load (200μl olive oil) followed by intravenous infusion of Triton WR-1339 to prevent lipoprotein clearance. Blood samples were collected prior to and up to 6 hours post fat load. Triglyceride-rich lipoproteins (TRL) which includes chylomicrons were isolated from plasma by density gradient ultracentrifugation and triglyceride (TG) content in this fraction was measured using an enzyme based colorimetric assay. Intravenous administration of 5-HT (1mg/kg) 5 minutes prior to oral fat load increased the rate of plasma TG and TRL-TG accumulation while higher doses of 5-HT (5 and 10mg/kg) produced a transient decrease in plasma TG and TRL-TG accumulation. Treatment with 5-HT4 receptor agonist, Bimu-8 (1mg/kg), increased plasma TG and TRL-TG accumulation. Endogenous 5-HT depletion by para-chloro-phenylalanine (PCPA), an inhibitor of 5-HT synthesis, reduced the rate of TG and TRL-TG accumulation compared to vehicle controls. Furthermore, enhancing 5-HT action by inhibiting 5-HT reuptake with fluoxetine increased the rate of TG and TRL-TG accumulation.
Our results demonstrate that 5-HT is a key regulator of postprandial lipoprotein metabolism and could have important implications for diabetic dyslipidemia.

Disclosure
F. Raka: None. K. Adeli: None.

Funding
Canadian Institutes of Health Research (967131)
1320-P: Building Trust between Researchers and African American and Latino Families of Children with T1D to Enhance Recruitment, Retention, and the Relevance of Research
Authors: BUTLER ASHLEY , HILLIARD MARISA E. , FEGAN-BOHM KELLY , HENDRIX KRISTEN , KARAVITI LEFKOTHEA 
Published: June 2020

Background: African American and Latino children with type 1 diabetes (T1D) have persistent disparities in diabetes outcomes. Diabetes outcomes can be significantly improved through behavior change interventions. However, existing behavioral family interventions for T1D have almost exclusively been implemented and evaluated among samples comprised of primarily non-Latino white families because of obstacles to building trust in studies. Challenges to building trust include relatively low percentages of youth with T1D compared to non-Latino whites, and aspects of the academic environment. Identifying and implementing strategies to build trust with minority communities will improve representation in behavioral intervention research.
Methods: We describe methods used to improve recruitment and retention in an ongoing pilot randomized control trial for parents of 60 African American and Latino children. Our community-engaged approach included consultation with culturally-informed communications experts, partnering with community resources (e.g., Health Department and Cooperative Extension Program), and engaging a family advisory board to advise on study branding, recruitment methods, and intervention components. We developed and implemented community information sessions about the study and a “T1D Research and Education Day Event” to launch recruitment. We conducted in-person recruitment visits within a diabetes care center.
Results: Six parents joined the advisory board. Six families attended the informational events. To date, 51 families have consented to participate in the study: 89% of the 8 eligible families in attendance enrolled at the launch event, and 66% of 67 approached in clinic enrolled (68% overall enrollment rate).
Conclusions: Innovative methods for building trust with African American and Latino families have increased engagement compared to previous T1D behavioral research.

Disclosure
A. Butler: None. M.E. Hilliard: None. K. Fegan-Bohm: None. K. Hendrix: None. L. Karaviti: None.

Funding
National Institutes of Health (1DP3DK113236)