bluuebunny/crossref_metadata_2025_split huggingface dataset:
1208-P: Perspectives of Barriers and Enablers from Stakeholders of the Current Model of Care for Diabetes Management in an Australian Regional Area
Authors: KENNEDY ELIZABETH L. , NG ASHLEY , GORDON BRETT A. , SMITH GILLIAN , FORSYTH ADRIENNE 
Published: June 2020

As the prevalence of type 2 diabetes (T2D) escalates, improved models of care (MoC) are necessary to provide the most appropriate care across different geographical locations. Current issues that influence diabetes health include physical, social and psychological factors. This study explores the perspectives of Stakeholders (staff members of community health services) relating to barriers and enablers towards the MoC for individuals with T2D. Semi-structured interviews were conducted with 21 stakeholders working in a semi-rural, low socio-demographic region of Victoria, Australia. Questions were designed to elicit participants’ views on factors that can facilitate or impede access to care, and how best to enhance adoption of an appropriate MoC. Interview transcripts were analysed thematically and categorised using the individual, relationship, community, and societal levels of the socio-ecological model. Stakeholders identified barriers such as living alone and socio-economic constraints, as important to individuals. In terms of relationship factors, many complex influences outside the control of the individual were identified as resulting in diabetes management becoming a non-priority. Transportation issues and lack of culturally sensitive/safe spaces were also identified as significant barriers for clinic attendance, as were lack of GP understanding of other health professionals’ roles, particularly in a multidisciplinary care setting. Improved diabetes management was identified as an enabler. Stakeholders also perceived implementing an holistic approach to diabetes management as an important enabler for attendance at community centres. This study concludes that stakeholders valued a focus on improving the accessibility of a MoC, by adopting a more integrated approach in a more culturally and physically approachable environment. This may enhance patients’ engagement and the sustainability of care.

Disclosure
E.L. Kennedy: None. A. Ng: Consultant; Self; Roche Diabetes Care, Ypsomed AG. B.A. Gordon: None. G. Smith: None. A. Forsyth: None.
1214-P: Assessing the Efficacy of Home-Based Kidney Care on Patient Activation Measure (PAM) among Patients with Diabetes
Authors: SHAH VALLABH , PANKRATZ VERNON S. , GHAHATE DONICA M. , BOBELU JEANETTE , NELSON ROBERT 
Published: June 2020

Objective: Home-Based Kidney Care (HBKC) is a pragmatic treatment approach that addresses patient preferences and cultural barriers to healthcare. We previously reported the results of a clinical trial of HBKC vs. usual care in a cohort of Zuni Indians in New Mexico. This study investigated the potential for differential efficacy of HBKC vs. usual care according to type 2 diabetes status of the Zuni Indians who had participated in the trial.
Methods: Participants identified as having evidence of chronic kidney disease were enrolled into the original trial, and were randomized into either HBKC or usual care. Participants were subsequently categorized according to type 2 diabetes status. Linear regression models were used to test for the presence of a differential treatment effect by diabetes status and to estimate treatment effects within those with and without diabetes.
Results: The original study enrolled 63 participants into the HBKC group, and 62 into usual care. Twenty-four (38.1%) participants in the HBKC group and 32 (51.6%) in usual care had diabetes. The test for interaction between diabetes status and treatment arm suggested a significant differential treatment effect by diabetes status (p=0.022). The treatment effect among those with diabetes showed that PAM total scores increased by 16.0 points (95% Confidence Interval [CI]: 8.8 to 23.1) more in the HBKC group than in the usual care group, while changes in PAM total scores were similar in both treatment groups among those without diabetes (treatment effect [95% CI] = -1.4 [-12.4 to 9.6]).
Conclusions: We have previously shown that HBKC is effective in increasing the engagement of Zuni Indians with CKD in their healthcare. This secondary analysis suggests that the effectiveness of this intervention on increasing patient activation is most notable among those CKD patients who also have diabetes.

Disclosure
V. Shah: None. V.S. Pankratz: None. D.M. Ghahate: None. J. Bobelu: None. R. Nelson: None.

Funding
Patient-Centered Outcomes Research Institute
1218-P: Interactive Insulin Teaching by Pharmacists Prior to Hospital Discharge
Authors: ODOM JESSICA M. , GHIZZONI-BURNS ALYSON , PROBST MEGAN , SUTHERLAND MELANIE W. , FAIR MELISSA L. , WEBER SANDRA L. 
Published: June 2020

The primary objective of this study was to evaluate the impact on patient health outcomes of incorporating iPad insulin education videos into standardized pharmacist insulin teaching prior to inpatient discharge. Inclusion criteria comprised of hospitalized patients &gt;18 years old with either new insulin orders or, if taking insulin prior to admission, a HbA1c ≥ 8.5%. Patients were excluded if they did not speak English or were discharged to a facility. From July 2018 to January 2019, control patients (n=180) received standard, bedside insulin-administration education from a trained pharmacist. From February to June 2019, intervention patients (n=114) received pharmacist-deployed educational videos on iPads that included the same content as the standard education. The primary outcome was the change in an eight-item survey administered pre- and post-education, assessing confidence in insulin administration and storage, hypoglycemia management, and sharps disposal on a scale of 1 to 5, with 5 indicating highest confidence. Secondary outcomes included 30-day hospital readmission and change in HbA1c post-discharge. Pharmacist-provided education significantly improved confidence across all survey items in both the intervention and control groups (mean (SD) increase = 0.57 (0.74), p &lt; 0.01). There were no statistically significant differences between groups after adjusting for age, sex, race/ethnicity, and prior insulin use. Baseline HbA1c was similar in both groups (10.7 vs. 10.9, p= 0.51) and decreased within 4 months post-discharge (9.4 vs. 8.7, p= 0.09). The decrease did not differ between groups. Diabetes-related readmissions were similar between the two groups (14 vs. 13%, p= 0.93). Inpatient education by pharmacists prior to discharge improved patient confidence in insulin administration for both traditional and technology-enhanced education groups. Technology-enhanced insulin education may reduce pharmacist burden without negatively impacting patient outcomes.

Disclosure
J.M. Odom: None. A. Ghizzoni-Burns: None. M. Probst: None. M.W. Sutherland: None. M.L. Fair: None. S.L. Weber: None.

Funding
Prisma Health
1222-P: Implementation of an Electronic Medical Record Tool to Improve Type 2 Diabetes Management in a Large Health System
Authors: MISRA-HEBERT ANITA D. , PANTALONE KEVIN M. , RAJPATHAK SWAPNIL , WEISS TRACEY , HAMATY MARWAN , ZIMMERMAN ROBERT S. 
Published: June 2020

Guidelines recommend individualized treatment for patients with type 2 diabetes (T2D), avoidance of clinical inertia, and specific therapeutic choices for patients at risk for cardiovascular disease, congestive heart failure, or chronic kidney disease. However, a gap exists in translating these guidelines into practice.
We created an electronic medical record (EMR) tool to improve evidence-based treatment intensification for T2D and studied its implementation in endocrinology and primary care (PC). The tool included a best practice alert (BPA) informing providers at an office visit of an A1C ≥ 8% and prompted providers, within the tool, to make therapeutic choices based upon five priority care goals- cardiovascular risk reduction, A1c lowering, low hypoglycemia risk, cost, or weight loss.
After a 3-month pilot at one site, the tool was implemented using a stepped-wedge approach from March-November 2019 to all PC (N=52) and endocrinology (N=17) sites in our health system with 1903 eligible patient visits by November 2019. Within endocrinology, provider tool usage ranged from 94% of visits at the pilot site to 34% after full rollout; in PC, usage ranged from 52% during the pilot to just above 5%. Usage varied by practice site (range &lt;1- 44%) and by provider (0 - 100%). Providers expressed interest in tool utility but reported the timing of the BPA, during a busy office visit, as a barrier to use. Of note, the BPA was deferred up to 20% of the time in PC citing patient nonadherence to current therapy.
Uptake of a point of care EMR tool to promote treatment intensification for T2D in endocrinology and PC demonstrated variation at the specialty, practice site, and provider levels. Our findings also suggest that, given time pressures, provider focused point of care EMR-based interventions to improve T2D care may need to be supplemented with tools asynchronous to the office visit and should address patient factors in adherence. Further analyses will focus on tool effects on A1c control.

Disclosure
A.D. Misra-Hebert: Research Support; Self; Agency for Healthcare Research and Quality, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk Inc. K.M. Pantalone: Consultant; Self; Bayer Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. Research Support; Self; Merck & Co., Inc., Novo Nordisk Inc. Speaker’s Bureau; Self; AstraZeneca, Merck & Co., Inc., Novo Nordisk Inc. S. Rajpathak: Employee; Self; Menarini Group. T. Weiss: Employee; Self; Merck & Co., Inc. M. Hamaty: Research Support; Self; Merck & Co., Inc. R.S. Zimmerman: Research Support; Self; Bayer U.S., Merck & Co., Inc., Novo Nordisk A/S. Speaker’s Bureau; Self; LifeScan, Inc., Merck & Co., Inc. Stock/Shareholder; Self; Baxter, Bristol-Myers Squibb, Pfizer Inc., Procter & Gamble Company.
124-LB: Praliciguat, a Clinical-Stage Soluble Guanylate Cyclase (sGC) Stimulator, Improved Oral Glucose and Lipid Handling and Slowed Diabetic Weight Loss in TALLYHO Mice
Authors: SCHWARTZKOPF CHAD , CARVALHO ANDREW , HADCOCK JOHN , CURRIE MARK , JONES JULI E. 
Published: June 2020

Background: Praliciguat (IW-1973) is an sGC stimulator in clinical development as a potential treatment for diabetic kidney disease. In animal models, praliciguat distributes broadly to tissues and elicits hemodynamic, anti-inflammatory, anti-fibrotic, and metabolic effects. Here, we assessed the metabolic effects of praliciguat in diabetic TALLYHO mice housed at thermoneutrality in order to minimize any confounding contribution of brown fat thermogenesis on metabolism, which is rare in humans but common in mice.
Methods: Six- to eight-week-old male TALLYHO/JngJ mice were maintained on low-fat diet (10% kcal from fat, LFD). Due to incomplete penetrance of the diabetic phenotype in this model, diabetic mice were identified prior to study initiation using HbA1c and urinary glucose/creatinine ratio as criteria. At 10-12 weeks of age, a diabetic control group (n=6) was maintained on LFD, while another group (n=6) was switched to LFD formulated with praliciguat to achieve a Cmax drug exposure similar to a 20 mg oral clinical dose. Plasma was collected at baseline and after 4 weeks of treatment. Oral glucose tolerance tests (OGTT) and oral lipid tolerance tests (LTT) were performed after 5 and 6 weeks of treatment, respectively.
Results: At week 4, praliciguat treatment attenuated the HbA1c increase in TALLYHO diabetic mice (+0.40 vs. +0.95%, in praliciguat and control groups, respectively P&lt;0.05). At week 5, fasting glucose (561 ± 33 vs. 650 ± 46 mg/dl; -14%, P&lt;0.01) and OGTT glucose AUC (-12%, P&lt;0.01) were lower in praliciguat-treated mice than in untreated controls. At week 6, fasting plasma triglycerides (721 ± 97 vs. 1134 ± 190 mg/dl; -36%, P&lt;0.05) and LTT triglyceride AUC (-23%, P&lt;0.01) were lower in praliciguat-treated mice than in untreated controls. Body weight loss and food intake were lower in praliciguat-treated mice than in untreated mice.
Conclusion: Praliciguat improved nutrient handling in diabetic TALLYHO mice.

Disclosure
C. Schwartzkopf: None. A. Carvalho: Stock/Shareholder; Self; Cyclerion Therapeutics. J. Hadcock: None. M. Currie: Employee; Self; Cyclerion Therapeutics. Stock/Shareholder; Self; Cyclerion Therapeutics. J.E. Jones: None.
1253-P: Yields and Costs of Recruitment Methods with Participant Baseline Characteristics for a Diabetes Prevention Research Study in an Underserved Pediatric Population
Authors: VANDER WYST KILEY B. , OLSON MICAH , SOLTERO ERICA G. , KONOPKEN YOLANDA P. , KELLER COLLEEN , CASTRO FELIPE GONZÁLEZ , WILLIAMS ALLISON , FERNANDEZ ARLENE D.R. , HOOKER ELVA , PATRICK DONALD L. , AYERS STEPHANIE , HU HOUCHUN H. , PENA ARMANDO , KNOWLER WILLIAM C. , SHAIBI GABRIEL Q. 
Published: June 2020

Background: Diabetes disproportionately impacts Latino youth, yet few diabetes prevention programs (DPP) have prioritized inclusion of this vulnerable population. Recruitment is often the most challenging aspect of clinical trials and the optimal strategy to meet enrollment goals is unknown. This report describes the recruitment yields, costs, and baseline characteristics for a DPP focused on Latino youth.
Methods: Recruitment methods included clinics, community efforts, media, and word-of-mouth with the goal of enrolling 120 Latino youth age 12-16 with obesity and prediabetes. Yields, costs, and baseline characteristics of youth were compared by recruitment method with final prediabetes eligibility determined by an Oral Glucose Tolerance Test (OGTT).
Results: Recruitment spanned 47 months and yielded 655 referrals from clinics (N=344), community efforts (N=143), media (N=137), and word-of-mouth (N=31). From this pool, 50% (N=325) declined participation and 14% (N=93) were ineligible by general inclusion criteria. A screening OGTT was performed on 237 youth with 52% (N=122) meeting prediabetes eligibility and 117 subsequently randomized. The clinical sites yielded the highest number of total referrals (53%, N=344/655) while word-of-mouth yielded the highest proportion (35%, N=11/31) of randomized participants per referral. There were no significant differences in anthropologic or diabetes risk biomarkers between recruitment sources. Community recruitment efforts were the most costly ($486/randomized participant) followed by media ($236/randomized participant) and clinic ($248/randomized participant).
Conclusions: These data suggest that yields and costs to recruit Latino youth into a DPP vary by method, and there were no differences in youth diabetes risk profiles. Recruiting hard-to-reach populations into clinical trials requires multiple strategies to meet target enrollment.

Disclosure
K.B. Vander Wyst: None. M. Olson: None. E.G. Soltero: None. Y.P. Konopken: None. C. Keller: None. F. González Castro: None. A. Williams: None. A.D.R. Fernandez: None. E. Hooker: None. D.L. Patrick: None. S. Ayers: None. H.H. Hu: None. A. Pena: None. W.C. Knowler: None. G.Q. Shaibi: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK10757901)
1258-P: Lack of Monitoring for Glucose Intolerance in Overweight and Obese Youth on Second-Generation Antipsychotics Despite Increased Risk
Authors: CRIMMINS NANCY A. , DELBELLO MELISSA P. , CORRELL CHRISTOPH , KLEIN CHRISTINA , BLOM THOMAS , WELGE JEFFREY 
Published: June 2020

Second-generation antipsychotics (SGAs) increase risk for glucose intolerance in adults; less is known about risk in youth. MOBILITY is a large, multi-center, pragmatic study designed to assess the effect of metformin added to a lifestyle intervention compared to lifestyle alone on weight gain and metabolic parameters in overweight and obese pediatric (ages 8-19) patients with bipolar-spectrum disorders (BSD) receiving SGAs. Frank diabetes was an exclusion criterion. It was recommended to obtain baseline, +6 month, and +12 month fasting metabolic labs in this trial conducted in real-world psychiatry clinics. We estimated prevalence of glucose intolerance prior to intervention. We hypothesized that youth with elevated fasting plasma glucose (FPG) and hemoglobin A1C (HbA1C) would be more likely to have repeat metabolic assessment. Altogether, 684 youth (mean age=14.3 years, 53% male, 64% with baseline BMI ≥95th%ile) were included in these analyses. Baseline FPG was obtained in 73% (501/684); 12.1% of these had impaired fasting glucose (IFG). Baseline HbA1C was obtained in 53% (360/684); 11.1% had HbA1C ≥5.7%. Six patients (1.6%) had both measures elevated. Only 41% of patients with IFG and 40% of those with HbA1C ≥5.7% had repeat glucose measures within 1 year; neither were more likely to have repeat laboratory testing than patients with normal baseline laboratory results (OR=0.88, p=0.773; OR=0.85; p=1.00, respectively). Of six patients with both IFG and HbA1C elevated at baseline, only three had repeat laboratory testing; one of these developed diabetes on follow-up. Overweight and obese youth with BSD on SGA therapy have clinically relevant rates of glucose intolerance. However, assessment and, especially, reassessment of abnormal glucose status in this population is poor. Further studies are needed to identify and address barriers for evaluation for glucose intolerance in this at-risk population.

Disclosure
N.A. Crimmins: None. M.P. DelBello: None. C. Correll: Consultant; Self; Alkermes plc., Allergan plc., Janssen Pharmaceuticals, Inc., Lundbeck, Otsuka Pharmaceutical Co., Ltd., Pfizer Inc., Sumitomo Dainippon Pharma Co., Ltd., Sunovion Pharmaceuticals Inc., Takeda Pharmaceutical Company Limited, Teva Pharmaceutical Industries Ltd. C. Klein: None. T. Blom: None. J. Welge: None.

Funding
Patient-Centered Outcomes Research Institute (to M.P.D.)
126-OR: Baseline Omega-3 Status Is Associated with Nerve Regeneration following 1 Year of Omega-3 Nutrition Therapy in Patients with Diabetic Neuropathy
Authors: LEWIS EVAN J.H. , PERKINS BRUCE A. , LOVBLOM LEIF ERIK , METHEREL ADAM , WOLEVER THOMAS , BRIL VERA 
Published: June 2020

We have recently demonstrated that omega-3 nutrition therapy is associated with small nerve fiber regeneration in individuals with type 1 diabetes (T1D). It is unclear if baseline omega-3s relate to the presence of diabetic sensorimotor polyneuropathy (DSP) or nerve regeneration. Forty individuals with T1D participated in a 12-month single-arm open label study of seal oil omega-3 (10 mL/d; 750 mg EPA, 560 mg DPA acid, and 1,020 mg DHA). The primary outcome was the 1-year change in corneal nerve fiber length (CNFL) measured by in vivo corneal confocal microscopy, with sensory and nerve conduction measures as secondary outcomes. Plasma PUFAs were measured at 0, 4, 8 and 12-months. The 40 participants (53% female) had mean±SD age 48±14 years, body mass index 28.1±5.8 kg/m2, diabetes duration 27±18 years and 23(59%) had DSP. At baseline, participants with DSP had lower DHA concentration compared to those without (1.73±0.89% vs. 2.27±0.70, p=0.049). At 12-months, omega-3 nutrition therapy increased group mean plasma EPA by 185%, DPA by 29%, DHA by 79% (p&lt;0.001) and decreased the omega-6 to omega-3 ratio by 45% (p&lt;0.001). On average, CNFL increased 29±46% over the study, indicating small nerve fiber regeneration. This change was associated with the increase in total omega-3 (r=0.41, p=0.013), DPA (r=0.33, p=0.047) and DHA (r=0.42, p=0.012). There were 26(65%) participants that responded to therapy with a change in CNFL &gt;0% and 9(22%) with a clinically significant loss of CNFL &gt;-6%. At baseline, responders had higher total omega-3 (4.38±1.35% vs. 3.12±0.56%, p=0.010), EPA (0.91±0.47% vs. 0.59±0.23%, p=0.040) and DHA (2.16±0.90% vs. 1.34±0.40%, p=0.009).The change in these variables was not different between responders and non-responders (p&gt;0.05). One year of seal oil omega-3 nutrition therapy increased blood omega-3s, while small nerve fiber regeneration appears to be related to baseline omega-3 status.

Disclosure
E.J.H. Lewis: Board Member; Spouse/Partner; Nutarniq Corp. Employee; Self; Nutarniq Corp. Stock/Shareholder; Self; Nutarniq Corp. B.A. Perkins: Consultant; Self; Abbott, Boehringer Ingelheim International GmbH, Insulet Corporation. Research Support; Self; Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Other Relationship; Self; Medtronic. L. Lovblom: None. A. Metherel: None. T. Wolever: None. V. Bril: Advisory Panel; Self; Alexion Pharmaceuticals, Inc., Alnylam Pharmaceuticals, Takeda Canada. Consultant; Self; Akcea Therapeutics, CSL Behring, Sanofi. Research Support; Self; Biogen, Grifols, Momenta Pharmaceuticals.

Funding
Diabetes Canada (OG-2-13-4093-VB)
1263-P: Nutritional Reprogramming of Hepatic Metabolism by Feeding a Diet Containing Large, Phospholipid-Coated Lipid Droplets in Early Life Protects against Western Style Diet–Induced Insulin Resistance in Adult Mice
Authors: JELENIK TOMAS , KODDE ANDREA , PESTA DOMINIK , ROHBECK ELISABETH , DEWIDAR BEDAIR , PHIELIX ESTHER , OOSTING ANNEMARIE , VAN DER BEEK ELINE M. , RODEN MICHAEL 
Published: June 2020

Early life nutrition possibly influences long-term metabolic outcomes. Previous studies in mice showed that adult obesity and energy metabolism can be improved by early life exposure to an infant milk formula (IMF) with large (3-5μm), (milk)-phospholipid coated lipid droplets (Concept diet, Nuturis®). This study examined the effects of the Concept diet on (adult) fasting insulin sensitivity and hepatic mitochondrial capacity. From postnatal day (PN) 16 to PN42, male C57BL/6j mice were exposed to a semisynthetic rodent diet containing Concept or Control (CTRL)-IMF. Subsequently, mice were fed either Western-style (WSD) or standard rodent diet (AIN) from PN42 to PN98 and sacrificed after 3 hours fasting, at PN98. Homeostasis model assessment insulin resistance index (HOMA-IR) was calculated from fasting insulin and glucose levels. Mitochondrial function was assessed by high-resolution respirometry in liver tissue at PN98 using substrates stimulating β-oxidation (β-OX) and tricarboxylic acid cycle (TCA) flux. Plasma thiobarbituric acid reactive substances (TBARS), a marker of lipid peroxidation, were measured fluorometrically. At PN98, WSD induced insulin resistance in CTRL, but not in Concept fed mice (p&lt;0.05). Furthermore, Concept mice on WSD had a lower liver weight (p&lt;0.05) and 69% higher maximal β-OX compared to CTRL (p&lt;0.05). Liver fat content increased with WSD independent of initial diet (p&lt;0.05) and was not different between CTRL and Concept groups. Yet, plasma TBARS were 23% lower in Concept compared to CTRL mice fed WSD (p&lt;0.05).
In conclusion, early life feeding of the Concept diet improved hepatic oxidative capacity and protected adult mice against diet-induced insulin resistance. These results suggest that early postnatal metabolic priming may decrease systemic oxidative damage which can help to maintain liver health in an obesogenic environment.

Disclosure
T. Jelenik: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. A. Kodde: Employee; Self; Danone Nutricia Research. D. Pesta: None. E. Rohbeck: None. B. Dewidar: None. E. Phielix: None. A. Oosting: Employee; Self; Danone Nutricia Research. E.M. van der Beek: Employee; Self; Danone Nutricia Research. M. Roden: Advisory Panel; Self; Servier. Board Member; Self; Poxel SA. Consultant; Self; Eli Lilly and Company, Gilead Sciences, Inc., ProSciento, TARGET PharmaSolutions. Research Support; Self; Boehringer Ingelheim International GmbH, Novartis Pharma K.K., Sanofi US. Speaker’s Bureau; Self; Novo Nordisk A/S.

Funding
Danone Nutricia Research