bluuebunny/crossref_metadata_2025_split huggingface dataset:
696-P: Vasodilatory Response of the Muscular Artery Was Improved to Sheer Stress, but Paradoxically Decreased to Endothelium-Dependent Vasodilator in Diet and Aerobic Exercise in Type 2 Diabetes
Authors: HAN KYUNG AH , YANG BOYEON , MIN KYUNGWAN 
Published: June 2020

The aims of this study were to investigate whether the stiffness of large elastic artery such as aorta and the muscular artery such as brachial artery improves through lifestyle modifications in type 2 diabetes. Total 82 overweight women with type 2 diabetes (age 55.0±7.6 years) were randomly assigned to control (C), diet (D), aerobic exercise (AE) and resistance exercise (RE) and completed the weight loss program for 12 weeks. We assessed BMI, augmentation index (AI) of aorta and also the flow-mediated dilation (FMD), the right brachial artery blood flow responses to an endothelium-independent vasodilator(ED), acetylcholine,, and an endothelium-dependent vasodilator(EID), isosorbide dinitrate, adiponectin/leptin ratio(ALR), free fatty acid(FFA), hsCRP, and insulin sensitivity (KITT) at baseline, and 12 week. There was no change in AI despite significant decreases in BMI in all intervention groups. FMD increased only in D and AE, but ED decreased in all 3 groups. EID increased only in D. The vascular function to sheer stress improved in muscular artery, not in large elastic artery with lifestyle changes. The response to isosorbide dinitrate was not consistent with FMD.

Disclosure
K. Han: None. B. Yang: None. K. Min: None.
707-P: Physical Exercise Decreases Notch1 Activation and Reduces the Gluconeogenesis in Liver of Obese Mice
Authors: GASPAR RAFAEL C. , MUÑOZ VITOR , NAKANDAKARI SUSANA C. , CRISOL BARBARA M. , VIEIRA RENAN F.L. , CONCEIÇÃO LUCIANA R. , SILVA ADELINO , CINTRA DENNYS E. , MOURA LEANDRO P. , ROPELLE EDUARDO R. , PAULI JOSÉ R. 
Published: June 2020

Notch1 protein has an important role in the hepatic metabolism. In this way, it has been observed in obese individuals that Notch1 is correlated with insulin resistance in the liver, which makes it an interesting research target. On the other hand, the physical exercise are associated with the prevention and treatment of insulin resistance and type 2 diabetes. Thus, the present study aims to verify the role of physical exercise in the Notch1 protein modulation in the hepatic tissue of obese mice and its contribution in the control of gluconeogenesis. For this, we used obese mice induced by high fat diet and ob/ob animals. The trained animals group performed treadmill-running protocol, with intensity corresponding to 70% of the maximum running speed, for a period of four weeks. At the end of the exercise protocol (24 hours later), we analyzed the physiological parameters, mRNA levels, and protein content of key molecules in the control of gluconeogenesis and Notch1 signaling. We found that exercise reversed the physiological damage generated by obesity. In addition, trained animals showed a reduction in protein content and Notch1 activity when compared to the sedentary obese group. Furthermore, we observed reduction in pyruvate intolerance in exercised animals and a decrease in gluconeogenesis enzymes. Such findings were also observed in ob/ob mice submitted to physical exercise. Thus, we verified the physical exercise mice reduce Nocth1 activation and decrease PEPCK protein content. Finally, we found that inhibition of Notch1 activity decreases pyruvate intolerance as well as reduces the protein content of gluconeogenesis enzymes. Therefore, we concluded that physical exercise is able to modulate the Notch1 pathway in the liver and contribute to the gluconeogenesis control in obese mice.

Disclosure
R.C. Gaspar: None. V. Muñoz: None. S.C. Nakandakari: None. B.M. Crisol: None. R.F.L. Vieira: None. L.R. Conceição: None. A. Silva: None. D.E. Cintra: None. L.P. Moura: None. E.R. Ropelle: None. J.R. Pauli: None.

Funding
São Paulo Research Foundation (2019/11338-9, 2017/20542-3)
750-P: Characterizing Diabetes Distress in Adolescents with Type 1 Diabetes
Authors: CAO VIENA T. , ESHTEHARDI SAHAR S. , ANDERSON BARBARA , HILLIARD MARISA E. 
Published: June 2020

Objective: Adolescents are often expected to take on more autonomy in their T1D management, which can increase diabetes distress. Elevated distress has been linked to suboptimal glycemic outcomes. Characterizing the aspects of diabetes distress that teens report as most difficult may help care teams address the most relevant psychosocial concerns during this challenging developmental stage.
Methods: We analyzed baseline data from two behavioral trials, totaling 135 adolescents (age 12-17) with T1D (M age=15.1±1.6, 57% female, 59% non-Hispanic White, M HbA1c=8.7±1.9). Youth completed the Problem Areas in Diabetes Teen scale, a measure of diabetes distress where teens rate how much each of 26 items is a problem for them (6-point scale, 5-6 represent a “serious problem”). We extracted HbA1c from the electronic medical record.
Results: The Table presents the frequency with which teens rated each item as “serious problem” and significant correlations with HbA1c.
Conclusion: A wide range of issues (20 of 26 items) were endorsed by ≥10% of teens as very distressing. At least 20% identified social issues and concerns about possible complications as problems causing serious distress. Items significantly linked to HbA1c were not necessarily those that teens found most distressing. Addressing teens’ most pressing concerns may help them feel understood, reduce self-management barriers, and ultimately improve quality of life and health.

Disclosure
V.T. Cao: None. S.S. Eshtehardi: None. B. Anderson: None. M.E. Hilliard: None.

Funding
National Institutes of Health (1R21DK107951); Texas Children’s Hospital; Caroline Weiss Law Fund for Research in Molecular Medicine
792-P: Understanding Barriers to Diabetic Foot Care in an Urban Low-Income Hospital: A Focus Group Qualitative Assessment
Authors: FAYFMAN MAYA , SCHECHTER MARCOS , AMOBI CHIMORA N. , WILLIAMS REBEKAH N. , HILLMAN JOANNA L. , RAJANI RAVI , ZIEMER DAVID C. , ALAM MUHAMMAD M. , KEMPKER RUSSELL , UMPIERREZ GUILLERMO E. 
Published: June 2020

Diabetes is a leading cause of lower limb loss in the United States that disproportionately affects minority groups of lower socioeconomic status. The reasons for these disparities are poorly characterized. We employed qualitative (focus group discussions, FGD) and quantitative (survey) methods among persons with diabetic foot disease. Participants were stratified into two groups: a diabetic foot ulcer (DFU) group and minor amputation (ankle or below) group. The FGDs addressed patient experience with a goal of understanding: (1) foot care knowledge, (2) barriers to care, and (3) preferred foot-related educational methods. 5 sessions were conducted with 6-12 people each. Participants were recruited from clinics at a safety-net hospital in Atlanta that provides care to an inner-city population with a high burden diabetic foot related complications. Forty participants (90% Black) were enrolled. Surveys revealed an adequate knowledge of proper diabetic foot care, with ≥70% of participants correctly answering questions relating to proper self-care. Several dominant themes emerged from the FGDs. Personal barriers to self-care included lack of motivation, difficulty accessing supplies due to cost and/or lack of insurance, and being unable to limit activity for proper offloading. Participants frequently reported systematic barriers, citing difficulty making timely appointments and reaching a provider to arrange care. Participants reported that foot-related knowledge and access to care improved with greater disease severity but that knowledge and interventions seemed to come too late in their disease course. They expressed interest in peer support groups to facilitate learning and sharing information about diabetic foot care. These findings indicate patients with DFU or minor amputations in our institution have adequate footcare-related knowledge, but barriers to care and lack of motivation limit appropriate foot care.

Disclosure
M. Fayfman: None. M. Schechter: None. C.N. Amobi: None. R.N. Williams: None. J.L. Hillman: None. R. Rajani: None. D.C. Ziemer: None. M.M. Alam: None. R. Kempker: None. G.E. Umpierrez: None.
830-P: Screening for Depressive Symptoms in Adolescent Type 2 Diabetes Point to a Need for Improvement in Clinical Processes and Resources
Authors: STONE JENINE Y. , MULVANEY SHELAGH A. , MARA CONSTANCE A. , KICHLER JESSICA C. , MAJIDI SHIDEH , DRISCOLL KIMBERLY A. , WESTEN SARAH C. , RAWLINSON ALANA , JACOBSEN LAURA M. , HOOD KOREY K. , MONAGHAN MAUREEN , ADAMS REBECCA N. 
Published: June 2020

Objective: To document rates of elevated depressive symptoms endorsed during routine screening for adolescents and young adults (AYA) with type 2 diabetes (T2D), review clinical actions taken in response to screening results, and evaluate associations of depressive symptoms with AYA characteristics.
Research Design and Methods: The Patient Health Questionnaire (PHQ) was administered to 218 AYA with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centers. Data from electronic health records were collected from the screening date and 12 months prior.
Results: The mean age was 16.77 (SD 2.10 years); 56% male; 74% non-Hispanic White; Mean T2D duration 3.48 (SD 2.51 years). On the PHQ, 21.6% of AYA with T2D endorsed elevated depressive symptoms (PHQ score≥10) and 15.2% endorsed thoughts of self-harm. Older age, shorter T2D duration, not on insulin, and more blood glucose checks per day were significantly associated with more depressive symptoms. Of those AYAs endorsing the harm-to-self item, 8.3% were in mental health treatment. For AYAs expressing harm-to-self who were not in treatment (91.7%),18.2% did not have a documented referral for mental health treatment in the medical record.
Conclusions: Screening for depressive symptoms identifies individuals in need of referral for mental health treatment; however, a focus on self-harm assessment, standardized methods for documentation of symptoms, mental health referrals and increased referral resources are needed.

Disclosure
J.Y. Stone: None. S.A. Mulvaney: None. C.A. Mara: None. J.C. Kichler: None. S. Majidi: Advisory Panel; Self; Companion Medical. K.A. Driscoll: None. S.C. Westen: None. A. Rawlinson: None. L.M. Jacobsen: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. M. Monaghan: Research Support; Self; American Diabetes Association. R.N. Adams: Employee; Self; Virta Health Corp.

Funding
National Center for Advancing Translational Sciences (UL1TR002243, UL1TR001427)
834-P: Understanding Risks for Depressive Symptoms among Caregivers of Young Children Newly Diagnosed with T1D: The Role of Social Support and Social Problem-Solving
Authors: WANG CHRISTINE H. , SINISTERRA MANUELA , HERRERA NICOLE , TULLY CARRIE , CLARY LAUREN , MONAGHAN MAUREEN , HILLIARD MARISA E. , STREISAND RANDI 
Published: June 2020

Introduction: Elevated depressive symptoms are common in caregivers following their children’s T1D diagnoses. In the general population, strong social support and social problem-solving abilities buffer depressive symptoms during stressful life events. To evaluate whether these constructs apply to diagnosis-related distress, we examined the associations among caregiver social support, social problem solving, and depressive symptoms after their children’s T1D diagnoses. We hypothesized that higher social support and higher social problem solving would be related to lower caregiver depressive symptoms.
Methods: Participants included 157 young children (M age=4.46±1.64 years) newly diagnosed with T1D (M days diagnosed = 28.78±15.10) and their primary caregivers (70% Caucasian, 74% married, 90% female) assessed at baseline of an ongoing behavioral RCT. Caregivers self-reported their social support (Protective Factors Survey (PFS)-Social Support), social problem solving abilities (Social Problem Solving Inventory- R:SF; SPSI), and depressive symptoms (Center for Epidemiological Studies-Depression Scale; CES-D).
Results: Overall, 46.5% of caregivers exceeded the clinical cut-off on the CES-D (M=16.60 (11.58)). Further, higher social support (B=-.235,-p=.004) and higher social problem solving abilities (B=-.317,-p&lt;.001) were related to lower caregiver depressive symptoms, controlling for child age/sex, and presence of other caregivers (all p&gt;.05). Higher negative (not positive) problem orientation was related to higher depressive symptoms (B=.373,-p&lt;.001); problem solving styles were unrelated to depressive symptoms (p&gt;.05).
Conclusions: Behavioral interventions focused on promoting positive social support and social problem solving abilities may decrease caregivers depressive symptoms after their children’s initial T1D diagnosis. Replication using longitudinal data is needed.

Disclosure
C.H. Wang: None. M. Sinisterra: None. N. Herrera: None. C. Tully: None. L. Clary: None. M. Monaghan: Research Support; Self; American Diabetes Association. M.E. Hilliard: None. R. Streisand: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK102561)
854-P: Effective Use of Computerized Insulin Dose Adjustment Algorithms (CIDAA) on Continuous Glucose Monitoring (CGM) Results in Poorly Controlled Patients by a Clinical Pharmacist: A Proof-of-Concept Project
Authors: DAVIDSON MAYER B. , DAVIDSON JOSH 
Published: June 2020

The largest challenge for appropriate adjustment of insulin doses for PCPs is lack of time and for patients is provision of enough blood glucose values. Potential solutions to these two issues are CIDAA for PCPs and CGM for patients. The combination of these two innovations was evaluated in a FQHC serving a poor, mostly minority, medically underserved population.
Poorly controlled diabetic patients (A1C levels &gt;9.0%) are referred to a specially trained clinical pharmacist (CP). The pharmacy department supported CGM (Free Style Libre Pro) for 13 patients, 10 on basal insulin alone and 3 on basal/bolus who had ≥2 visits. Their downloaded CGM results were analyzed by FDA-cleared CIDAA and a report containing recommendations for dose adjustments that the CP could modify or accept was provided within 30 seconds. The mean number of reports was 4.8 which covered a period of 97 days. The glycemic responses are shown in the Table. Total insulin doses increased by 42%.
Conclusion: Analysis of CGM results by CIDAA addresses the two largest challenges of adjusting insulin doses for PCPs and patients. Using both together has the potential of markedly improving A1C levels in poorly controlled insulin-requiring diabetic patients.

Disclosure
M.B. Davidson: None. J. Davidson: Employee; Self; Mellitus Health.
856-P: Video Connect Clinic for Veterans Wearing Diabetes Technology
Authors: AMOLE MOROLAKE , WHYTE LOREN , GHAYEE HANS , LEEY JULIO A. 
Published: June 2020

Background: Telehealth has been shown to be effective in the management of chronic disease. We describe our experience using Telehealth for patients wearing insulin pump or continuous glucose monitor (CGM).
Methods: In Sep 2019, a weekly VA video connect clinic (Diabetes VVC) was started for patients on insulin pump or CGM. The clinic is staffed by a registered dietitian, who is a certified diabetes educator and insulin pump trainer. Patients are seen in the telehealth clinic between face-to-face visits with endocrinologist. In these video visits, CGM and pump downloads were reviewed, and specialized diabetes education provided. Sometimes changes in management are suggested after discussion with endocrinologist.
In this retrospective study, several metrics were evaluated: travel distance, type of diabetes, type of insulin pump or CGM, medications, weight, height, BMI, time in rage 70-180mg/dL (when CGM was in use) and recommendations. We also assessed [U1] the number of interactions (visits) with the diabetes team.
Results: 34 patients participated in the VVC leading to 85 encounters. Most of them were males, 88% (30/30). The majority were on CGM alone (25/34) and remaining on CGM and insulin pump (9/34). Their A1c before the first VVC encounter was 8.7% +/-1.5. About 21/34 patients requested additional follow up via VVC appointments, leading to an average of 2.33 encounters during the 3 months study period. Distance travelled one way for face-to-face visit was estimated to be 74.2 miles +/-37.4. Changes in diabetes care was recommended for insulin dosing in 22% (19/85) of encounters. Adjustments in CGM/pump settings recommended in 18% (16/85) of encounters. Overall there were meaningful changes made to diabetes care in 41% of encounters.
Conclusions: The use of telehealth for diabetes care resulted in significant changes in diabetes therapy in a sizeable number of patients and saves time and travel distance. A telehealth clinic supports and enhances patient preference and experience.

Disclosure
M. Amole: None. L. Whyte: None. H. Ghayee: None. J.A. Leey: None.
859-P: Estimated A1C Reduction in High-Risk Patients over Two Years of Using a Digital Diabetes Management Platform
Authors: HERSHCOVITZ YIFAT , DAR SHARON , FENIGER EITAN 
Published: June 2020

A Digital Diabetes management platform aims to improve diabetes self-management. Glycemic control is best evaluated by the combination of blood glucose average (BGavg) and A1c. Frequent fluctuation of blood glucose may contribute to diabetes-related complications. Long-term management of type 2 diabetes remains challenging to significant number of patients. This study followed glycemic parameters observed over 2-years.
Method: A retrospective data evaluation study was performed on high-risk users with type 2 diabetes that measured their blood glucose using Dario® platform database for two consecutive years. The study assessed BGavg, estimated A1c (eA1c) values and glycemic variability following 24 months compared to the first month (baseline).
Results: A group of 148 high-risk users with type 2 diabetes, non-Insulin treated was evaluated. Their BGavg was of &gt;180mg/dL (eA1c&gt;8.0) for users taking ∼2 blood glucose measurements per day in the first month and in the 24th month on average. Their BGavg was consistently reduced by 18% and sustained (179±45 vs. 219±56 mg/dL) and eA1c was reduced by 1.5 percentage points (9.26±1.3 vs. 7.86±1.8). Glycemic variability was reduced by 20% (SD: 45 vs. 56) at the end of 2 years. Additional analysis of 220 users with type 2 diabetes,147 started with eA1c &gt;9.0% and 73 started with eA1c &gt;10%, revealed substantial eA1c reduction of 2.0 percentage points (10.31 ± 1.8% vs. 8.36 ± 1.2%) and 2.4 percentage points (11.15 ± 1.2% vs. 8.73% ± 2.1%) from baseline after 2 years, respectively. Glycemic variability was reduced by 20% for both (SD: 55 vs. 69 and 59 vs. 74, respectively).
Conclusion: Overall this study confirms the potential of digital diabetes solutions to sustain glycemic achievements in users with type 2 diabetes over two years. The system may assist the users to experience an actual behavior modification in their diabetes self-management as well as in their long-term routine for self-care.

Disclosure
Y. Hershcovitz: Employee; Self; DarioHealth. S. Dar: Employee; Self; DarioHealth. E. Feniger: Employee; Self; DarioHealth.
902-P: Introducing Continuous Glucose Monitoring Technology at Diagnosis in Pediatric Type 1 Diabetes: A Proof-of-Concept Study
Authors: HIERS PAUL , ADAMS JANEY , FILIPP STEPHANIE L. , HALLER MICHAEL J. 
Published: June 2020

Diabetes technology is changing and integral for diabetes care. Our hypothesis is patients who start using continuous glucose monitoring (CGM) technology at diagnosis will have better clinical outcomes and higher levels of satisfaction and lower levels of burden than patients who initiate CGM therapy later in the course of their disease management.
Methods: This quality improvement study offered Freestyle Libre CGM to all patients newly diagnosed with T1D. The primary outcome was improvement in self-reported treatment satisfaction as measured by the Diabetes Treatment Satisfaction Questionnaire-Parent (DTSQ-P). Secondary outcomes included adolescent treatment satisfaction, fear of hypoglycemia, diabetes distress, burden, and QOL. Measures were given at baseline and 3 months. Data for participants was compared with retrospective data from age-matched controls who did not receive a Libre at diagnosis.
Results: 26 parent-child dyads between the ages of 4-17 years old participated in the study. Preliminary results showed improved DTSQ-parents scores 47.1 ± 8.0 to 50 ± 9.9 over the 3 month study. Please see tables for parent and child version of DTSQ- DDS, PedQL, FOH, PAID results.
Conclusions: There were trends towards improved satisfaction and QOL scores. This shows supportive data for improved quality and satisfaction measures in using CGM technology starting at diagnosis.

Disclosure
P. Hiers: None. J. Adams: None. S.L. Filipp: None. M.J. Haller: Advisory Panel; Self; SAB Biotherapeutics, Inc.

Funding
Diabetes Action Research and Education Foundation (468)
92-OR: EMC10, a Novel Serum Predictor for Coronary Artery Disease, Exerts an Impact on the Development of Atherosclerosis via Negatively Modulating Endothelial Insulin Signaling
Authors: JING YU , WANG XINRU , YU YIFEI , CHEN KUANGYANG , JIN SHUOSHUO , LI YANLIANG , WANG XUANCHUN 
Published: June 2020

Cardiovascular disease is the leading cause of global mortality, accounting for about one third of deaths worldwide. Secreted proteins from metabolically regulated organs are released into circulation and exert impacts on the pathogenesis of cardiovascular disease. In this study, we identified a novel secreted protein, EMC10, that might influence the development of atherosclerosis. We initially observed that serum EMC10 is significantly decreased in patients with coronary artery diseases evidenced by coronary artery stenosis over 50 percent, compared with those suffering stenosis less than 50%. In addition, we found that the levels of serum Emc10 are even lower in patients who meanwhile suffered from hypertension. After adjusted for age, BMI, hypertension, and diabetes, the regression analysis revealed that serum EMC10 is an independent predictor for coronary artery diseases. To determine the role of EMC10 in cardiovascular disease, we established Emc10 whole body knockout mice and found that both the systolic and diastolic blood pressure are significantly decreased in EMC10 KO mice in comparison to wild type ones. Furthermore, in vitro experiments showed that EMC10 significantly decreases the insulin-stimulated phosphorylations of both Akt and eNOS, and conversely, significantly increases VCAM-1 mRNA in endothelial cells. Collectively, these preliminary data suggest EMC10 leads to endothelial insulin resistance and plays a role in the development of atherosclerosis, by which EMC10 is involved in the pathogenesis of cardiovascular disease. Our findings establish Emc10 as a novel modulator of endothelial insulin signaling and a potential target for the intervention of diabetic vascular diseases.

Disclosure
Y. Jing: None. X. Wang: None. Y. Yu: None. K. Chen: None. S. Jin: None. Y. Li: None. X. Wang: None.

Funding
National Natural Science Foundation of China (81370936); Science and Technology Commission of Shanghai Municipality (18140902100)