bluuebunny/crossref_metadata_2025_split huggingface dataset:
751-P: Cost Effectiveness of Program Active II: A Community-Based Depression Treatment for Rural and Urban Adults with Type 2 Diabetes
Authors: KUO SHIHCHEN , YE WEN , GROOT MARY DE , SHUBROOK JAY H. , HORNSBY W. GUYTON , PILLAY YEGAN , MATHER KIEREN J. , HERMAN WILLIAM H. 
Published: June 2020

Objective: Program ACTIVE II was a randomized controlled trial to assess the comparative effectiveness of cognitive behavioral therapy (CBT) and/or community-based exercise (EXER) individually and in combination (EXER+CBT) compared to usual care (UC) in adults with type 2 diabetes and major depression. We sought to estimate the cost-effectiveness of the three interventions relative to each other and to UC.
Research Design and Methods: Empirical trial data were integrated into the Michigan Model for Diabetes to estimate cost and health outcomes over a 10-year time horizon from the healthcare sector and societal perspectives, discounting both costs and benefits at 3% annually. The primary outcome was costs per quality-adjusted life-year (QALY) gained.
Results: From the healthcare sector perspective, compared to UC, the EXER intervention saved $313 per patient and produced 0.38 more QALY (cost-saving), the CBT intervention cost $596 more and gained 0.29 more QALY ($2,054/QALY), and the EXER+CBT intervention cost $403 more and gained 0.69 more QALY ($585/QALY). Both EXER and EXER+CBT interventions dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention cost $716 more and gained 0.31 more QALY ($2,323/QALY). From the societal perspective, compared to UC, the EXER intervention still saved $126, the CBT intervention cost $2,833/QALY, and the EXER+CBT intervention cost $1,167/QALY. Both EXER and EXER+CBT interventions still dominated the CBT intervention. Compared to EXER, the EXER+CBT intervention cost $3,021/QALY. Results were robust in sensitivity analyses.
Conclusions: All three Program ACTIVE II interventions represented a good value for money compared to UC. The EXER+CBT intervention was highly cost-effective or cost-saving compared to the EXER or CBT intervention.

Disclosure
S. Kuo: None. W. Ye: Research Support; Self; Bayer Healthcare Pharmaceuticals Inc. M. de Groot: Consultant; Self; Kenner Family Foundation, Inc., LifeScan Diabetes Institute. J.H. Shubrook: Advisory Panel; Self; Bayer U.S., Eli Lilly and Company, Novo Nordisk Inc., Sanofi US. W. Hornsby: None. Y. Pillay: None. K.J. Mather: Research Support; Self; Abbott, Merck & Co., Inc., Novo Nordisk Inc., Sanofi. W.H. Herman: Consultant; Spouse/Partner; Nestlé. Other Relationship; Self; Merck Sharp & Dohme Corp.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK092765, R34DK071545)
758-P: Daily Blood Glucose Predicted by Sleep, Exercise, and Relationship Quality in Young Married Couples with Type 1 Diabetes
Authors: YORGASON JEREMY B. , SAYLOR JENNIFER 
Published: June 2020

T1DM care is critical during emerging adulthood (18-30 years of age), as this age group is known for inconsistent T1DM management, beginning complications, and frequent hospital visits, along with higher hemoglobin A1c levels than any other age group. Complications related to maintaining blood glucose may be due to emerging adults transitioning to new environments, where T1DM management patterns change and less time is spent with blood glucose “in range” (the time in which glucose levels are in an ideal range). An important new environment for emerging adulthood with T1DM is the transition to living with a partner resulting in new patterns of diabetes management, sleep and exercise patterns, and relationship processes. Using data from a pilot study of 15 young married couples, we examined daily glucose levels as predicted by daily sleep, daily physical activity, and baseline relationship quality. We controlled for relationship length, income, education, time since diagnosis, and baseline hemoglobin A1c levels. Sleep and physical activity were measured using actigraphy watches, and daily glucose levels were measured using continual glucose monitors (where available). Findings suggest that sleep efficiency is linked with higher average daily blood glucose readings. Further, this link was moderated by relationship quality such that those with higher relationship quality and higher sleep efficiency also reported higher average glucose levels. Results from this preliminary study suggest that better sleep and relationship processes are associated with higher average blood glucose levels.

Disclosure
J.B. Yorgason: None. J. Saylor: None.

Funding
Brigham Young University
761-P: Historical Trauma, Contemporary Trauma, and Type 2 Diabetes Self-Management among American-Indian/Alaska-Native Women
Authors: JOLLEY DOROTHY R. , PERRY ANTHONY 
Published: June 2020

Endemic type 2 diabetes mellitus (T2DM) is one of the leading causes of mortality among American Indian/Alaska Natives (AI/ANs). Trauma and stress have been shown to impact the progression of diabetes and can negatively impact health-related behaviors. Previous studies have not examined the relationship between historical and contemporary trauma and T2DM self-management among AI/AN women. The purpose of this research was to examine the relationship between historical loss, historical loss associated loss symptoms, stressful life events, microaggressions (microinsults and microinvalidations), and T2DM self-management (glucose management, dietary control, physical activity, healthcare-use) among AI/AN women with diabetes. Historical trauma theory was the basis of this study and explains the consequences of colonization resulting in contemporary trauma that affects physical and mental health. A cross-sectional survey design included data from a convenience sample of AI/AN adult women. Multiple regression analyses showed that the more experiences with microinvalidations predicted poorer glucose management (B = -0.283, p &lt; .05), less physical activity (B = -0.272, p &lt; .05), less health care use (B = -0.248, p &lt; .05), and poorer overall T2DM self-management
(B = -0.848, p &lt; .05). Also, more experiences of historical loss predicted poorer glucose management (B = -0.054, p &lt; .05), and the more stressful life events predicted poorer dietary control (B = -0.040, p &lt; .05). The study demonstrated that microaggressions and historical loss had a significant and negative impact on T2DM self-management among AI/AN women. The results may be used to improve T2DM self-management and the high levels of mortality, morbidity, costs, and quality of life among AI/AN women.

Disclosure
D.R. Jolley: None. A. Perry: None.
763-P: Parent–Child Mealtime Behavior and Glycemic Control in T1D Preschoolers
Authors: MEIGHAN SEEMA , SINISTERRA MANUELA , TULLY CARRIE , MACKEY ELEANOR , STREISAND RANDI 
Published: June 2020

Parents of T1D preschoolers must balance nutrition, insulin needs, and eating behaviors of this age group. The present study examined the relationship between parent feeding practices, child mealtime behavior, and glycemic control in T1D preschoolers. 36 parent-child dyads (2-5 y, T1D≥1 y) were part of a baseline assessment for a RCT (M child age=4.7 y; M A1c=8.3; M parent age=36.3 y). Parent feeding practices and child mealtime behaviors were measured using the Structure and Control in Parent Feeding Questionnaire (SCPF Table 1) and the Behavioral Pediatrics Feeding Assessment Scale (BPFAS Table 1). Glycemic control measured with CGM. Descriptive statistics for glycemic control, parent and child behaviors are in Table 1. Greater frequency of problematic child behavior at mealtime was associated with greater reports of control-based feeding practices (restriction and pressure to eat; r=.44, p&lt;.01) and greater problematic feeding practices as a whole (r=.37, p&lt;.05). There was a trend towards an association (p&lt;.1) between limiting food exposure, food restriction, and % TBR at breakfast. Problematic child behavior at mealtimes may be related to parents’ engagement in control-based feeding practices, which may lead to increased hypoglycemia at breakfast. Understanding behaviors that trigger more problematic feeding practices may help parents engage in more positive feeding practices, with the goal of better glycemic control.

Disclosure
S. Meighan: None. M. Sinisterra: None. C. Tully: None. E. Mackey: None. R. Streisand: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
764-P: Art Therapy as a Novel Mental Health Therapy Aimed at Reducing the Psychological Burden of Living with Type 1 Diabetes
Authors: LAMPRON CARA , GOLAND ROBIN , LEIBEL NATASHA 
Published: June 2020

Objectives: Type 1 diabetes (T1D) is strongly linked with an increase in stress, depression, and anxiety. Mental health care is widely acknowledged to be an essential component of T1D clinical care. However, it has proven challenging to identify a successful model of mental health care for T1D. We investigated whether art therapy could be used in the psychological care of patients with T1D. Art therapy allows for the expression and exploration of complex emotions related to illness in an age-appropriate manner, and has been shown to be an effective mental health therapy in other chronic illnesses, but has not been studied in T1D.
Methods: We evaluated the effectiveness of an art therapy intervention for stress management in T1D patients. We administered a 17-question questionnaire to 22 sequential patients referred to the on-site art therapist. Mean age of the subjects was 13.1 +/- 7.5 years (range: 8-40 years) and mean duration of diabetes was 5.3 +/- 5 years. The subjects saw the art therapist a mean of 7 +/- 6.4 visits prior to completing the questionnaire.
Results: All participants found the sessions stress reducing and planned to continue with ongoing therapy and to incorporate strategies learned into diabetes self-care. The most common responses associated with art therapy were “calm,” “safe,” “feeling understood,” “less overwhelmed.” The average A1c prior to receiving art therapy was 8.7+/-1.8%, and fell to 7.7% +/- 1.5% after a mean of 7 art therapy sessions.
Conclusions: Art therapy was a well-received effective mental health treatment in reducing stress in T1D. In this sample, glucose control improved as well. Art therapy is a novel modality in the psychological care of patients living with T1D that can alleviate some of the psychological burden of the disease, a treatment that will be studied in a larger trial.

Disclosure
C. Lampron: None. R. Goland: None. N. Leibel: None.
776-P: Characteristics of Overnight Blood Glucose Levels Are Related to Sleep Quality in People with Type 1 Diabetes
Authors: BRANDT RACHEL , PARK MINSUN , QUINN LAURIE T. , CHU MINSEUNG , SONG YOUNGKWAN , BURTON-FREEMAN BRITT M. , CINAR ALI 
Published: June 2020

Nineteen people with T1D (10 male, 9 female. Age: 31 +/- 9 yrs, A1c: 6.6 +/- 0.8 and duration of diabetes: 19 +/- 11 years) had their sleep monitored with an EEG-based device (Zmachine Insight+) for a total of 154 nights. Their blood glucose levels (BGL) were measured with a CGM. From the CGM data, the participant’s average BGL, standard deviation of BGL, coefficient of variation of BGL, Percent Time in Range (70-180 mg/dL), Percent Time Above Range (&gt;180 mg/dL), and Percent Time Below Range (&lt;70 mg/dL) was calculated for each overnight period. A t-Test was used to determine if there was a difference between characteristics in the participants’ overnight BGL based on different sleep quality metrics. Participants who had sleep efficiency scores &gt; 85% had less variable overnight BGL determined by the standard deviation and coefficient of variation of CGM (p = 0.0013 and 0.017). Participants who had higher average overnight BGL and more fluctuations, as determined by standard deviation and coefficient of variation, in their BGL (p = 0.017, 0.000004, and 0.0004) spent more time awake overnight. Those who have lower average overnight BGL spent more time in Deep and REM sleep stages (p = 0.044 and 0.0043). From these findings, we can conclude that overnight BGL has a significant impact on sleep quality in people with T1D. Based on previous research, this reduction in sleep quality may negatively impact daytime control.

Disclosure
R. Brandt: None. M. Park: None. L.T. Quinn: None. M. Chu: None. Y. Song: None. B.M. Burton-Freeman: None. A. Cinar: Research Support; Self; Dexcom, Inc., JDRF. Stock/Shareholder; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S, Tandem Diabetes Care.

Funding
JDRF (A18-0036-001)
790-P: Multicomponent Integrated Care Program Benefits on Diabetes-Related Grief and Stage of Change and Glycemic Control Association
Authors: SILVA-TINOCO RUBÉN , SALAS-MARTÍNEZ OSCAR , DELATORRE-SALDAÑA VIRIDIANA , GUZMAN EILEEN B. , CUATECONTZI ENEDINA TERESA C. , CABRERA-GERARDO DOLORES , CASTILLO-MARTINEZ LILIA , GALLARDO-RINCÓN HECTOR , SERNA JAVIER , GONZALEZ-CANTU ARNULFO , ROMERO-IBARGUENGOITIA MARIA ELENA 
Published: June 2020

Self-care behavior is the cornerstone in diabetes care. Strategies to promote behavior change and overcome grief process to improve diabetes outcomes have been poorly studied. We examined a quality initiative Multicomponent Integrated Care (MIC) program on Grief Stage (GS) and Stage of Change (SOC) allocation and its association with A1c in persons with type 2 diabetes (PwT2D) in a public primary care T2D clinic. DIABEMPIC is a 5-months empowerment-based program including: interdisciplinary case management team, diabetes self-management education, individual/group sessions, shared medical appointments, audit and feedback, and guaranteed supply of medications. We evaluated the effect of the intervention using a ’before and after’ design. Advanced stages were defined by higher than “anger” and higher than “contemplation” for GS and SOC, respectively. Total PwT2D were 451, the mean (SD) age was 54.6 (11) years, 66% were female, diabetes duration was 12 (8) years and baseline A1c was 9.5% (2.1). Baseline GS: denial 43.6%, anger 25.1%, bargaining 22.8%, depression 8.2% and acceptance 0.3%. Baseline SOC: precontemplation 55.4%, contemplation 40.6%, determination 2.5%, action 2.5% and maintenance 0%. GS and SOC improved after the intervention (83% and 68.7% presented advanced stages, respectively), p&lt;0.001. A1c decreased 2.7% (2.2), p-value &lt;0.001. Advanced GS and SOC were associated with an A1c ≦ 8% (OR 0.29, 95% CI, 0.16-0.52 and OR 0.21, 95% CI, 0.12-0.38, respectively). Also, these advanced stages had higher decrease of A1c (-0.8, -0.7%, respectively) than those who persist in earlier stages (p&lt;0.001). We report a high prevalence of initial GS and SOC in PwT2D and poor glycemic control. MIC program participation was associated with improving GS and SOC. Advanced stages of GS and SOC at the end of the program were associated with better glycemic control. MIC strategies must be considered to promote behavior change and overcome grief process in PwT2D.

Disclosure
R. Silva-Tinoco: Speaker’s Bureau; Self; Novo Nordisk Inc. O. Salas-Martínez: None. V. delaTorre-Saldaña: None. E.B. Guzman: None. E.C. Cuatecontzi: None. D. Cabrera-Gerardo: None. L. Castillo-Martinez: None. H. Gallardo-Rincón: None. J. Serna: None. A. Gonzalez-Cantu: None. M. Romero-Ibarguengoitia: None.
794-P: “The Tool Created a Chance to Discuss Topics You Don’t Normally Address in Diabetes Consultations”: A Study of Using Patient-Reported Outcomes to Promote Person-Centered Care and Psychosocial Support
Authors: JOENSEN LENE E. , SCHULTZ ASTRID A. , MADSEN KRISTOFFER P. , PERSSON FREDERIK , NØRGAARD KIRSTEN , WILLAING INGRID 
Published: June 2020

The aim of this study was to test the usefulness of a dialogue tool from the perspective of people with type 1 diabetes. The tool was expected to prime adults with type 1 diabetes and diabetologists to discuss relevant psychosocial aspects of diabetes during diabetes consultations. The tool (PAID-5, WHO-5 and three open-ended questions) was filled out by 40 people with type 1 diabetes three days before routine diabetes consultations and tested in consultations. Participants’ age ranged from 22 to 72 years; 39% were men; diabetes duration was four to 59 years; HbA1c: 41-59 mmol/mol (5.9-7.9%). Perceptions of using the tool and overall experience of the consultation were explored with interviews and questionnaires (CARE, PEQ). A control group of 42 people with type 1 diabetes (attending regular consultations) also filled out questionnaires about overall consultation experiences. No differences were found in age, diabetes duration, HbA1c or gender between control and intervention group. Questionnaires showed that the dialogue tool did not influence perceptions of patient-centered care (no significant between-group differences in CARE or PEQ). However, participants who experienced high diabetes distress (n=6) found the tool more relevant and useful in bringing up important and difficult topics compared to people experiencing no distress (p=0.004). Interviews showed that participants found the tool useful and relevant in preparing them for consultations and in creating an opportunity for dialogue about psychosocial aspects of diabetes. However, some participants found the tool irrelevant and the dialogues to be “mechanical.” Consultation dialogue tools seem to be a relevant way to meet the needs of people experiencing diabetes-related emotional difficulties, but these tools require diabetologists to be flexible in adapting them to the needs and wishes of the person with diabetes.

Disclosure
L.E. Joensen: None. A.A. Schultz: None. K.P. Madsen: None. F. Persson: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S. Research Support; Self; Amgen, AstraZeneca, Novo Nordisk A/S. Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S. K. Nørgaard: Advisory Panel; Self; Abbott, Medtronic. Research Support; Self; Novo Nordisk A/S. Speaker’s Bureau; Self; Medtronic, Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk Inc. I. Willaing: None.
795-P: Novel Brief Questionnaire and User Guide to Improve Injection Technique
Authors: BARNARD KATHARINE D. , MAHONEY EDWARD T. , MOREL DIDIER , GLEZER STANISLAV 
Published: June 2020

Background and Aim: The efficacy of insulin and other injectable therapies depends on injection technique. To develop and validate a brief self-administered injection technique assessment questionnaire.
Methods: The questionnaire was developed using an iterative process with people with diabetes (PWD) and healthcare professionals (HCP). Focus groups and 1:1 interviews were held with adults with T1D, T2D and HCPs separately to elicit views and refine the tool ready for broader distribution to target audience. Questions addressed ease of understanding, relevance, included questions and potential missing questions, feelings about diabetes and any discomfort or judgement felt. A user guide was developed with cognitive interviewing performed to ensure relevance, acceptability and understanding by potential users. Multiple Component Analysis assessed relationships between questions after extensive descriptive statistical analysis. Propensity score matching compared the questionnaire to the ITQ WW.
Results: Five HCPs and 16 PWD participated in the initial focus groups and interviews. Questions were reported to be clinically relevant by HCPs and simple to complete. PWD reported the 9-item questionnaire to be ’about the right length’, with questions relevant and the user guide easy to read and interpret. 268 participants completed the survey reviewing the questionnaire and provided feedback. A further 16 participants (10 HCPs and 6 PWD) took part in the cognitive interviews. The complete resource was finally reviewed by a further 23 PWD as a check of completeness and usability. Statistical analyses showed the questionnaire to depict similar trends to those assessed in the detailed questionnaire (ITQ WW), confirming the validity of this new questionnaire as a shorter, more straightforward tool.
Conclusions: The novel, brief questionnaire and user guide are clinically relevant, acceptable and easy to use both as a clinical resource and a self-assessment tool for people using injectable therapies.

Disclosure
K.D. Barnard: Advisory Panel; Self; Roche Diabetes Care, Sanofi-Aventis. Research Support; Self; BD, Novo Nordisk A/S, Roche Diabetes Care. E.T. Mahoney: Employee; Self; Becton, Dickinson and Company. D. Morel: Employee; Self; Becton, Dickinson and Company. S. Glezer: Employee; Self; Becton, Dickinson and Company. Employee; Spouse/Partner; Pfizer Inc. Stock/Shareholder; Self; Sanofi. Stock/Shareholder; Spouse/Partner; Sanofi.

Funding
BD
796-P: Undiagnosed Diabetes Is Associated with Stress-Related Behaviors in African Immigrants
Authors: OSEI-TUTU NANA H. , HORMENU THOMAS , SHOUP ELYSSA M. , HOBABAGABO ARSENE F. , DUBOSE CHRISTOPHER , CHUNG STEPHANIE T. , MABUNDO LILIAN , SUMNER ANNE E. 
Published: June 2020

Whether stress-related behaviors or social factors are associated with diabetes (DM) in African-born blacks living in the United States is unknown. Thus, African immigrants who identified as healthy underwent OGTT and had extensive questioning about lifestyle and socioeconomic status. Neither participants nor investigators knew the outcome of the OGTT at the time surveys were administered. The participants were 470 African-born blacks living in Washington, DC (male: 66%, age 38±10y, range 20-65y, BMI 27.6±4.5, range 19.5-39.9). DM was diagnosed by glucose criteria for the OGTT or A1C≥6.5%. DM was identified in 9% (40/470) of participants. Age, BMI and years in the United States were higher in the group with DM (age: 44±10 vs. 38±10y; BMI: 29.8±4.9 vs. 27.4±4.4; Years in U.S.:16±10 vs. 12±10y, all P&lt;0.01). Participants with DM had significantly higher alcohol intake and tended to have higher rates of smoking and a lower intake of fruits and vegetables (Figure). There was no difference by DM status in exercise, sleep duration, education, income or health insurance (all P&gt;0.5). Overall, undiagnosed DM was associated with stress-related behaviors such as alcohol intake, smoking and diet. Whereas, difficult to address social characteristics such as education, income and health insurance did not differ by DM status. Combining DM screening with counseling on stress may lead to improved health for African immigrants.

Disclosure
N.H. Osei-Tutu: None. T. Hormenu: None. E.M. Shoup: None. A.F. Hobabagabo: None. C. DuBose: None. S.T. Chung: None. L. Mabundo: None. A.E. Sumner: None.