bluuebunny/crossref_metadata_2025_split huggingface dataset:
791-P: Identifying the Diabetes Distress among People with Diabetes in Taiwan
Authors: CHEN KWANG-WEN , CHEN HSIAO-HSUAN , HUNG CHIA-WEI , HWANG JING-FEN , CHUANG YUH JUE , CHEN ZHI-XIAN 
Published: June 2020

Objective: People with higher level of diabetes distress (DD) may have difficulty in managing their diabetes and possible higher A1c. In order to provide proper psychosocial care, we designed this study to understand the DD of participants in a diabetes clinic.
Methods: The study was a cross-sectional design conducted in a diabetes clinic in Taiwan. Diabetes distress (DD) was assessed by Diabetes Distress Scale and accompanied by a semi-structured interview to collect qualitative information. DD includes 4 dimensions which are emotional burden (EB), interpersonal (IP), physician related (PR) and regimen-related (RR) distress. The correlation analysis was conducted to portray the relationships between DD and sociodemographic variables. Emotional state using Hospital Anxiety and Depression Scale, quality of life using WHO Quality of Life-BREF, and HbA1C levels were also gathered as the dependent variables in regression models to understand how DD related to the adaptive index in people with diabetes.
Results: There were 71 (37 M and 34 F, 64 T2D and 7 T1D, 27 insulin treated) participants and mean age 51.6 ± 14.5 yrs. According to correlation analysis, age (r = -.30, p = .011) and taking insulin (r = .33, p = .005) were associated with the level of DD. Female participants had a higher level of EB (r = .26, p = .031) and IP distress (r = .29, p = .014). In the regression model with single independent variable, mean DD (β = .29, p = .016) and RR (β = .24, p = .040) was related to the level of HbA1C respectively, but they were not significant after entering control variables of taking insulin and new patients. Mean DD and EB distress were significant association with quality of life, the symptoms of depression and anxiety in the regression models.
Conclusions: Younger people and using insulin were associated with higher level of DD. The mean score of DD and RR dimension were also associated with the levels of A1c, however, using insulin and new patients might have a stronger association with the levels of A1c.

Disclosure
K. Chen: None. H. Chen: None. C. Hung: None. J. Hwang: None. Y. Chuang: None. Z. Chen: None.
80-OR: ß-Cell Hif1a-miR-21 Signaling Exacerbates ß-Cell Dysfunction Occurring during Diabetogenic Stress
Authors: IBRAHIM SARA , STEPHENS CLARISSA , MOORE RACHEL E. , MIRMIRA RAGHAVENDRA , SIMS EMILY K. 
Published: June 2020

We previously showed that β cell microRNA 21 (miR-21) is increased by islet inflammatory stress and diabetes, that miR-21 induces β cell dysfunction by targeting mRNAs maintaining β cell identity, and that β cell miR-21 induction in vivo leads to hyperglycemia. However, upstream regulators of β cell miR-21 are poorly defined. We hypothesized that increases in the transcriptional regulator Hypoxia Inducible Factor 1 Subunit Alpha (Hif1a) during diabetogenic islet stress activate β cell miR-21 transcription, thereby contributing to loss of β cell identity occurring under these conditions. To test this, we examined Hif1a and miR-21 levels in β cell lines and mouse islets. Hif1a was increased in islets from mice after multiple low dose streptozotocin (STZ) or 4 wks of 60% high fat diet (HFD). INS1 cells and flow-sorted β cells showed increases in both miR-21 and Hif1a mRNA after 24-hr IL1β treatment. Hif1a overexpression in INS1 cells increased miR-21 levels, insulin and glucagon co-expression, and aldehyde dehydrogenase 1a3 staining, all suggesting loss of β cell identity. By contrast, siRNA depletion of Hif1a abrogated cytokine-induced reductions in mRNAs regulating β cell identity. Chromatin immunoprecipitation studies verified increased HIF1a occupancy at the miR-21 promoter after IL1β treatment. To test if these HIF1a-mediated increases in β cell miR-21 exacerbate β cell dysfunction under diabetogenic conditions in vivo, transgenic mice harboring a β cell tamoxifen inducible miR-21 transgene (Tg(β-miR-21, Ins1(CreERT2)Thor) were treated with STZ or HFD. Compared to controls, STZ and HFD-induced hyperglycemia was exacerbated in Tg(β-miR-21) mice following tamoxifen administration. By contrast, after STZ, conditional β cell miR-21 knock out (Ins1(Cre)Thor) mice showed improved glycemia.
In conclusion, these findings implicate Hif1a-miR-21 signaling as a contributor to β cell dysfunction under conditions of inflammation and diabetes.

Disclosure
S. Ibrahim: None. C. Stephens: None. R.E. Moore: None. R. Mirmira: Advisory Panel; Self; Hibercell, Sigilon Therapeutics, Veralox Therapeutics. Employee; Spouse/Partner; Eli Lilly and Company. E.K. Sims: None.
801-P: Health Beliefs and Knowledge about Gestational Diabetes (GDM) in American Indian/Alaska Native (AI/AN) Female Adolescents and Young Adults (AYA) and Their Mothers: Preliminary Findings from the Stopping GDM Trial
Authors: SEREIKA SUSAN M. , MOORE KELLY R. , STOTZ SARAH A. , FISCHL ANDREA F. , CHALMERS LAURA , GARROW HEATHER , GONZALES KELLY L. , O’BANION NANCY , CHARRON-PROCHOWNIK DENISE 
Published: June 2020

Introduction: Little research has focused on enhancing knowledge and health beliefs in female AYA at risk for GDM and their mothers, particularly in the AI/AN population. We examined the change in knowledge and health beliefs about GDM at the baseline visit between the intervention (n=60) and control (n=53) arms of the Stopping GDM Trial among AI/AN female AYA at risk for GDM (i.e., daughters) and their mothers.
Methods: Grounded in the Expanded Health Belief Model and using a randomized controlled trial design, this investigation focused on the efficacy of a video viewed at the baseline visit of a culturally tailored online program to enhance knowledge and health beliefs to decrease GDM risk in 113 AI/AN female AYA (74% AI; on average 16.9±3.0 years old; 45% in grades 9-12) and their mother or an adult female (e.g., grandmother) (80% mother; 82% AI; on average 44.7±9.4 years old; 44% college educated). All completed established measures of knowledge and health beliefs (benefits, barriers, severity, susceptibility) before and after viewing the video. Data were analyzed using descriptive statistics and linear mixed modeling.
Results: At the baseline visit daughters in the intervention group had greater mean increase in overall reproductive health and GDM knowledge (p=.010), and more specifically family planning knowledge (p=.003), compared to the control group. Daughters on average increased both diabetes prevention comprehensive (p=.048) and GDM (p&lt;.001) knowledge. Mothers showed mean increases in all knowledge scores (p&lt;.05). Regarding health beliefs, both daughters and mothers on average increased perceived susceptibility scores and decreased perceived barriers scores (p&lt;.05).
Conclusions: These initial results support the use of culturally tailored behavioral interventions to improve knowledge and health beliefs to reduce GDM risk in AI/AN female AYA.

Disclosure
S.M. Sereika: None. K.R. Moore: None. S.A. Stotz: None. A.F. Fischl: None. L. Chalmers: None. H. Garrow: None. K.L. Gonzales: None. N. O’Banion: None. D. Charron-Prochownik: None.

Funding
National Institutes of Health (R01NR114831)
804-P: How Barriers Affect Primary Care Providers’ Referral to the National Diabetes Prevention Program Lifestyle Change Program
Authors: ZHANG XUANPING , CANNON MICHAEL , NHIM KUNTHEA , KHAN TAMKEEN 
Published: June 2020

Primary care providers’ (PCP) referral of participants to the National Diabetes Prevention Program lifestyle change program (National DPP LCP) needs to be amplified or increased. Using data from 2016, 2017, and 2018 DocStyles surveys, we examined how barriers affect PCPs’ referral and how their practice patterns change over time. Barriers were measured by survey questions regarding PCPs’ perspectives on the importance of 1) claim adjudication processes/payment for the service; 2) interconnectivity of electronic health records (EHRs) with other systems; 3) incentives for referrals; and 4) awareness of prediabetes and National DPP LCP. A logistic model was used to analyze the trend, and the full model controlled for age, gender, practice type, and practice regions. Our analytic cohorts consist of PCPs who were selected repeatedly in two years. The 2016-2018 cohort had 502 PCPs, and the 2017-2018 cohort had 462 PCPs. In the first cohort, the referral rate decreased by 38.5%, from 23.3% in 2016 to 14.3% in 2018 (P&lt;0.05). In the second cohort, the rate decreased by 37.8%, from 24.0% in 2017 to 14.9% in 2018 (P&lt;0.05). Not realizing the importance of the above 4 barriers contributed significantly to the decreased referral rate. Referral rates for those who did not realize barriers 1 and 2 in 2016 did not differ significantly from those who did; however, by 2018 those who did not realize the barriers had lower referral rates (odds ratio (OR) 2.26 (95% confidence interval: 1.31-3.91) for barrier 1 and 1.78 (1.05-3.00) for barrier 2). Similarly, for barriers 3 and 4 differences were not significant in 2017, but ORs increased to 1.89 (1.02-3.51) and 2.91 (1.62-5.20) in 2018. Our findings suggest that lack of realizing the importance of claim/payment, EHR usage, incentives for referrals, and awareness of National DPP LCP discouraged PCP referral practice and the negative effect amplified over time. Future interventions need to focus on how to overcome these barriers.

Disclosure
X. Zhang: None. M. Cannon: None. K. Nhim: None. T. Khan: None.
807-P: Pathways between Neighborhood Factors, Stress, and Glycemic Control in Adults with Type 2 Diabetes
Authors: MOSLEY-JOHNSON ELISE , CAMPBELL JENNIFER A. , WALKER REBEKAH J. , EGEDE LEONARD E. 
Published: June 2020

Background: Neighborhood factors are known barriers to optimal diabetes outcomes; however, the pathways for these findings are not adequately understood. This study examined the direct and indirect pathways between neighborhood factors and glycemic control.
Methods: Data on 615 adults with type 2 diabetes was analyzed. Latent variables were created for neighborhood violence, neighborhood aesthetics, social cohesion, and access to healthy foods. Stress and HbA1c were entered as measured variables. Structured equation modeling (SEM) was used to investigate direct and indirect relationships between neighborhood factors, stress, and glycemic control.
Results: In the final model (Figure 1) (chi2 (158)= 406.97, p&lt;0.001, RMSEA=0.05, p-close 0.38, CFI=0.97, TLI 0.96, CD=1.0), neighborhood violence (r=0.79, p=0.006), neighborhood aesthetics (r=0.74, p=0.02), and social cohesion (r=0.57, p=0.04) were significantly directly associated with stress. Stress was significantly directly associated with glycemic control (r=0.06, p=0.004). Neighborhood violence (r=0.05, p=0.05) and aesthetics (r=0.05, p=0.07) were marginally indirectly associated with glycemic control through stress.
Conclusions: The pathway between neighborhood factors and glycemic control is via chronic stress, therefore, interventions are needed to target chronic stress in adults with type 2 diabetes.

Disclosure
E. Mosley-Johnson: None. J.A. Campbell: None. R.J. Walker: None. L.E. Egede: None.

Funding
American Diabetes Association (1-19-JDF-075 to R.J.W.); National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861); National Institute on Minority Health and Health Disparities (R01MD013826)
810-P: A Behaviorally-Enriched Diabetes Prevention Program for a State Employee Driver Population
Authors: WELCH GARRY , DOWNS SARAH M. , VIDETTO MARYANN , GRISWOLD ALYSSA M. 
Published: June 2020

Objective: Transportation workers, including drivers, are at high risk of developing diabetes but are a challenging workforce to reach for public health initiatives. We evaluated an innovative, culturally-tailored Diabetes Prevention Program (DPP) designed to strengthen driver behavioral engagement and program outcomes as part of a collaboration with the CT State Employer and the drivers’ Labor Union. The DPP included behavior and psychosocial assessments and health coaching to meet ADA Psychosocial Care Guideline recommendations.
Methods: Outcomes were: program attendance, weight loss, and physical activity level. Drivers (N=117) attended informational sessions, completed DPP screening, and signed up for a 1-year DPP at 11 work sites. Standard DPP group education was enriched with group and individual health coaching sessions that targeted behavioral and psychosocial barriers. Health coaches (N=3) developed customized educational resources and used validated behavior and psychosocial barriers assessments.
Results: Participants (N=98, 84% of enrolled) were: 97.8% male, mean age=49.0±8.9 yrs., baseline weight=245±48.6 lbs., gender 95% male, race 76% White, Ethnicity 13.6% Latino. One year results showed: mean attendance=70.8% ≥ 22 sessions and N=418 coaching sessions using individual driver behavior and psychosocial diagnostic results to compliment DPP group work. Behavior and psychosocial assessments completed were: Health literacy N=86, Self-management (Meal plan, Physical activity) N=77, Behavioral health N=80, Bodily pain N=83, Poor sleep N=92. Mean weight loss=14.0±11.5 lbs. with 63.3% achieving ≥5% body weight, and 89.8% ≥150 min/week of physical activity. Mean HbA1c improved from 5.7%±0.8 to 5.3%±0.6.
Conclusions: Drivers with challenging work schedules at high risk of developing diabetes were strongly engaged in a tailored, behaviorally-focused, enriched DPP that showed strong weight loss and physical activity improvements at the end of the one year DPP.

Disclosure
G. Welch: Stock/Shareholder; Self; Silver Fern Healthcare LLC. S.M. Downs: Employee; Self; WellSpark Health. M. Videtto: None. A.M. Griswold: None.
811-P: Depression and Suicidal Risk in Adolescents and Young Adults with Diabetes: Are Screeners Sufficient?
Authors: MOSS ASHLEY , ROBERTS ALISSA J. , YI-FRAZIER JOYCE , READ KENDRA L. , PIHOKER CATHERINE , HIRSCH IRL B. , WEAVER KATHRYN W. , TAPLIN CRAIG , MALIK FAISAL 
Published: June 2020

Aims: Depression screeners in adolescents and young adults (AYAs) with diabetes may under-identify patients at risk for suicide. We examined prevalence of suicidal ideation (SI) using the Patient Health Questionnaire 9 (PHQ-9) depression screener and an in-person safety assessment conducted by a pediatric psychologist.
Methods: Participants included 104 AYAs with diabetes seen for their first Diabetes Transition Clinic appointment. Participants were administered the PHQ-9 and completed a safety assessment with a pediatric psychologist. The safety assessment included questions about AYA’s recent history of passive/active SI, plan, or intent (suicidal risk). Safety assessment responses were dichotomized to represent presence or absence of suicidal risk. Analyses included rates of positive depression screens and comparison of SI risk based on response to PHQ-9 SI question (i.e., “thoughts that you’d be better off dead or thoughts of hurting yourself in some way” over the past 2 weeks) and the safety assessment.
Results: On PHQ-9 screening, 19% of AYAs (n=21; age 20.3 + 1.0 years, 66.7% female) reported moderate to severe symptoms of depression and 5 reported SI in the past 2 weeks. The safety assessment identified 5 AYAs as at suicidal risk. The SI sensitivity rate for the PHQ-9 was 60% and specificity rate was 98%. The PHQ-9 misclassified 40% of AYAs as not at risk that were identified by the safety assessment and over-identified 2% of patients as at risk not corroborated by the safety assessment.
Conclusion: Moderate to severe symptoms of depression are common in AYAs with diabetes. Results suggest the PHQ-9 as a proxy for identifying SI may result in under-identification of some patients who may otherwise be at risk for suicide. The need for consistent identification of suicidality is critical. Besides better assessment tools for SI, this study reinforces the value of an embedded pediatric psychologist as a part of a multidisciplinary care team to address the needs of this unique population.

Disclosure
A. Moss: None. A.J. Roberts: None. J. Yi-Frazier: None. K.L. Read: None. C. Pihoker: None. I.B. Hirsch: Consultant; Self; Abbott, Bigfoot Biomedical, Roche Diabetes Care. Research Support; Self; Medtronic, Omnipod. K.W. Weaver: None. C. Taplin: None. F. Malik: None.
817-P: Financial Stress Factors, Psychological Factors, and Self-Management Outcomes in Emerging Adults with Type 1 Diabetes
Authors: BLANCHETTE JULIA E. , TOLY VALERIE B. , WOOD JAMIE R. , MUSIL CAROL M. , MORRIS DIANA L. , VOTRUBA MARK E. 
Published: June 2020

Emerging adults, ages 18-25, with type 1 diabetes (T1D) may be vulnerable to financial and psychological barriers to self-management as they grapple with the developmental milestones of financial and self-management independence. This correlational, cross-sectional study described the relationships among financial stress factors (perceived stress, financial stress, and financial independence) and psychological factors (depressive symptoms, trait anxiety, and diabetes distress) on self-management outcomes (HbA1c and diabetes-related quality of life [DQoL]) in emerging adults with T1D. Data from 413 emerging adults recruited from the T1D Exchange (mean age 22.1±1.83 years; 62% female; 80.4% white; 37.3% private high-deductible insurance; T1D duration 13.2±4.41 years; 8.0±1.6 HbA1c) were analyzed. The Perceived Stress Scale, Personal Financial Well-Being Scale, Willingness to Pay Scale, Financial Independence Visual Analog Scale, Center for Epidemiological Studies-Depression Inventory, State-Trait Anxiety Inventory, Diabetes Distress Scale and DQoL Measure were completed via REDCap surveys. Hierarchical Multiple Regression analyses revealed that 20.6% of variance in HbA1c (F=15.555, p&lt;.001) was explained by greater financial stress (β=-.197, p&lt;.001) and diabetes distress (β=.181, p&lt;.001); 64.5% of the variance in DQoL (F=148.469, p&lt;.001) was explained by greater financial stress (β=-.112, p = .002), diabetes distress (β=.512, p&lt;.001), trait anxiety (β=.183, p=.001) and depressive symptoms (β=.162, p=.001). Greater financial stress and psychological factors have detrimental impacts on self-management outcomes during emerging adulthood. Future interventions should assess and address these self-management barriers in practice.

Disclosure
J.E. Blanchette: Other Relationship; Self; Tandem Diabetes Care. V.B. Toly: None. J.R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker’s Bureau; Self; Xeris Pharmaceuticals, Inc. C.M. Musil: None. D.L. Morris: None. M.E. Votruba: None.

Funding
Frances Payne Bolton School of Nursing; Sigma Theta Tau International
818-P: Mental Health History and DECIDE Self-Management Support Program Outcomes in an African American Sample with T2DM
Authors: VRANY ELIZABETH A. , JENNINGS ARIANNE , HILL-BRIGGS FELICIA 
Published: June 2020

Objective: To evaluate changes in behavioral and clinical outcomes from the DECIDE (Decision-making Education for Choices in Diabetes Everyday) self-management support program trial among participants with and without a mental health (MH) history.
Methods: Participants were urban African American adults with type 2 diabetes (T2DM) (N=182). DECIDE is a problem solving diabetes self-management support program. Participants were randomized to 1 of 4 intervention arms: Self Study (n=46), Individual (n=45), Group (n=46), or Enhanced Print Education (EPE; n=45). Those who screened positive on the Patient Health Questionnaire 2 or reported a mental health diagnosis were coded as having MH history. Outcomes were self-management, knowledge, problem solving, and A1C assessed at baseline and 6 months post intervention, stratified by MH history status.
Results: 72 participants (40%) reported a MH history, including depression, bipolar, and schizophrenia. Among those with no MH history, knowledge and problem solving improved at 6 months post intervention in all intervention arms (knowledge: Self Study p&lt;.001, Individual p=.011, Group p=.004, EPE p=.026; problem solving: Self Study p=.023, Individual p=.015, Group p=.010, EPE p=.015). For those with MH history, knowledge and problem solving improved in the Self Study and Individual arms (diabetes knowledge: Self Study p=.018, Individual p=.037; health problem solving: Self Study p=.006, Individual p=.011) but not in the Group or EPE arms (ps≥.10). Although changes in A1C were not significant in any group (ps≥.20), A1C decreased by 1% among those with MH history in the Self Study arm (baseline A1C=9.1%; 6 month A1C=8.1%; p=.20).
Conclusion: In an urban minority sample with T2DM, those with a MH history benefited from a diabetes self-management intervention, but delivery modality mattered. Robust improvements in skills and A1C were observed when those with a MH history had self-paced or one-on-one formats rather than group.

Disclosure
E.A. Vrany: None. A. Jennings: None. F. Hill-Briggs: None.

Funding
National Heart, Lung, and Blood Institute (R01HL089751, 5T32HL007180)
820-P: Depression and Glycemic Control after Identification of Depression in Adults with Type 1 Diabetes
Authors: ZAFFUTO BRANDON J. , GREENFIELD MARGARET , TRIEF PAULA M. , MORLEY CHRISTOPHER P. , WEINSTOCK RUTH S. 
Published: June 2020

Objectives: Assess whether adults with type 1 diabetes (T1D) with probable depression subsequently received pharmacological intervention for depression, and the impact of this intervention on glycemic control.
Research Design and Methods: Retrospective chart reviews were performed on adults ages 18-85 years, routinely screened for depression, with T1D of &gt;1-year duration and no hemoglobinopathy, renal dysfunction (GFR &lt;30), or dementia. Probable depression was defined by a score of ≥10 on the Patient Health Questionnaire (PHQ-9). Adults with probable depression at Time-1 were included if they had a follow-up PHQ-9 10-16 months later (Time-2) and a HbA1c within 1 month of completing each PHQ-9.
Results: The study included 93 participants (mean age=44 years, 55% female, 81% white, mean HbA1c 8.9%). At Time-1, 50 persons (53.8%) were prescribed anti-depressants. At Time-2, 5 additional persons (5.3%) received prescriptions. There were decreases in mean PHQ-9 scores (Time-1 15.99; Time-2= 4.55, p&lt;.001) and HbA1c levels (Time-1= 9.3%; Time-2= 8.9%, p=.03). PHQ-9 scores related to HbA1c at each time point but did not relate to HbA1c change (p=0.48). There were marginally significant differences in PHQ-9 scores at Time-2 for those given anti-depressants (mean PHQ-9 = 5.75) versus those who were not (mean PHQ-9 = 2.82; p=.058), and a smaller decrease in HbA1c for those prescribed antidepressants (-.09) vs. those who were not (-.82; p= .042). Other interventions for depression (e.g., counseling) are not reliably captured in the EMR.
Conclusions: About 60% of adults with T1D and probable depression received anti-depressant medications. Despite an association between measures of depression and glycemic control, changes in each did not relate over 10-16 months. EMRs should improve documentation of therapeutic strategies to facilitate communication between providers working with depressed individuals and better inform future approaches to improve care.

Disclosure
B.J. Zaffuto: None. M. Greenfield: None. P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. C.P. Morley: None. R.S. Weinstock: Board Member; Self; JDRF. Consultant; Self; Insulogic LLC. Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Jaeb Center for Health Research, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc.

Funding
Type 1 Diabetes Exchange QI Learning Collaborative