bluuebunny/crossref_metadata_2025_split huggingface dataset:
611-P: Splenic Stimulation with Focused Ultrasound Aids in Wound Healing
Authors: MORTON CHRISTINE A. , COTERO-LEFEVRE VICTORIA E. , PULEO CHRIS , ASHE JEFFRAY 
Published: June 2020

Wound care in at risk populations is a growing problem. The cost of care of these non-healing wounds is projected to be in the billions with the number of people affected being above 6.5 million and increasing as the population ages. There is significant mortality related with non-healing wounds with 5-year rates being higher than many cancers such as prostate or breast. Chronic inflammation, a comorbidity of type 2 diabetes, when left unchecked may result in non-healing wounds. This study explores the use of non-invasive focused ultrasound (FUS) targeted to the spleen to aid in healing of full thickness excision skin wounds in Obese Zucker Diabetic (ZDF) or Zucker Diabetic Sprague Dawley (ZDSD) rats. Splenic stimulation with FUS has been shown to decrease TNF-α 60 minutes post stimulation in both whole blood and the spleen of animals injected with LPS. By decreasing systemic proinflammatory cytokines, wounds may progress to better outcomes. In the current study, FUS was targeted to the spleen daily while wounds were healing (16 days). Hyperglycemic (fed glucose &gt;250 mg/dL) ZDF stimulated with FUS were predicted (by linear regression) to heal 5 days faster than shams (17.1 ±0.8 days vs. 22.3±1.6 days respectively). Glucose levels remained similar throughout the study. The same FUS conditions were applied to prediabetic ZDSD (fed glucose &lt; 195 mg/dL). FUS stimulated rats were predicted to heal 2 days faster than shams (20 ±1.2 vs. 22.3±1.1 respectively).

Disclosure
C.A. Morton: None. V.E. Cotero-Lefevre: None. C. Puleo: Employee; Self; General Electric. J. Ashe: Employee; Self; General Electric.
613-P: The Needs of Caregivers for Recently Hospitalized Older Adults with Type 2 Diabetes Mellitus
Authors: DANNER ALYSSA , OCONNOR MELISSA , WHITEHOUSE CHRISTINA 
Published: June 2020

Background: Caregivers play a crucial role in the management of older adults with type 2 diabetes mellitus (T2DM). Caregivers often lack support and experience caregiver burden.
Purpose: The purpose of the study was to investigate the needs and experience of caregivers of recently hospitalized older adults with T2DM.
Methods: Qualitative interviews were conducted using a semi-structured interview guide with open-ended questions that highlighted the caregivers’ experience caring for a recently hospitalized older adult with T2DM. All interviews were digitally recorded and professionally transcribed. Once transcribed, transcripts were uploaded to ATLAS.ti to organize and retrieve data. Transcripts were analyzed using qualitative content analysis.
Results: A total of 20 caregivers were interviewed. Most of the subjects were caregivers for a family member, with a majority of subjects caring for their parents. Participants were mostly female (75%), above age 50, and non-Hispanic Black (80%). The main themes that emerged from the qualitative data were: (1) the role itself, (2) challenges, (3) role preparation, and (4) additional comorbid diagnoses.
Conclusion: Our findings provide an understanding of experience, tasks, and needs of caregivers for older adults with T2DM. This study revealed that many caregivers feel that care taking is an obligation and a full-time role. A majority of caregivers indicated they did not receive education regarding caring for someone with DM, despite being solely responsible for providing care. Although many of the caregivers did not identify T2DM as the main concern due to additional comorbid conditions, the most pertinent patient and caregiver challenges identified include diet, multiple responsibilities, and time-management. This study identifies the importance of inclusion of family caregivers when providing education.

Disclosure
A. Danner: None. M. OConnor: None. C. Whitehouse: None.
619-P: The Impact of Type 2 Diabetes Mellitus Risk Perception on Adoption of Preventive Strategies in Women with a History of Gestational Diabetes
Authors: VU AMANDA V. , TURK NORMAN , DURU O. KENRIK , MANGIONE CAROL , PANCHAL HEMALI , AMAYA SARAH A. , NORRIS KEITH C. , MOIN TANNAZ 
Published: June 2020

Background: Gestational diabetes confers a 3-7 fold higher risk of incident diabetes. However, studies show women with GDM underestimate their personal risk, even when they understand GDM is a risk factor for incident T2DM. The study objectives were to identify predictors of T2DM risk perception in women with GDM and to determine if their level of risk perception impacts adoption of evidence-based health behaviors for T2DM prevention.
Methods: Using electronic health records to identify eligible women between 18-50 years old, we surveyed women with a history of GDM who had not progressed to T2DM.
Results: The study sample (n=264) was racially and ethnically diverse; 37% Hispanic, 29% Asian, 27% non-Hispanic white, and 5% black. About one in five (21%) women were unaware that GDM increases the risk of incident T2DM after pregnancy; almost half (48%) believed their personal risk of T2DM was low. In multivariate analyses adjusting for race, ethnicity, education level, time since index GDM pregnancy, and agreement with GDM diagnosis, family history of T2DM (OR 2.1, 95% CI 1.1-4.0) and knowledge of GDM increasing risk of T2DM (OR 4.5, 95% CI 2.1-9.7) were independent predictors of higher risk perception of T2DM. Higher risk perception was associated with both a higher level of interest in taking metformin (unadjusted OR 2.2, 95% CI 1.1-4.1) and a higher level of interest in attending a National Diabetes Prevention Program (unadjusted OR 2.3, 95% CI 1.3-3.9) compared to women with lower risk perception.
Conclusion: Educating women with a history of GDM about their increased risk of T2DM is important; our study underscores the need to identify ways to effectively convey personal risk of T2DM. Family history of T2DM, which is strongly associated with personal risk perception, may be a key area for discussion with women with GDM to positively impact the adoption of T2DM preventive strategies; this may be relevant for all patients with higher risk of progression to T2DM.

Disclosure
A.V. Vu: None. N. Turk: None. O. Duru: None. C. Mangione: None. H. Panchal: None. S.A. Amaya: None. K.C. Norris: None. T. Moin: None.

Funding
National Institutes of Health (5R18DK105464)
624-P: Primary Care Education Leads to Improved Diabetes Knowledge and Clinical Practice
Authors: WOOLLEY RYAN , COLWELL ELAINE , FORD ERICA , SAXENA ANKITA , BRADLEY SARAH 
Published: June 2020

Primary care providers (PCPs) are the initial treatment provider for a majority of the more than 100 million adults in the U.S. now living with diabetes or prediabetes. Constant changes in health care delivery and new diabetes therapies make it challenging for PCPs to stay up to date on the latest diabetes guidelines. In addition, only 14% of PCPs refer all patients with type 2 diabetes to diabetes self-management education and support (DSMES) programs despite their evidence base for improving diabetes-related outcomes. The American Diabetes Association (ADA) developed a professional education program designed to broaden the knowledge and usage of the Standards of Medical Care in Diabetes (SOC) among PCPs and increase referrals to evidence-based interventions for the prevention and management of diabetes. Programs provide 6 hours of case-based, accredited, interactive education built around the realities of primary care to a group of 100-200 PCPs. The program covers treatment options, strategies to improve compliance in diabetes management, and prevention of type 2 diabetes. To assess changes in clinical practice, online surveys are administered before and 6 months following the program. From June 2018 to March 2019, 1,183 PCPs participated in one of 9 in-person programs hosted across the country. Six months after the program, 98% of PCPs reported a gain in knowledge related to their clinical practice, and knowledge of pharmacologic treatment options increased 21%. In addition, 56% of PCPs increased their use of the SOC and PCP referrals to DSMES programs increased 16%. Results from the program demonstrate positive impact on PCP knowledge and clinical practice in the primary care setting. PCPs are learning how to optimize patient care in a changing health care landscape, thus increasing the likelihood of improved patient outcomes. Notably, this program has an estimated reach of 2.7 million patients with diabetes and 1.4 million with prediabetes leading to a widespread improvement in care across the country.

Disclosure
R. Woolley: Employee; Self; American Diabetes Association. E. Colwell: None. E. Ford: None. A. Saxena: None. S. Bradley: None.

Funding
Abbott Diabetes Care; AstraZeneca; Merck & Co., Inc.; Novo Nordisk
625-P: CME Effectively Improves Physician Knowledge and Competence Related to Hypoglycemia Risk Reduction with Basal Insulin in the Modern Era
Authors: LARKIN AMY , LE ANNE 
Published: June 2020

We sought to determine if an online continuing medical education (CME) curriculum could improve the clinical knowledge/competence of primary care physicians (PCPs) related to hypoglycemia risk reduction with basal insulin. We also measured education needed for endocrinologists (endos) in this area. The online CME curriculum consisted of 3 text- or video-based activities about reducing hypoglycemia risk with newer basal insulins. Educational effects were assessed using repeated pairs pre-assessment/post-assessment, where individual participants served as his/her own control. For all questions combined, a chi-squared test assessed whether the mean post-assessment score differed from the mean pre-assessment score. P values &lt;.05 are statistically significant. The activities launched in November or December, 2018 and data were collected through November 2019. • 16% of PCPs (P&lt;.01) demonstrated improvement in recognizing the impact of hypoglycemia in patients with diabetes (knowledge) • 11% of PCPs (P=.68) demonstrated improvement in recognizing the link between hypoglycemia and cardiovascular events (knowledge) • 20% of PCPs (P&lt;.001) demonstrated improvement in using newer basal insulins to decrease hypoglycemia risk (competence) Persistent knowledge/competence gaps remain: • 19% of endos and 28% of PCPs need additional education to improve knowledge on the impact of hypoglycemia in patients with diabetes • 66% of endos and 72% of PCPs need additional education to improve knowledge on the link between hypoglycemia and cardiovascular events • 8% of endos and 18% of PCPs need additional education to improve competence related to using newer basal insulins to decrease hypoglycemia risk This study demonstrates the success of an online curriculum at improving knowledge and competence of PCPs related to reduction of hypoglycemia risk with basal insulins. Persistent gaps were identified among PCPs and endos for future educational targets.

Disclosure
A. Larkin: None. A. Le: None.

Funding
Novo Nordisk
631-P: Front-Line Clinician Perspectives on Immediate Self-Care Needs of Patients with Diabetes
Authors: COYNE KASEY , HAKIMIAN STEPHANIE , POLLACK TERESA , KARAM SUSAN , PRINCE GRACE , TOUMA EMILIE K. , GATCHELL DAVID W. , KHORZAD REBECA , ANKENMAN BRUCE , HOLL JANE L. , WALLIA AMISHA 
Published: June 2020

Diabetes mellitus (DM) self-care teaching is often provided at point of care, but “clinician-centered” feedback about teaching is lacking. Semi-structured, facilitated interviews of front-line clinicians involved in DM care (e.g., meter, medications, injection technique) were conducted. Clinicians were asked their perspectives on the needs of newly diagnosed DM patients, specifically during transitions of care (e.g., discharge home). Clinicians were also asked to review current DM education materials (training supplies, print handouts) and subsequently developed potential solutions. Interview transcripts were independently coded by 3 coders, using a constant comparative method, to identify themes. MAXQDA software was used. Key themes were additionally audited by a diabetologist.
Eleven sessions were conducted with clinicians (N=14, 2 certified DM educators, 4 endocrinology MD fellows, 3 advanced practice providers, 1 DM nurse, 2 pharmacists, 2 internal medicine MDs). The most commonly identified theme across clinician type was simplified, understandable content (8/11 sessions). Participants identified lack of centralization of supplies and education materials as the most significant barrier (9/11 sessions) to optimal care. Other top themes were insurance coverage for diabetes supplies and medications, need for customization, and limited access to diabetes educators. The most preferred solution was use of patient simulation (repetitive practice) [7/11 sessions], followed by teaching videos (5/11 sessions).
Clinicians preferred comprehensive but simplified, understandable, customizable, diabetes teaching content. The lack of centralization of supplies and content and insurance coverage for supplies/medications are major barriers for clinicians to deliver optimal DM self-care teaching. These data also suggest that use of simulation could facilitate improvement in DM teaching by front-line clinicians.

Disclosure
K. Coyne: None. S. Hakimian: None. T. Pollack: None. S. Karam: None. G. Prince: None. E.K. Touma: None. D.W. Gatchell: None. R. Khorzad: None. B. Ankenman: None. J.L. Holl: None. A. Wallia: Research Support; Self; Eli Lilly and Company, Novo Nordisk Inc., UnitedHealth Group.

Funding
American Diabetes Association (1-13-JF-54 to A.W.); Chicago Center for Diabetes Translation Research/National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092949); Agency for Healthcare Research and Quality (5R18HS026143-02)
634-P: Improvement of Care for Type 2 Diabetes Outpatients through a Self-Care Multidisciplinary Workshop: A Randomized Controlled Trial
Authors: GARCIA SHEILA PICCOLI , TELO GABRIELA H. , SCHNEIDERS JOSIANE , BLUME CARINA , BERLANDA GABRIELA , SPARRENBERGER KAREN , GOSSENHEIMER AGNES N. , MADALOSSO MARIANA M. , BOTTINO LEONARDO G. , SCHEIN ANDRESSA S.O. , MACEDO ALINE C.P. , HELAL LUCAS , CHRISTOFOLI CHRISTOFER , SANTOS LUCAS P. , SCHAAN BEATRIZ D. 
Published: June 2020

Type 2 diabetes (T2DM) is a chronic disease that requires multidisciplinary patient-centered treatment. Although important, promoting self-care strategies is still a challenge.
Methods: Patients with T2DM and poor glycemic control (HbA1c &gt; 7.5%) were randomly assigned to participate in the Self-Care Multidisciplinary Workshop for Diabetes (MW) or usual care (UC). The MW consisted of 15-minute individual meetings with each T2DM providers (nurse, pharmacist, dietitian, physical educator and social worker) to approach diabetes self-care topics. It was offered in 3 different modules through 12 weeks aiming to bring knowledge and skills necessary for patients to improve their diabetes care. UC included 3 brief meetings in which printed educational folders were provided. Both groups maintained standard care at outpatient T2DM clinic with endocrinologists. Generalized estimating equation model was performed to assess HbA1c, Diabetes-related Quality of Life and Summary of Diabetes Self-Care Activities questionnaires variation from baseline to 12 months.
Results: Ninety-six patients (59 ±9 years-old, 60% women, diabetes duration of 16 ±10 years, 62% medium-low/low socio-economic status, HbA1c 9.6 ±1.4%) were included. Variation from baseline of HbA1c [UC -0.52% (CI 95% -1.08 to 0.26) vs. MW -0.30% (CI 95% -1.05 to 0.45) p=0.072], healthful eating plan in the last 7 days (d) [UC -0.22 d (CI 95% -1.27 to 0.82) vs. MW -0.03 d (CI 95% -0.85 to 0.79) p=0.15] and foot exam in the last 7 d [UC 0.51 d (CI 95% -0.75 to 1.77) vs. MW 1.1 d (CI 95% -0.16 to 2.39) p=0.329] to 12 months were not different between groups. There was a decrease in worry about future effects of diabetes in MW [-0.46 (CI -0.81 to -0.12)], not found in UC [0.11 (CI -0.20 to 0.42) p=0.004].
Conclusion: A short-term MW reduced worry about diabetes but failed to improve glycemic control and self-care activities in long-standing T2DM patients of a low-income country.
ClinicalTrials.gov Identifier: NCT03074383.

Disclosure
S. Piccoli Garcia: None. G.H. Telo: None. J. Schneiders: None. C. Blume: None. G. Berlanda: None. K. Sparrenberger: None. A.N. Gossenheimer: None. M.M. Madalosso: None. L.G. Bottino: None. A.S.O. Schein: None. A.C.P. Macedo: None. L. Helal: None. C. Christofoli: None. L.P. Santos: None. B.D. Schaan: None.

Funding
Fundo de Incentivo à Pesquisa e Eventos do Hospital de Clínicas de Porto Alegre
639-P: The HbA1c Test Frequency and Metabolic Control in Patients with Type 2 Diabetes after Share-Care Model Management: A Chinese Survey of 5,183 Adult Patients
Authors: AN LINGWANG , LEE TAO-CHUN , YEH KUEICHUN , HSU HUI-CHUN , JI LINONG 
Published: June 2020

Background and Aims: To explore the effect of HbA1c test frequency on HbA1c control in patients with T2D who had been followed up in a diabetes share-care model in five Chinese diabetes hospitals.
Methods: From January 2016 to December 2019, 5183 patients with more than 2 times HbA1c tests and 6 months follow up were included in this study. Three groups were divided according to annual HbA1c tests frequency: &lt;2.0 times [1495 (28.9%)], 2.0∼3.0 times [1898 (36.6%)] and &lt;3.0 times [1790 (34.5%)].
Results: Significant difference was seen on the proportion of patients reaching HbA1c target of below 7.0% in the three groups from baseline to the last visit. Receiving &gt;3.0 tests/year led to significant larger HbA1c change [-0.60 (-0.68∼-0.52)%] from baseline compared to receiving&lt;2.0 tests/year [-0.16 (-0.27∼-0.04)%] and 2.0∼3.0 tests/year [-0.25 (-0.33∼-0.16)%]. Only &gt;3.0 tests/year were positively associated with higher likelihoods of reaching HbA1c target at last visit (odds ratio 1.862, 95%CI 1.518 to 2.285). No significant association was found in group receiving 2.0∼3.0 times/year.
Conclusions: We showed that 71.1% of patients received more than 2.0 HbA1c tests/year within the diabetes share-care model management, however, only &gt;3.0 tests/year is associated with higher likelihoods of achieving HbA1c target.

Disclosure
L. An: None. T. Lee: None. K. Yeh: None. H. Hsu: None. L. Ji: None.
645-P: Diabetes Pueblo: A Community Health Worker–Led Educational Intervention for Latinos with T2D
Authors: CREASON JAMIE , AXELROD CEARA , CONNEELY MARY M. , LANDEROS CHRISTOPHER , DIAZ-REA MARGARITA , XI ANN D. , PACZKOWSKI ROSIRENE , REED BEVERLY , GELSEY FELICIA , CASTORINO KRISTIN N. 
Published: June 2020

In the U.S., Latinos have the highest proportion of type 2 diabetes (T2D) of any racial/ethnic group. Addressing cultural barriers and limited access to diabetes education may improve diabetes care and outcomes in this population. Diabetes Pueblo (DP) is an 11-week, culturally tailored, diabetes self-management education and support (DSMES) program led by Latinos in the community (Promotores). The program has two modules, diabetes fundamentals (DF) and insulin success. A pilot study was conducted to evaluate the feasibility of DP through class attendance and participant satisfaction. Additional endpoints included biometric data, HbA1c, the Diabetes Self-Management Questionnaire (DSMQ), and the Insulin Treatment Appraisal Scale (ITAS). Participants were 25 Latinos with T2D (20 completers) with a mean age of 55.8±10.5 years (64% female, 92% born in Latin America, 39% completed high school). Class attendance averaged 82%. Small nonsignificant improvements were observed in HbA1c, DSMQ, and ITAS positive appraisal at the completion of the program. ITAS negative appraisal scores improved significantly from 43 to 38 (p=0.02). Participant feedback reported improvement in distinguishing between diabetes and prediabetes (p=0.01). Post-class focus groups revealed very high satisfaction with the program, including improved understanding of how behaviors impact health and that insulin initiation does not indicate personal failure. There were no significant changes in biometrics possibly due to the short study duration. These results demonstrate the program’s feasibility through high attendance, program approval, improved diabetes self-management knowledge and acceptance of insulin therapy. This highlights the importance of using a culturally appropriate education program taught by community health workers for higher attendance and engagement. Future research may include larger-scale evaluations of the program with long-term follow-up to detect changes in biometric data.

Disclosure
J. Creason: None. C. Axelrod: None. M.M. Conneely: None. C. Landeros: None. M. Diaz-Rea: None. A.D. Xi: Employee; Self; Eli Lilly and Company. R. Paczkowski: Employee; Spouse/Partner; Amgen. Employee; Self; Eli Lilly and Company. B. Reed: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. F. Gelsey: Employee; Self; Lilly Diabetes. Stock/Shareholder; Self; Lilly Diabetes. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc.

Funding
Eli Lilly and Company
65-OR: Remote Monitoring of CGM Data at Diabetes Camp Mitigates Hypoglycemia Day and Night
Authors: GLEICH SARAH E. , GIBSON-NORTH NATHANIEL D. , PUHR SARAH , WELSH JOHN , WALKER TOMAS C. , CARUSO DANIEL 
Published: June 2020

Some diabetes camps require campers to relinquish diabetes technology upon arrival. We evaluated the acceptability of continuous glucose monitoring (CGM) use and remote monitoring of CGM data at camp. Insulin-treated campers ages 7-18 years were enrolled at a week-long diabetes camp in the U.S. All campers performed regular fingerstick testing, which informed treatment decisions. Campers that monitored their glucose with fingerstick testing at home were fitted with blinded Dexcom CGM at camp. Campers that used Dexcom CGM Systems with the capacity to share data at home continued to use their self-supplied systems; shared data were displayed on the Follow app on counselor-carried smart devices and on a centralized display in the medical cabin. Remote monitoring informed staff of glucose values 250 mg/dL, prompting fingerstick testing outside of regular intervals. Data were compared between blinded and remotely monitored, non-blinded CGM systems. Remote monitoring of CGM data was associated with significant reductions in hypoglycemia and improvements in overnight time in range (Table). Remote monitoring facilitated 73 interventions overnight that may have otherwise been missed by fingerstick testing. Remote monitoring of CGM data at diabetes camp allows implementation of tighter target glucose ranges, facilitates timely hypoglycemia treatment, and should be encouraged at all diabetes camps.

Disclosure
S.E. Gleich: Research Support; Self; Dexcom, Inc. N.D. Gibson-North: None. S. Puhr: Employee; Self; Dexcom, Inc. J. Welsh: Employee; Self; CSL Behring. T.C. Walker: Employee; Self; Dexcom, Inc. D. Caruso: None.