bluuebunny/crossref_metadata_2025_split huggingface dataset:
73-LB: Expanding the Definition of Intraday Glucose Variability
Authors: CHO PETER J. , BENT BRINNAE M. , WITTMANN APRIL H. , MERWIN RHONDA M. , THACKER CONNIE R. , FEINGLOS MARK N. , DUNN JESSILYN P. 
Published: June 2020

Glucose variability (GV) is an established risk factor for hypoglycemia and diabetes complications. Over 20 GV metrics have been identified, but there is no consensus on which metrics are most effective for determining glucose control. A1c is the clinical standard of glucose control.
Two of the most common GV metrics include intraday standard deviation (iSD) and intraday coefficient of variation (iCV), which are calculated for each day and then averaged over multiple days. Thus, the current metrics of iSD and iCV are aggregate means, which are influenced by outliers and do not consider variations over multiple days. To reduce the influence of outliers and examine variation in these metrics over multiple days, we propose expanding the definition of iSD and iCV to include median and standard deviation of iSD and iCV over multiple days.
We examined iSD and iCV in a population of 14 high normoglycemic or prediabetic participants (A1c 5.5-6.4%). Participants wore a continuous glucose monitor for 8-10 days. In addition to iSD and iCV, 23 metrics of glucose and GV were calculated. To determine the strength of the relationship between each GV metric and A1c, Pearson correlation coefficients (PCC) were calculated. There were higher PCC between A1c and the standard deviation of iSD and iCV than the traditional metric of iSD and iCV (traditional: 0.296, SD: -0.387). Interestingly, all metrics of iSD and iCV calculated (mean, median, and standard deviation) were more closely correlated with A1c than mean glucose (0.296, 0.138, -0.387, and 0.220, respectively).
We demonstrate that expanding the definitions of iSD and iCV can provide a more comprehensive view of GV. Additionally, these metrics may provide more insight into glucose control than traditionally utilized metric, mean glucose.

Disclosure
P.J. Cho: None. B.M. Bent: None. A.H. Wittmann: None. R.M. Merwin: None. C.R. Thacker: None. M.N. Feinglos: None. J.P. Dunn: None.

Funding
MEDx (451-1746)
745-P: Novel Interventions in Children’s Healthcare (NICH): Attending to the Social Determinants of Health
Authors: CANTU ANNETTE , WAGNER DAVID V. , JENISCH CELESTE , LUZOD HANNAH , GOTTFRIED-LEE HANNAH , HARRIS MICHAEL A. 
Published: June 2020

Objective: Novel Interventions in Children’s Healthcare (NICH) is a community-based, family-focused intervention for youth with T1D and is associated with improved glycemic control and lower rates of acute care utilization. This study examines whether NICH is associated with changes in preventative outpatient attendance, with specific attention to the role of social determinants of health (SDoH) as potential moderators.
Methods: Youth in NICH with T1D were included if they had SDoH and electronic health record (EHR) data available (n=52). Retrospective EHR review included outpatient attendance (endocrinology, primary care) for the years prior to and following NICH initiation and social risk endorsement (e.g., food and housing security). Youth mean age was 14.5 years; 59% were female; and 77% were non-Hispanic Caucasian.
Results: More than half of NICH families (52%) endorsed food insecurity, with 49% and 40% reporting housing insecurity and unreliable transportation, respectively. Prior to NICH services, minority youth and those experiencing food insecurity attended significantly fewer preventative outpatient appointments (p&lt;.05). There were no significant differences in total number of outpatient visits attended while in NICH for the overall sample; however, following NICH initiation, minority youth demonstrated a significant increase in attendance, from 2.4 to 4.9 per year, and a significantly larger increase in attendance when compared to youth of majority race (p=.01).
Conclusions: This is the first study to examine the impact of NICH on preventative care access. There were no significant differences in total number of appointments attended while in NICH, which is unsurprising given that families are already attending additional weekly home sessions during program participation. However, minority youth seem to particularly benefit from NICH services, demonstrating more equitable access to preventative outpatient care during program involvement.

Disclosure
A. Cantu: None. D.V. Wagner: None. C. Jenisch: None. H. Luzod: None. H. Gottfried-Lee: None. M.A. Harris: None.

Funding
JDRF; The Leona M. and Harry B. Helmsley Charitable Trust
747-P: (Social) Profiling Youth with T1D: Examining the Standard Care Nonresponders
Authors: WAGNER DAVID V. , HARTMAN ALEXANDRA , JENISCH CELESTE , GUTTMANN-BAUMAN INES , EL-MANSY HEBA , HARRIS MICHAEL A. 
Published: June 2020

Objective: A subset of youth with chronic medical conditions, including T1D, are unresponsive to typical medical and behavioral health interventions, often resulting in avoidable acute health problems such as DKA. This study examines how youth with T1D who are unresponsive to standard care compare to similarly referred youth with other chronic medical conditions.
Methods: Participants were referred by medical providers due to lack of response to standard care - as evidenced by avoidable ED visits and/or lab values chronically out of range - including 50 youth with T1D and 54 with other chronic medical conditions, such as cystic fibrosis, end-stage renal disease, and seizure disorder. Retrospective chart reviews collected presence and frequency of social risks. Mean age was 14.5 years; 48% were female; 85% were non-Hispanic White.
Results: Social risk prevalence was high across medical conditions (see Figure).Youth with T1D were significantly more likely to have experienced multiple social risks, such as difficulty attending school, DHS involvement, and drug/alcohol abuse by youth and caregivers.
Conclusions: When compared to youth struggling with self-management of other chronic conditions, youth with T1D experienced significantly higher prevalence and frequency of social risks. Interventions developed for this vulnerable population should include components that directly target these important social factors.

Disclosure
D.V. Wagner: None. A. Hartman: None. C. Jenisch: None. I. Guttmann-Bauman: None. H. El-Mansy: None. M.A. Harris: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
755-P: Generalizability of Pediatric to Adult Transition Models: Preliminary Results from the Supporting Emerging Adults with Diabetes (SEAD) Program
Authors: LOPEZ-PRIETO CORAL , JANG ALYSSA , GREENBERG MICHAEL , AGARWAL SHIVANI 
Published: June 2020

Structured programs facilitating healthcare transition of young adults (YA) (18-30 yrs) have shown improved A1c and loss to follow-up. However, generalizability of these models is lacking. We previously published on a transition program (SEAD) based in an adult diabetes center in Philadelphia, PA that improved A1c, glucose monitoring adherence, and loss to follow-up. We have since moved SEAD to a new health system in the Bronx, NY, expanding care to economically vulnerable and minority YA. We were interested in examining whether the SEAD model was generalizable to a new health system and population. We prospectively followed YA with T1D in the first year of SEAD and collected standardized data on sociodemographic, visit attendance, and clinical factors for 1 year prior to and during care. The program involved an adult endocrinologist and nurse practitioner, and focused on topics including pediatric care coordination, self-management re-education, adult healthcare orientation, behavioral support, and engagement in care efforts. We used multilevel linear and logistic regression with repeated measures to examine visit attendance, A1c, and diabetes technology use. Of 79 YA with a scheduled SEAD visit (mean age at transition 23 yrs, 46% female, 93% Hispanic or Black, 89% Medicaid), 30% (n=24) never attended SEAD or re-established care. Of the 55 YA who attended SEAD, 74% (n=41) returned for at least 1 follow-up within 3 months. Mean A1c improved by 0.97% from 9.81% to 8.84% (n=41, p&lt;0.05). For diabetes technology use, 29% (n=14) were initiated while 66% (n=27) continued use (p&lt;0.05). SEAD preliminary results from a new health system and population demonstrate retention of YA after initial establishment of care, rapid improvement in glycemic control, and robust technology use. More efforts to promote establishing care are needed. The SEAD program is promising as a generalizable model for healthcare transition of YA with T1D.

Disclosure
C. Lopez-Prieto: None. A. Jang: None. M. Greenberg: None. S. Agarwal: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)
767-P: Psychological Treatment Is Associated with Improved Diabetes Distress and Glycaemic Control
Authors: CROKER VANESSA M. , CALDERWOOD CLARE , HAYES STUART , HIBBERT EMILY 
Published: June 2020

Introduction: Diabetes distress (DD) is associated with poorer health outcomes in diabetes mellitus (DM). Addressing DD through diabetes education improves glycaemic control. However, few studies have examined the effects of psychological therapy on DD and physical health outcomes, especially in low socioeconomic populations.
Methods: This study examines the impact of intervention by a clinical psychologist as part of a multidisciplinary team (MDT) on glycaemic control, hospital presentations and admissions, DD, and psychological factors. Participants were 50 outpatients aged 17-67 at a public hospital diabetes service in a socioeconomically disadvantaged area of Sydney, Australia. Inclusion criteria were DD, indicated by a PAID score ≥ 40, together with either 1) recent diabetes-related hospitalisation, 2) high HbA1c or 3) conflict over diabetes management. Measures used at baseline and treatment completion were the PAID, the 21-item Depression, Anxiety, Stress Scale (DASS-21), HbA1c, and number of emergency department presentations and hospital admissions in the three months before and after treatment commencement.
Results: All psychological variables showed a significant reduction: DD measured by PAID scores decreased by 36.8% from 57 to 36 (p&lt;0.001); DASS21 scores showed depression reduced by 36.4 % from 11 to 7 (p&lt;0.0001), anxiety by 33.4% from 10 to 6 (p&lt;0.0001) and stress by 16.7% from 12 to 10 (p&lt;0.0002). HbA1c decreased from 9.0% pre-treatment to 8.2% in the three months after treatment commenced. For 25 participants with matched pre and post treatment HbA1cs, mean HbA1c reduction was 0.7% (95% CI 0.1-1.3, p = 0.02). Emergency department presentations halved from 22% (11/50) of participants in the pre- treatment 3 months to 10% (5/50) in the 3 months post treatment. Hospital admissions halved, from 8% (4/49) to 4% (2/49).
Conclusion: This study provides preliminary evidence that treatment by a clinical psychologist can improve health outcomes for people with diabetes.

Disclosure
V.M. Croker: None. C. Calderwood: None. S. Hayes: None. E. Hibbert: None.
772-P: Both Sides of the Coin Matter: Resilience and Distress One Year Postdiagnosis Are Associated with Long-Term A1C Outcomes in Adolescents with Type 1 Diabetes Mellitus
Authors: SCOTT SAMANTHA R. , ELLISOR BRITNEY M. , O’DONNELL MAEVE B. , O’DAFFER ALISON , MANCZAK ERIKA M. , MALIK FAISAL , YI-FRAZIER JOYCE 
Published: June 2020

Objectives: Adolescents with newly diagnosed T1D are at risk for poor physical and psychosocial outcomes. Our aim was to understand if diabetes distress and resilience assessed at 1-year post diagnosis was associated with A1C up to 5 years following diagnosis.
Method: Adolescents (age 10-17) with newly diagnosed T1D completed diabetes distress (Problem Area in Diabetes Scale – Teen version) and the Connor-Davidson Resilience Scale at one-year post diagnosis. A1C was extracted from patient charts from time of diagnosis up to 5 years later, and values were averaged for each year. Regression analyses were used to investigate the associations between: 1) resilience and A1C and 2) diabetes distress and A1C, both up to five years post diagnosis.
Results: At one year post-diagnosis, N=60 adolescents (M=13.22 years, SD=2.09 years) completed distress (M=27.97, SD=7.01) and resilience scales (M=40.35, SD=17.10). Average A1C was 7.73 (SD=1.57). Diabetes distress was associated with average A1C in the second year (F(1,29)=4.397, p=.045, R2=.132), third year, (F(1,27)=6.596, p=.016, R2=.196), fourth year, (F(1,24)=10.196, p=.004, R2=.298), and fifth year post-diagnosis (F(1,19)=10.665, p=.004, R2=.360).
Resilience was associated with average A1C in the second year (F(1,29)=6.848, p=.014, R2=.191) and fifth years (F(1,19)=4.790, p=.041, R2=.201) post-diagnosis. (Trends were observed for the third (p=.095) and fourth years (p=.065)).
Conclusions: Diabetes distress and resilience levels shortly following diagnosis (at 1-year) are both associated with glycemic control up to 5 years later. Thus, targeted psychosocial interventions to boost resilience and decrease diabetes distress in the first year following diagnosis should be explored to improve long term outcomes in this high-risk population.

Disclosure
S.R. Scott: None. B.M. Ellisor: None. M.B. O’Donnell: None. A. O’Daffer: None. E.M. Manczak: None. F. Malik: None. J. Yi-Frazier: None.

Funding
Seattle Children’s Research Institute’s Center for Clinical and Translational Research Clinical Research Scholars Program; National Institutes of Health Clinical and Translational Science Award (UL1TR000423) of the University of Washington Institute of Translational Health Science
775-P: Mobile Self-Management Apps to Manage Diabetes and Chronic Disease: A Systematic Review and Meta-analysis into Dropout and Attrition Rates
Authors: MEYEROWITZ-KATZ GIDEON , ASTELL-BURT THOMAS , RAVI SUMATHY , ARNOLDA LEONARD F. , FENG XIAOQI 
Published: June 2020

Background: Management of diabetes and chronic disease is a challenge, making mHealth an increasingly attractive option. There is evidence that these apps may be effective, with systematic reviews demonstrating improvements in HbA1c and other measures of diabetes control. However, dropout can be a major issue in apps. Recent research has indicated that rates of attrition in mHealth interventions may be as high as 98%. Knowledge of mHealth dropout rates is critical to assessing their efficacy.
Methods: Medline, Pubmed, Cochrane CENTRAL, and Embase were searched from 2003 to the present, looking at mHealth and attrition or dropout. Studies looking at chronic disease with measures of dropout were included.
Results: Of 830 studies identified in the literature search, 16 were included in the review and meta-analysis (results presented below). Chronic disease management apps had an overall dropout rate of 47%. Apps targeting metabolic disease had a lower rate of 32%. The studies were varied, with high heterogeneity (I2&gt;99%).
Conclusion: Dropout rates in mHealth interventions are high, but lower in apps targeting metabolic disease. Reducing dropout rates will make these apps more effective for disease management in the long term.

Disclosure
G. Meyerowitz-Katz: None. T. Astell-Burt: None. S. Ravi: None. L.F. Arnolda: None. X. Feng: None.
779-P: Fatigue in Adults with Type 2 Diabetes: An Integrative Review
Authors: KUO HSUAN-JU , HUANG YA CHING , GARCIA ALEXANDRA A. 
Published: June 2020

Introduction: People with type 2 diabetes mellitus (T2DM) experience various symptoms that are likely to worsen mental and physical well-being. Fatigue is one of the most prevalent and disturbing symptoms for adults with T2DM. This literature review 1) examined demographic, physiologic, and psychosocial factors related to fatigue, and 2) explored the associations among fatigue, diabetes self-management and quality of life (QoL) in adults with T2DM.
Methods: We searched PubMed, PsycINFO, and CINAHL electronic databases for research articles that included a sample of adults with T2DM; were peer-reviewed, written in English; and investigated fatigue as a primary or secondary outcome. Two investigators independently appraised the quality of the studies and extracted the data.
Results: Twenty-two articles met the inclusion criteria (representing n = 15,610 people): 17 observational studies, 2 randomized controlled trials, 1 quasi-experimental study, and 2 qualitative studies. All were of high quality. Most studies were conducted in the U.S. (n = 13); others were conducted in 9 other countries. Non-Hispanic White and Black were the most studied. Fatigue was measured using the Multidimensional Fatigue Inventory (n = 6) and 8 other measures. Demographic (e.g., age, sex, education, social support), physiological (e.g., T2DM duration, complications, inflammatory biomarkers), and psychological factors (e.g., diabetes distress, depression, sleep quality) were related to fatigue in adults with T2DM. Most studies examined physiological factors related to fatigue using a cross-sectional design. Fatigue was negatively associated with both diabetes self-management and QoL.
Conclusion: Research demonstrates significant relationships between fatigue and self-management and QoL in adults with T2DM. Gaps in the literature include the trajectory of fatigue over time, effects of interventions (e.g., sleep interventions) to alleviate fatigue, and unique experiences of fatigue in under-represented populations.

Disclosure
H. Kuo: None. Y. Huang: None. A.A. Garcia: None.
784-P: Personality Traits as Predictors of Self-Management Behaviors and Glycemic Control in Taiwanese Adults with Type 2 Diabetes
Authors: YANG SHIAN-CHIN , LEE TAO-CHUN , HSU HUI-CHUN 
Published: June 2020

Purpose: Because the individual differences influenced the execution of diabetes self-management, the present study explored the contribution of personality traits associated with the depressive mood, the self-management and the glycemic control among adults with diabetes.
Method: We measured the Big Five personality traits and self-care behaviors of 440 outpatients (mean age = 61.6 years) with type 2 diabetes in Taiwan. After 2-4 months (mean interval= 88.6 days) personality traits scale was administered, the depressive mood, self-care behaviors and glycosylated hemoglobin (HbA1c) were measured.
Results: The path analysis (Figure 1) revealed that conscientiousness predicted HbA1c via the mediation of taking medication and emotional stability predicted HbA1c via healthy eating. The extroverted patients were prone to do exercise regularly, but patients with lower emotional stability did exercise less through the contribution of depressive mood. And then, doing exercise indirectly (via BMI) predicted lower HbA1c. However, only emotional stability had the significant total effect (Bootstrapping Percentile 95% CI=-.029 ∼ -.006) on HbA1c.
Conclusion: The present findings revealed that Big Five personality maybe predicted the glycemic control after 2-4 months via mediators. Evaluation of personality might be helpful in providing tailored patient education.

Disclosure
S. Yang: None. T. Lee: None. H. Hsu: None.
79-LB: Automatically Generated Continuous Glucose Monitoring (CGM) Notifications and Their Association with Glycemic Control
Authors: SHANKAR KAUSHIK , HASTEDT PRISCILLA , DERDZINSKI MARK , WELSH JOHN , BARGER CALEB , COHEN GARY 
Published: June 2020

CGM data can be summarized and reviewed retrospectively. CLARITY provides options for reviewing data from Dexcom CGM systems, including on-demand reports and five types of notifications (disabled by default) that are auto-generated and pushed to users’ smart devices. We examined user engagement with CLARITY reports and notifications, and their associations with estimated glucose value (EGV)-based parameters. EGVs uploaded in October 2019 from a convenience sample of 2,637 U.S.-based users of Dexcom CGM systems were analyzed. Group 1 did not access CLARITY, Group 2 accessed on-demand reports but not auto-generated notifications, and Group 3 enabled all types of auto-generated notifications throughout that month. For each group, EGV-based parameters including time in range (TIR) and the % of users meeting consensus-based goals were calculated. Unpaired t-tests were used to compare time in ranges; two-proportion z-tests were used to compare % of users meeting goals. Auto-generated CLARITY notifications were associated with more TIR and less time spent in hyperglycemia, with clinically and statistically significant differences in favor of Group 3 vs. Group 1. A significantly higher proportion of users in Group 3 than in Group 1 met consensus goals for TIR (Table). Push notifications related to CGM data may contribute to patient engagement and/or to beneficial therapeutic choices.

Disclosure
K. Shankar: Employee; Self; Dexcom, Inc. P. Hastedt: None. M. Derdzinski: Employee; Self; Dexcom, Inc. J. Welsh: Employee; Self; CSL Behring. C. Barger: Employee; Self; Dexcom, Inc. G. Cohen: Employee; Self; Dexcom, Inc.
79-OR: Signal-Dependent Chromatin Accessibility Dynamics in Pancreatic Islet Dysfunction
Authors: WEI ZONG 
Published: June 2020

In type 2 diabetes (T2D), inflammation induces massive changes in beta cell transcriptome and epigenome, resulting in eventual dysfunction and death of beta cells. Accordingly, strategies designed to protect beta cells from inflammatory stress at transcriptional and epigenetic level could be attractive for combating diabetes. Through genome-wide CRISPR screening in human stem cell differentiated islet like organoids, we identified a novel mechanism connecting signal- dependent transcription by vitamin D receptor (VDR) and fine-tuning of chromatin accessibility by a balance between two SWI/SNF complexes, BAF and PBAF. Our studies revealed that VDR recruits BAF and PBAF complexes through two bromodomain proteins, BRD9 and BRD7, respectively. The balance between BAF-BRD9 and PBAF-BRD7 determines the VDR-driven anti-inflammatory and pro-survival response in pancreatic beta cells. In a dual regulatory mechanism, inhibition of the VDR-BRD9 interaction in combination with ligand activation of VDR cooperate to dismiss the BAF-BRD9 complex and shift the balance to the activating PBAF-BRD7 complex to induce a coordinated transcriptional response. Notably, pharmacologically potentiated VDR signaling by a synthetic ligand in combination with a BRD9 inhibitor can partially restore beta cell function and glucose homeostasis in various T2D mouse models. Tissue specific models further confirmed the functional role of VDR and BRD9 in beta cell stress response in vivo. Together, our results revealed that an unexpected epigenetic balance between the bromodomain readers has a major impact on beta cell survival and glucose homeostasis, and demonstrated the therapeutic potential of targeting inflammatory/metabolic stress through synergistic modulation of hormone receptors and chromatin accessibility.

Disclosure
Z. Wei: None.

Funding
National Institutes of Health (1K01DK120808)