bluuebunny/crossref_metadata_2025_split huggingface dataset:
620-P: Improving Glycemic Control in Patients with T2D in Brazil through Tech-Enabled Low-Cost Virtual Monitoring
Authors: CARRICA MARTIN , VALENTE FERNANDO , MIGLIANO LUCIANA , LORDA DUMONT YVES SEBASTIAN , SALLES JOAO E. 
Published: June 2020

T2D remains a global epidemic and has become a major public health concern in Brazil, with almost 17M people living with T2D. Poor glycemic control leads to severe loss in life expectancy, quality of life and increased healthcare expenses. The main challenges to support patients with T2D in developing countries are geographical dispersion and limited budgets.
The primary objective of this study is to determine whether the use of a low-cost, 100% virtual patient monitoring program, can improve disease control in patients with T2D in Brazil, using remote diabetes support through Appia’s digital platform connected to a smart BGM, coupled with remote coaches.
Methods: Thirty-one participants aged 36-69 years old previously diagnosed with T2D that measure their BG levels at least 2 times per week, were recruited online and enrolled in the program. Most of them were just receiving oral medication treatment. HbA1c was measured at the beginning and at the end of the program. During the 12-week lifestyle modification program, the patients were given an intelligent BGM connected to a mobile app that stores BG measurements in the cloud. Additionally, patients were given access to a remote diabetes coach for personalized content, weekly goals setting and support. Patients did not receive medical intervention outside of their PCP.
Results: The mean HbA1c was significantly reduced by 1.11% (95% CI: -1.5754 - -0.7446, p&lt;0.0001) from a starting mean of 8.5% to 7.39% at the end of the program. Total average BG levels dropped from 169 mg/dL to 138 mg/dL with n=2439 readings. Also, the severe hyperglycemic events (&gt;300 mg/dL) were reduced by 51.55%, without increasing level 2 (&lt;54 mg/dL) and 3 hypoglycemic events. Finally, the total number of BG measurements during the program increased by 8.43% in 90 days (from 0.8/day to 0.9/day per patient).
Conclusion: The combination of remote diabetes coaching with a smart BGM connected to an app was effective for improving glycemic control in patients with T2D in Brazil.

Disclosure
M. Carrica: Stock/Shareholder; Self; Appia. F. Valente: Consultant; Spouse/Partner; Sanofi Genzyme. Speaker’s Bureau; Self; AstraZeneca, Novo Nordisk Inc. L. Migliano: Employee; Self; Appia. Y. Lorda Dumont: None. J.E. Salles: Board Member; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc.
652-P: Patients with Diabetes at High Cardiovascular Risk with Chronic Kidney Disease: Online Virtual Simulation Improves Clinical Decisions
Authors: TRIER JOACHIM , GUNESEKERA DAYAN 
Published: June 2020

Purpose: Assess if simulation-based online education improves performance of cardiologists (C), diabetologists/endocrinologists (D/E) and primary care physicians (PCP) in managing patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk with chronic kidney disease (CKD).
Methods: Two patient cases were presented in an immersive, virtual patient simulation (VPS) platform designed to replicate the real-life decision-making process allowing learners to order lab tests, assess patients, make diagnoses, and prescribe treatments. Tailored clinical guidance (CG) was provided for each clinical decision (CD) so learners could modify their CDs and indicate their rationale. Physicians who fully completed each case were evaluated. Each learner’s pre-/post CDs were analyzed using a paired t-test. The activity posted on 1/31/2019; data were collected through 10/1/2019.
Results: Upon completion of this educational activity C (n=296/154, cases 1 and 2), D/E (236/128) and PCP (228/157) demonstrated improved performance in making appropriate, evidence-based CDs (all p&lt;0.05) with respect to • Ordering a suitable diagnostic workup to establish elevated reno-vascular risks resulting in a significantly higher proportion of correct diagnoses of CKD and hypertension • Tailoring a comprehensive risk management plan including increased patient education, weight management, foot examination and SGLT2 inhibitor or GLP-1 receptor agonist Rx. Predominant reasons for selecting an SGLT2i • Proven CV risk reduction • Recommended by guidelines. Main reasons for not choosing an SGLT2i • Economic considerations • Unfamiliarity with use.
Conclusion: Immersive VPS-based education improves evidence-based CDs related to the crucial aspects of managing T2D in patients at high CV risk with CKD. Collection of learners’ decision-making rationale data provides insight into the decision-making process of physicians in actual clinical practice.

Disclosure
J. Trier: Consultant; Self; WebMD LLC. D. Gunesekera: None.

Funding
Boehringer Ingelheim Global; Eli Lilly Global
666-P: Predictors and Effects of Participation in Peer Support: A Prospective Structural Equation Modeling Analysis
Authors: AYALA GUADALUPE X. , CHAN JULIANA C. , CHERRINGTON ANDREA , ELDER JOHN P. , FISHER EDWIN B. , HEISLER MICHELE , HOWARD ANNIE GREEN , PARADA HUMBERTO , SAFFORD MONIKA , SIMMONS DAVID , TANG TRICIA S. ,   WRITING GROUP OF PEERS FOR PROGRESS INVESTIGATORS
Published: June 2020

Peer support provides benefits across varied health concerns. As opposed to simple offer of support, however, predictors of and importance of levels of participation are not well understood. Analyses of 7 peer support interventions, with 1,612 participants address these questions, first identifying characteristics that predict participation, and then examining whether, controlling for those characteristics, participation itself predicts benefit, using reduced HbA1c as an indicator of benefit.
From the U.S. (5 sites), Hong Kong, and the UK, interventions shared emphases on peer supporters helping adults with type 2 diabetes improve disease management. Common data included pre/post hemoglobin A1c (HbA1c), contacts of participants with peer supporters, health literacy, availability/satisfaction with support for diabetes management from family/clinical team, and gender, age, education, and years with diabetes.
From structural equation modeling, significant findings indicated 1) older age and lower levels of support for diabetes management predicted more contacts with peer supporters, and 2) more contacts predicted lower levels of final HbA1c. Effects of contacts on HbA1c included those with baseline HbA1c &gt; 7.5% or &gt; 9%. No contacts and tertiles of low, moderate, and high contacts showed a linear, dose-response relationship with final HbA1c (p &lt; 0.001). Baseline and covariate-adjusted, final HbA1c was 8.19% versus 7.85% for those with no and high contacts, respectively. Among those using insulin (29.7%), only those in the high group achieved greater benefit than those with no contacts.
Reflecting other findings that peer support reaches/benefits those at greater disadvantage, those reporting less social support for diabetes management were more likely to participate in peer support. Participation in turn predicted better glycemic control across levels of baseline glycemic control and in a dose response relationship across levels of participation.

Disclosure
G.X. Ayala: None. J.C. Chan: None. A. Cherrington: None. J.P. Elder: None. E.B. Fisher: Research Support; Self; Merck Foundation, Sanofi China. M. Heisler: None. A. Howard: None. H. Parada: None. M. Safford: None. D. Simmons: None. T.S. Tang: None.

Funding
Merck Foundation; Eli Lilly and Company Foundation; Bristol-Myers Squibb Foundation
713-P: Educating Patients on Nutrition Using a Short Computer-Based Video: A Successful Clinic Model
Authors: COLE KALONJI , WENGER DANIELLE , GUHA ANIKA , YAROSH CARLYN , HOFFMAN CHERYL 
Published: June 2020

Purpose: The purpose of this study is to determine if computer-based videos successfully educate patients on a whole food, plant-based diet (WFPBD) during clinic wait time. We recognize the importance of nutrition in disease prevention and treatment, particularly for diabetes, obesity, hypertension, and vascular disease. We investigated the effectiveness of this model in increasing patient knowledge and confidence about diet.
Methods: Subjects (n = 77) were recruited at a radiology clinic. A 19-question survey was administered using an iPad. Patients completed the survey before and after watching a 5-minute computer-based video about the beneficial health effects of WFPBD. To assess knowledge, patients’ responses to the survey’s 10 knowledge-based (KB) questions were scored on a dichotomous incorrect/correct scale. To assess confidence in their knowledge, patients’ responses to the survey’s 9 confidence-based (CB) questions were scored on a Likert scale from 1 (strongly disagree) to 5 (strongly agree). Two paired difference scores (knowledge and confidence) were calculated and independently analyzed using a Related-Samples Wilcoxon Signed Rank Test. A Stepwise Linear Regression was used to investigate which survey questions were most educational.
Results: The Related-Samples Wilcoxon Signed Rank Test showed a statistically significant improvement in both patients’ knowledge and confidence in their knowledge of nutrition. Patients scored significantly higher on KB survey questions (p &lt; 0.001) and CB survey questions (p &lt; 0.001) post-video. Stepwise Linear Regression showed that the most educational survey questions included information on fiber, plant-based foods, and saturated fats.
Conclusion: Our findings indicate that providing patients with a computer-based educational video during clinic wait time significantly increases patient knowledge on the benefits of a WFPBD. Future studies can test a larger sample of patients and gauge the longevity of knowledge gained.

Disclosure
K. Cole: None. D. Wenger: None. A. Guha: None. C. Yarosh: None. C. Hoffman: None.

Funding
University of California, Los Angeles
732-P: Effect of Serum 25-Hydroxyvitamin D on Blood Lipid Profile in Type 2 Diabetics
Authors: LI NAN , WANG YANRU , ZHU BING , SUN HANG , YANG PENG , ZHANG LIJUAN , LI HONG , QU SHEN 
Published: June 2020

Objective: The relationship of serum 25-hydroxyvitamin D (25(OH)D) with type 2 diabetes(T2DM) is controversial and the correlation between 25 (OH) D and lipid metabolism is not clear. Therefore, our study intends to unveil the effect of 25(OH)D on blood lipid profile in T2DM.
Methods: A total of 587 patients with T2DM and 532 healthy people in our hospital from 2017 to 2018 were enrolled. The level of 25(OH)D between T2DM group and non-DM group was compared. Patients with T2DM were divided into a low 25(OH)D group(LVD group, &lt;47.7nmol/L,n=425) and normal 25(OH)D group(NVD group, ≥47.7nmol/L,n=162). Furthermore, we analyzed the association between the level of 25(OH)D with patients’ BMI, age, TC, TG, HDL-C, and LDL-C. According to the diabetic duration, HbA1c, and vascular lesion, the relationship between 25 (OH) D and the severity of diabetes was compared.
Results: The level of 25(OH)D in the T2DM group was significantly lower than the non-DM group (39.99±15.25 vs.50.00±11.53, P&lt;0.001). Level of TC (4.49(3.69∼5.34) vs. 4.09(3.45∼4.85), P&lt;0.001), TG (1.46(1∼2.29) vs. 1.19(0.87∼1.73), P&lt;0.001), LDL-C(2.75(2.07∼3.39) vs.2.44(1.96∼3.07), P=0.014) in the low 25(OH)D group were higher than normal group, and they all had significant difference. The level of HDL-C is lower (1.08(0.9∼1.33) vs. 1.13(0.97∼1.32), P=0.206), but there was no significant difference. In addition, gender, age, and BMI were found not related to 25(OH)D. Regression analysis showed that with the increase of diabetic duration and HbA1c, the level of 25(OH)D decreased, then the incidence of the vascular lesion was increased, but the difference was not statistically significant.
Conclusion: The 25(OH)D in patients with T2DM is lower than healthy people. Meanwhile, the atherosclerosis factors like TC, TG, and LDL-C are increased, but there is no definite correlation with HDL-C. Hence, we conclude that in patients with T2DM, supplementation of 25(OH) D may suppress the atherogenesis by regulating lipid metabolism, which needs further study.

Disclosure
N. Li: None. Y. Wang: None. B. Zhu: None. H. Sun: None. P. Yang: None. L. Zhang: None. H. Li: None. S. Qu: None.

Funding
National Natural Science Foundation of China (81900781, 81970677); National Key Research and Development Program of China (2018YFC1314100)
74-LB: Sustainable HbA1c Decrease at 12 Months for Adults with Type 1 and Type 2 Diabetes Using the FreeStyle Libre System: A Study within the National Diabetes Register in Sweden
Authors: EEG-OLOFSSON KATARINA , SVENSSON ANN-MARIE , FRANZÉN STEFAN , ISMAIL HODAN , LEVRAT-GUILLEN FLEUR 
Published: June 2020

The National Diabetes Register (NDR) launched in 1996 in Sweden includes primary and secondary care data and captures 94% of adult patients with diabetes. A cohort study using data from nationwide register from 2014/01/01 to 2019/06/25 was initiated with the objective to determine the effectiveness of the FreeStyle Libre system on HbA1c reduction. Eligible for inclusion were patients with diabetes (≥ 18 years old) using FreeStyle Libre recorded within the NDR. Index date was the 1st record of FreeStyle Libre use. Methodology was a before/after comparison; prior period was closest HbA1c measurement within 6 months before index date and after period was HbA1c closest to 6 and 12 months after index date within Day 91 - Day 272 and Day 272 - Day 455 respectively. During the study period, 39 554 T1 or T2 patients had at least one registration of FreeStyle Libre usage. HbA1c measurements were available within the defined prior and after period for a subset of the total patient study population who were incident FreeStyle Libre users. HbA1c was significantly reduced in T1 and T2 users with a sustainable effect at 12 months (-0.44 for type 1 and -0.66 for type 2). This large real-world study on a well-established diabetes register in Sweden concluded that people with T1DM and T2DM using FreeStyle Libre for between 9 to 15 months significantly reduced HbA1c.

Disclosure
K. Eeg-Olofsson: None. A. Svensson: None. S. Franzén: None. H. Ismail: None. F. Levrat-Guillen: Employee; Self; Abbott.

Funding
Abbott Diabetes Care
742-P: Socioeconomic Position (SEP) Attributes Intersect with Race to Influence Glycemic Control Patterns in Youth with Type 1 Diabetes (T1D) over Time
Authors: LIESE ANGELA D. , REBOUSSIN BETH A. , KAHKOSKA ANNA R. , FRONGILLO EDWARD A. , MALIK FAISAL , IMPERATORE GIUSEPPINA , SAYDAH SHARON , BELLATORRE ANNA , LAWRENCE JEAN M. , DABELEA DANA , MENDOZA JASON A. 
Published: June 2020

SEARCH for Diabetes in Youth has identified racial/ethnic disparities in patterns of glycemic control among T1D youth. How SEP and race/ethnicity intersect to influence these disparities is poorly understood. SEARCH T1D participants (n=1,313) age ≤20 years at diagnosis (dx) in 2002-5 were followed 6-13 years with 3+ hemoglobin A1c measures. Group-based trajectory modeling of A1c identified Group 1 (G1, 77%): lower A1c with mild increases (from mean 7.4 to 8.4%) and Group 2 (G2, 23%): high and increasing A1c (from 8.5 to 11.2%). Classification and regression tree analysis modeled patterns in 8 demographic and SEP attributes that distinguished between G2 and G1 (prediction accuracy 0.68). Race/ethnicity was most influential in predicting G2, with 39.6% G2 in minorities vs. 18.2% in non-Hispanic whites (NHWs) (Figure). Among minorities, 52.5% of those with public insurance were in G2 vs. 32.4% of those with private insurance. Among NHWs without college-educated parents, older age at dx (≥10 years) was associated with G2 (34.0% vs. 20.5% in dx &lt;10 years). Among NHWs with college-educated parents, living in a 1-parent household was associated with G2 (23.6% vs. 8.9% in a 2-parent household). Race/ethnicity intersects differentially with select SEP attributes for NHW vs. minorities suggesting more nuanced studies of health disparities are needed.

Disclosure
A.D. Liese: None. B.A. Reboussin: None. A.R. Kahkoska: Other Relationship; Self; Novo Nordisk A/S. E.A. Frongillo: None. F. Malik: None. G. Imperatore: None. S. Saydah: None. A. Bellatorre: None. J.M. Lawrence: None. D. Dabelea: None. J.A. Mendoza: None.

Funding
National Institutes of Health (1R01DK117461, 1UC4DK108173)
746-P: Identifying Health Care Disparities in Youth with T1D: Effectiveness of Novel Interventions in Children’s Healthcare (NICH) for Rural and Urban Youth
Authors: JENISCH CELESTE , WAGNER DAVID V. , MANABAT ANN JELINE F. , HEYWOOD MATTHEW , KARKULA ELIZABETH , SHEFFIELD ANNAN , OGDEN JIMMIE D. , NAGRA HARPREET , HARRIS MICHAEL A. 
Published: June 2020

Objective: Novel Interventions in Children’s Healthcare (NICH), an intensive behavioral health program, has demonstrated promise in reducing avoidable complications in youth with T1D. However, it is unclear whether these outcomes are consistent across regions, and how those variables may impact intensity of service delivery. This study aims to identify whether region and distance from NICH team base, when considering treatment intensity, moderate NICH outcomes.
Methods: Youth with T1D served by NICH and covered by one of four major Medicaid providers were included (n=47). EHR review included frequency of DKA one year prior and two years following initiation of NICH services, distance from NICH team, type of region, and intensity of services delivered.
Results: NICH youth demonstrated similar DKA reduction regardless of living in a rural or urban community. NICH providers delivered a per-family mean of 3 hours and 58 minutes per week of indirect and direct services, with more time spent in face-to-face service delivery and less time on transportation with families living closer to NICH team. NICH providers were significantly (p&lt;.05) more likely to meet weekly with caregivers if youth lived within an hour of the team. When examining DKA incidence following NICH initiation, youth living more than one hour from the NICH team averaged a 46% decrease, those within 1-2 hours showed a 71% decrease, and those living more than 2 hours away showed no change in DKA frequency.
Conclusion: This study represents the first examination of how system-level characteristics might moderate NICH services and related effectiveness. While outcomes were similar across urban and rural communities, NICH youth living closer to the NICH team experienced greater caregiver access to services and were more likely to demonstrate reductions in DKAs compared to those living more than 2 hours away. Such findings have implications for model adaptation and dissemination.

Disclosure
C. Jenisch: None. D.V. Wagner: None. A.F. Manabat: None. M. Heywood: None. E. Karkula: None. A. Sheffield: None. J.D. Ogden: None. H. Nagra: None. M.A. Harris: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
75-LB: Machine-Learned, Biophysical Prediction of Glucose Response for 1,000 Subjects
Authors: DALAL PARIN , YAZDANI MEHRDAD , SNYDER MICHAEL , RAHILI SALAR , TORBAGHAN SOLMAZ S. 
Published: June 2020

Background: Reducing glycemic excursions following oral intake decreases the risk for microvascular disease in those with type 2 diabetes (T2D) and prevents conversion to T2D in those with prediabetes. Currently there are no accurate methods by which to predict a real world subject’s glycemic response to a particular meal. We developed a novel machine learning tool to infer personalized physiological parameters using consumer sensors for the accurate prediction of glycemic responses to food and activity.
Method: We prospectively recruited 1,000 healthy, prediabetic and type 2 diabetic subjects instructed to wear a Freestyle Libre Continuous Glucose Monitor (CGM) and Heart Rate Monitor (HRM) and logged foods for 10 days. A novel biophysical, machine-learned model was trained on CGM, HRM data and food logs to predict and tune glucose responses to food and activity. The training used a separate deep-learning network trained to predict the infusion of glucose into subject bloodstream using known glycemic index (GI) values.
Results: 715 nondiabetic, 35 prediabetic, and 246 T2D subjects were enrolled. Our novel biophysical, machine-learned model predicted glucose excursions over a database of many million foods and activity rates and exceeded 99.9% on the Clarke Error Grid regions A and B for a wide variety of individuals. Many correlations exist between caloric intake and composition, fiber intake, household income, sleep quality, and inferred physiological parameters.
Conclusion: Precise prediction of glycemic responses will allow accurate counterfactual analysis of lifestyle choices and allow all individuals to better plan and select foods and activities to match their lifestyle, physiology, and psychological predispositions. This novel technology has potential novel applications for both diabetes treatment and prevention.

Disclosure
P. Dalal: Advisory Panel; Spouse/Partner; Arc Bio, Caribou Biosciences, Inc., January, Inc. Employee; Self; January, Inc. Other Relationship; Spouse/Partner; Illumina. M. Yazdani: None. M. Snyder: Stock/Shareholder; Self; January, Inc. S. Rahili: Employee; Self; January, Inc. S.S. Torbaghan: None.
754-P: Design of a Protocol and Psychometric Evaluation Questionnaires for a National PRO Diabetes Multisector Pilot Study in Denmark
Authors: SKOVLUND SOREN E. , BOEL LISE , BALK-MØLLER NINA C. , HØJHOLT PERNILLE M. , BERTHELSEN DORTHE B. , GLÜMER CHARLOTTE , PERRILD HANS , HESSLER DANIELLE M. , KAPLAN SHERRIE H. , JAKOBSEN POUL ERIK O. , EJSKJAER NIELS 
Published: June 2020

Aim: To develop a protocol and set of purpose-built psychometric PRO evaluation questionnaires for a national multi-sector study to evaluate feasibility, acceptability, validity, barriers, facilitators and perceived value of the National Danish PRO diabetes intervention (PRO diabetes questionnaire and dialogue tool) in Denmark.
Methods: The protocol was designed through a participatory process with People With Diabetes (PWD), multi-disciplinary representatives of diabetes centres and municipality diabetes rehabilitation centres from 3 regions of Denmark. Hypotheses and assessment tools were guided by formative qualitative research. The intervention involved that PWD fill out the PROM prior to their visit and the Health Care Professional (HCP) uses a PRO IT dialogue tool to collaboratively evaluate needs and plan care.
Results: The pragmatic mixed-methods study protocol involved hypothesis testing and exploratory research: 1) PRO-DIA-READY Scales for Clinic and HCP PRO-Diabetes Readiness (incl. structural/process indicators of person-centred care). 2) 6-item PRO-EVAL-P Scale completed by PWD after the PROM. 3) 8-item PROCON-EVAL-HCP and 13-item PROCON-EVAL-PWD scales completed by HCPs and PWD after the visit, 4) Clinician rating scales of PROM validity 5) Semi-structured interview/group workshop guides for PWD, Caregivers (CG), multi-disciplinary HCPs, and administrators based on RE-AIM: Reach, Effectiveness, Adoption, Implementation and Maintenance, 6) HCP/PWD Follow-Up Impact Questionnaires (incl. active participation, person-centred care, care utilisation and outcomes). Newly designed evaluation scales were analyzed psychometrically.
Conclusions: A protocol and new psychometric assessment tools for evaluation of validity, readiness, acceptability and impact of PRO in diabetes care were developed and successfully applied in large scale in Denmark. The new tools are available for comparative PRO research studies.

Disclosure
S.E. Skovlund: None. L. Boel: None. N.C. Balk-Møller: None. P.M. Højholt: None. D.B. Berthelsen: None. C. Glümer: None. H. Perrild: None. D.M. Hessler: Consultant; Self; Eli Lilly and Company. S.H. kaplan: None. P.O. Jakobsen: None. N. Ejskjaer: None.

Funding
Danish Health Data Board