bluuebunny/crossref_metadata_2025_split huggingface dataset:
59-LB: Risk of Type 2 Diabetes Is Reduced in the Second Year of a Digital Diabetes Prevention Program in a Workplace Setting
Authors: BIRSE CHARLES E. , FRAGALA MAREN S. , ARELLANO ANDRE R. , BARE LANCE A. , SWEET CYNTHIA CASTRO , LAGIER ROBERT J. 
Published: June 2020

Background: A digital Diabetes Prevention Program (dDPP) has been shown to reduce the 8-year risk of diabetes in the first year of implementation in a workforce setting. We asked whether the dDPP reduced the risk of diabetes in a second year.
Methods: Individuals were included in the study if they (i) participated in an employer-sponsored wellness program with year-end biometric screening for 4 consecutive years (2016 to 2019), (ii) had prediabetes-range fasting glucose (100 to 125 mg/dL) or Hb1Ac (5.7% to 6.4%), (iii) a BMI ≥25 kg/m2 at the end of 2017, and (iv) completed ≥9 lessons in a dDPP initiated at the beginning of 2018. In the first year of the dDPP, individuals participated in weekly online lessons. In the second year, no new content was introduced, but individuals had access to lessons delivered in year 1.
Results: The baseline characteristics from the 2017 year-end screen are provided (Table). On average, participants (n=401) completed 25.1 lessons (SD: 12.3). In the second year of intervention, levels of BMI, fasting glucose, triglycerides and HDL-C, all components of the 8-year diabetes risk score, improved relative to changes observed in the year before intervention. The 8-year risk of developing diabetes was also reduced (Table).
Conclusions: The risk of developing type 2 diabetes was reduced in the second year of a dDPP.

Disclosure
C.E. Birse: Employee; Self; Quest Diagnostics. M.S. Fragala: Employee; Self; Quest Diagnostics. A.R. Arellano: None. L.A. Bare: Employee; Self; Quest Diagnostics. C. Castro Sweet: Employee; Self; Omada Health. R.J. Lagier: Employee; Self; Quest Diagnostics. Employee; Spouse/Partner; Thermo Fisher Scientific.
59-OR: Lipoprotein Particle Distribution by NMR in Youth with Type 2 Diabetes (T2D) in the TODAY Study
Authors: KATZ LORRAINE E. , OTVOS JAMES D. , DREWS KIMBERLY , TESFALDET BEREKET , BACHA FIDA , WILLI STEVEN M. , MARCOVINA SANTICA M. , MCKAY SIRIPOOM , WEINSTOCK RUTH S. 
Published: June 2020

T2D in adolescents is associated with an unfavorable lipid profile, but data on lipoprotein particle size and distribution in this population have yet to be published. The TODAY Study, a randomized treatment trial of T2D in youth, provided the opportunity to evaluate lipoprotein particle distribution and relate lipoprotein particle number and size to HbA1C, need for insulin treatment, gender, race/ethnicity, BMI, and blood pressure (BP). TODAY participants (n=348) with yearly samples available for NMR Lipoprofile assessments (baseline, 12, 24, 36 mos) were included. Baseline participant characteristics (mean±SD) were: age 13.7±2.0 yrs; BMI 34.3±7.6 kg/m2; 62.4% female; 20.7% White, 32.2% Non-Hispanic Black (NHB), 43.7% Hispanic. Analysis demonstrated increasing numbers of LDL, HDL, and VLDL particles over the three yrs (all ps&lt;0.0001) with somewhat weaker trends for decreasing particle size (LDL p=0.0009, HDL p=0.02). HbA1c showed a strong positive correlation with LDL, VLDL, and HDL particle number (all ps&lt;0.005). HbA1c was negatively associated with LDL (p&lt;0.0001) and HDL size (p=0.001) but positively associated with VLDL size (p&lt;0.0001). Need for insulin treatment did not impact these associations. Female subjects had larger HDL particle size than males at baseline (p=0.0004) and throughout (p&lt;0.0001). NHBs had the largest LDL and HDL particle size and smallest VLDL particle size. BMI% and BP showed positive association with LDL, HDL, and VLDL particle numbers but negative association with LDL and HDL size. The preponderance of lipoprotein parameters were strongly associated with TG/HDL ratio and non-HDL-C after adjusting for baseline age, race, gender, BMI%, BP, and need for insulin treatment (p&lt;0.0001).
In conclusion, these data demonstrate an atherogenic lipoprotein phenotype in youth with T2D and strong relationships with glycemic control and other cardiac risk factors. Concern regarding premature development of atherosclerosis in youth with T2D is warranted.

Disclosure
L.E. Katz: None. J.D. Otvos: Employee; Self; LabCorp. K. Drews: None. B. Tesfaldet: None. F. Bacha: Research Support; Self; AstraZeneca, Takeda Development Center Americas, Inc. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim International GmbH. Research Support; Self; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Tolerion, Inc. Other Relationship; Self; Caladrius Biosciences, Inc. S.M. Marcovina: None. S. Mckay: 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
National Institute of Diabetes and Digestive and Kidney Diseases (U01DK61212)
594-P: Human Nrf2-Active Multipotent Stromal Cell Exosomes Promote Tissue Repair in a Wound Model of Type 2 Diabetes
Authors: KUHN JOSEPH , HASSAN ABSARA , SHARMA SONALI , KWONG JENNIFER , RAHMAN MONTAHA , ADAM SALMA , LEE JASMINE , VILLARREAL PONCE ALVARO P. , RABBANI PIUL S. 
Published: June 2020

Exosomes, nanosized extracellular vesicles, may be key to translating multipotent stromal cell (MSC) therapy to the bedside. We previously found that nuclear factor erythroid 2-related factor 2 (Nrf2) regulates MSC promotion of tissue repair in diabetes. Here, we explore a novel role of Nrf2 in exosome biogenesis and investigate whether exosome treatment recapitulates the effects MSCs have on wound healing in mice with type 2 diabetes. Exosomes were harvested by differential ultracentrifugation of conditioned human bone marrow derived MSC media. For Nrf2-active exosomes, MSCs were incubated with potent Nrf2 activator, CDDO-Im. MSC characterization demonstrated robust tri-lineage differentiation, &gt;95% expression of positive markers (CD44/CD73/CD90/CD105/CD106), and &lt;5% expression of negative markers (CD45/CD31/CD14/CD19/HLA-DR). Immunoblotting of exosome isolates demonstrates enrichment for CD81, CD9 and TSG101. Nanoparticle tracking analysis demonstrates that Nrf2-active MSCs increase exosome secretion by 54%, compared to Nrf2-baseline MSCs (p&lt;0.05). Exosomes were injected into the wound margin of full-thickness wounds on Leprdb/db (db/db) mice. Both Nrf2-baseline and Nrf2-active exosome treatment significantly reduced closure time to 15.5 and 14 days respectively, compared to 29.8 days for vehicle-treated wounds (p&lt;0.05). This reduction eliminated the delay in closure time compared to wounds of C57/B6 mice. Nrf2-active exosome treatment of db/db wounds reduced closure time by a further 2.6 days compared to untreated C57/B6 wounds. At day 10, exosome treated db/db wounds have significant decreases in epithelial gap, expanded granulation tissue, and greater density of CD31+ vessels compared to vehicle-treated wounds. We conclude that activating Nrf2 in MSCs increases isolation efficiency by amplifying exosome yield and content. MSC exosome based therapies have potential for rapid translation to improve clinical wound healing outcomes.

Disclosure
J. Kuhn: None. A. Hassan: None. S. Sharma: None. J. Kwong: None. M. Rahman: None. S. Adam: None. J. Lee: None. A.P. Villarreal Ponce: None. P.S. Rabbani: None.

Funding
Plastic Surgery Foundation; Wound Healing Society; New York University Clinical and Translational Science Institute
60-LB: Oral Diabetes Medication Adherence in Emerging Adults with Youth-Onset Type 2 Diabetes: TODAY2 iCount Study
Authors: TRIEF PAULA M. , KALICHMAN SETH , WANG DONGLIANG , DREWS KIMBERLY , ANDERSON BARBARA , WEINSTOCK RUTH S. 
Published: June 2020

Background: Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) participants have youth-onset type 2 diabetes (T2D) and often poor glycemic control. The role of medication adherence is unknown.
Aims: To assess oral diabetes medication adherence in the TODAY2 cohort; To assess participant factors related to adherence.
Methods: Participants provided data at TODAY2 visits and at 3 monthly unannounced phone pill counts. Those taking ≥80% of pills were classified “high adherent,” those taking &lt;80% of pills were defined “low adherent.” If not taking oral medications (meds) they were asked reasons and adjudicated (no need for meds vs. non-adherent). The unadjusted association of each factor with adherence status was assessed by ANOVAs (continuous variables) and Pearson χ-square (categorical variables). Factors with p&lt;0.2 were entered into logistic models for adherence.
Results: Of 381 individuals, 224 were either taking oral meds (n=190) or taking none though meds were recommended (n=34) [mean age 25 yrs, 67% female, 18% white, 34% black, 39% Hispanic, 84% &lt;$36K income]. Per pill counts, 66.1% were low adherent (includes 15.2% adjudicated non-adherent). Unadjusted results: HbA1c was lower in high vs. low adherent groups (9.2% vs. 10.0%, p&lt;0.04). Racial/ethnic differences in adherence (55.3% non-Hispanic whites, 60.2% Hispanics, 85.7% non-Hispanic blacks were low adherent, p&lt;0.002). Of those with/without insurance, 65.5%/91.4% were low adherent (p&lt;0.004). After adjustment, race/ethnicity (p&lt;0.02) and insurance status (p&lt;0.007) remained related to adherence. HbA1c, age, gender, education, income, employment, BMI, T2D duration, family history, and no. of complications did not relate to adherence.
Conclusion: In emerging adults with youth-onset T2D, poor adherence to oral diabetes meds was common, and significantly more likely in those without health insurance and in non-Hispanic blacks. Interventions are needed to improve adherence and outcomes.

Disclosure
P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. S. Kalichman: None. D. Wang: None. K. Drews: None. B. Anderson: 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
National Institutes of Health (R01DK110456)
600-P: Single-Cell RNA Sequencing Identifies Novel Molecular Targets of Endothelial MicroRNA-200b in Diabetic and Ischemic Wounds
Authors: SINGH KANHAIYA , HERNANDEZ EDWARD , KUMAR MANISHEKHAR , RUSTAGI YASHIKA , MOHANTY SUJIT K. , ABOUHASHEM AHMED S. , KHANNA SAVITA , ROY SASHWATI , SEN CHANDAN K. 
Published: June 2020

Injury induced transient downregulation of endothelial miR-200b is required to jump-start wound angiogenesis but the underlying mechanisms remain unclear. To interrogate the transcriptional changes, single-cell RNA sequencing was performed on ∼15000 human endothelial cells following treatment with miR-200b inhibitor or its mimic. The 3’ scRNA-seq analysis was conducted using the Chromium single cell system (10x Genomics). Unsupervised clustering using CellRanger identified 13 cell clusters, few of which were miR-200b responsive. To verify the novel potential targets of miR-200b identified in endothelial cells, we used Stable Isotope Labelling by Amino acids in Cell culture (SILAC) based proteomic analysis using mass spectrometry. A total of 3818 proteins were detected which were then filtered using statistical cut-offs (p value &lt; 0.05; % change &gt; 10%) identifying 319 proteins targeted by miR-200b. To dissect mechanisms involved in vascular function post-miR-200b silencing in vivo, we generated miR-200b-429fl/fl-Tie2 Cre mice where endothelial miR-200b levels was depleted. The therapeutic significance of miR-200b inhibition was studied using ischemic hind limb in these mice. Perfusion imaging was performed using Laser Speckle Perfusion imaging. Color-coded perfusion maps were acquired at different time-points post-surgery (d3, d7, d10, d14) and average perfusion was calculated using PimSoft v1.4 software. Inhibition of endothelial miR-200b rescued hindlimb ischemia with improved perfusion (n=5). This rescue was associated with increased abundance of CD31+/vWF+ vasculogenic cells at the site of injury (n=5). This work identified miR-200b regulated endothelial cell clusters, the functionality of which are explained by SILAC proteomics. These findings provide insight into novel mechanisms explaining how transient inhibition of endothelial miR-200b helps switch vascular homeostasis into an angiogenic fate in response to injury.

Disclosure
K. Singh: None. E. Hernandez: None. M. Kumar: None. Y. Rustagi: None. S.K. Mohanty: None. A.S. Abouhashem: None. S. Khanna: None. S. Roy: None. C.K. Sen: None.

Funding
National Institutes of Health (GM108014); Eli Lilly and Company; Indiana Collaborative Initiative for Talent Enrichment (to C.K.S., S.R.)
608-P: Empagliflozin Ameliorates Ankle-Brachial Index in Real-World Setting in Indian Patients with Type 2 Diabetes Mellitus
Authors: PADHYE DAKSHATA 
Published: June 2020

Ankle Brachial Index (ABI) is an established marker for screening peripheral vascular disease and an independent predictor of amputation, cardiovascular event and mortality risk in patients with diabetes. We conducted a longitudinal cohort study using electronic health record data from the Conquer Diabetes Podiatry Center Registry (CDPCR) evaluating 29 patients for the ABI values, who have been adherent to empagliflozin for more than 24 weeks. Normal ABI was defined as &gt;0.9 and &lt;1.4. The assessment parameters included the risk of regression of high ABI versus progression to high ABI (risk-ratio), proportion (%) of patients with ABI decline of &gt;0.15. Based on assumptions of 5% alpha-error, 25% progression-rate to high ABI, and risk-ratio of 3 with 50% error margin, sample size of 54 was determined. ANOVA was used for the statistical analysis. 58 baseline readings of ABI, from 29 patients of T2DM, were analyzed. Mean age was 57 years, duration of diabetes was 11 years. 45% of patients were females. Mean baseline ABI was 1.3, with 11 abnormal readings (11 high, 0 low). The mean duration of exposure to empagliflozin was 16 months. At follow-up, mean ABI was 1.28. Of the 11 high baseline ABI readings, 5 regressed to normal. Of the 47 normal baseline ABI readings, 7 progressed to high ABI. Relative risk of regression versus progression for high ABI, was 3.66 (95% CI 1.53, 8.75; p = 0.003). Then Number Needed to Treat (NNT) was 3. No patient had ABI decline of &gt;0.15, or developed low ABI, at follow-up. This real-world evidence suggests possible role of empagliflozin in mediating regression of high ABI. We postulate that these clinical benefits may be in part due to the ability of empagliflozin to maintain vascular health especially in a pro-inflammatory environment of endothelium in patients with diabetes. Further, larger long-term randomized trials would be helpful to corroborate our findings.

Disclosure
D. Padhye: None.
616-P: Path Analysis to Assess the Effect of Health Literacy on Glycemic Control in African-American Adults
Authors: WILLIAMS JONI S. , EGEDE LEONARD E. 
Published: June 2020

Background: While health literacy has been shown to influence health outcomes, recent evidence suggests nearly 25% of African American (AA) adults have below basic health literacy compared to only 9% of White Americans. This disparity may contribute to poorer outcomes observed in AA adults with type 2 diabetes mellitus (T2DM). Therefore, the aim of this study was to assess the pathways for the relationship between health literacy and diabetes outcomes in AA adults with T2DM.
Methods: Data from 277 AA adults with T2DM from the southeastern U.S. were analyzed. Path analysis was used to assess the direct and indirect relationships between health literacy (comprehension and numeracy) and self-care and between self-care and glycemic control (HbA1c). We hypothesized that health literacy would have both a direct and indirect effect on HbA1c via self-care behaviors (specific diet, general diet, exercise, blood sugar monitoring, foot care).
Results: In the path analysis for comprehension, health literacy did not have a direct effect on HbA1c (p=0.247), but did have a direct effect on specific diet (β=-0.18; p=0.002), blood sugar monitoring (β =-0.21; p&lt;0.0001), and foot care (β=-0.13; p=0.032) and an indirect effect on HbA1c through specific diet (β=-0.13; p=0.043) and blood sugar monitoring (β=-0.29; p&lt;0.0001). In the path analysis for numeracy, health literacy had a direct effect on glycemic control (β=-0.12; p=0.047) and specific diet (β=-0.13; p=0.039), blood sugar monitoring (β=-0.14; p=0.019), and foot care (β=-0.12; p=0.048) and an indirect effect on HbA1c through specific diet (β=-0.13; p=0.042) and blood sugar monitoring (β=-0.29; p&lt;0.0001).
Conclusions: In this sample of AA adults with T2DM, only numeracy had a direct effect on glycemic control, whereas both comprehension and numeracy had direct effects on self-care behaviors. These findings suggest the need for greater emphasis on increased numeracy for interventions in AA adults with T2DM.

Disclosure
J.S. Williams: None. L.E. Egede: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861)
628-P: Educational Sessions at ADA Camp Midicha Improve Carbohydrate Counting and Insulin Calculation in Children with Type 1 Diabetes Mellitus
Authors: JOSEPH MINA , DEGNAN BERNARD M. , SZPUNAR SUSAN 
Published: June 2020

Introduction: Type 1 diabetes mellitus (DM) is one of the most common chronic diseases in children. The ability of affected children to calculate carbohydrate consumption per meal, apply a correction factor based on their blood glucose and administer an accurate dose of insulin is a key component for good diabetes control. Multiple studies, however, have shown that insulin dosage calculations, particularly carbohydrate assessment, are inaccurate in &gt; 50% of children with DM. Surveys of attendees at diabetes camps show that campers and camp personnel have reported increased confidence and ability in counting carbohydrates and administering insulin, but no quantitative tools have been used in these reports. The aim of this study was to determine whether educational sessions provided during a one-week diabetes camp would improve carbohydrate counting and insulin dosage calculation in children with type 1 DM.
Methods and Materials: We consented 144 parents/campers with type 1 DM to participate in the study. The Pediatric Carbohydrate Quiz (PCQ) was administered to the children before or on the first day of camp. All subjects participated in camp activities, which included dietary education. A post-intervention PCQ was administered on the last day. Pre- and post-camp test scores were compared using the paired t-test.
Results: Over 2 sessions, 79.2% (114/144) of campers completed both questionnaires. Their mean age was 13.8 ± 1.5 years, 61.4% female, 84.2% White and 16.4% first-time campers., The highest possible score on the PCQ administered is 72. The mean pre-camp PCQ score was 59.0 ± 7.1 vs. a mean post-camp score of 61.2± 5.9 (p&lt;0.0001). The degree of improvement for female campers was greater than for males.
Conclusion: Attendance at a one-week session at Camp Midicha improved the ability of adolescent campers to assess carbohydrate counting and calculate insulin doses.

Disclosure
M. Joseph: None. B.M. Degnan: None. S. Szpunar: None.

Funding
Ascension St. John Hospital
633-P: Impact of Simulation-Based CME on Clinicians’ Knowledge and Competence Related to Hypoglycemia Management
Authors: KARANDREA SHPETIM , AGARWAL NEHA , JAMROGIEWICZ AMANDA 
Published: June 2020

We sought to determine if real-time patient simulation technology, designed to mimic a patient visit, could improve clinicians’ knowledge/competence regarding the management of hypoglycemia in patients with type 2 diabetes (T2D). The patient simulation technology, DecisionSim, was incorporated as part of a live symposium, and changes in competence and knowledge were evaluated using pre-/post-assessment questions. A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p &lt;0.05 indicated statistical significance). The live activity took place on October 26, 2018. In total, 66 allied health professionals (PAs, RNs, NPs, PharmDs, CDE/RDs) and 41 MDs/DOs answered the assessment questions. An increase in knowledge was observed, albeit not statistically significant (4% relative increase compared to baseline, p = 0.6). A significant increase in competence in selecting the most appropriate treatment to address hypoglycemia risk for a patient with T2D was observed (120% relative increase compared to baseline, p &lt;0.0001). 82% selected the correct treatment decisions in the branching simulation platform, including the intensification of therapy that addresses HbA1c goals while minimizing the risk of hypoglycemia in a virtual patient with T2D. Additionally, 83% indicated in the post-activity survey that they would make changes to practice based on information received, including to provide patient-centered care, assess the current diabetes guidelines, and use diabetes treatments that minimize hypoglycemia. Continued educational gaps were identified: lack of knowledge about the benefits of GLP-1RA/insulin combinations (17%), and lack of competence in individualizing T2D therapy in the context of hypoglycemia risk (21%). These results indicate that simulation-based CME can lead to significant improvements in competence related to hypoglycemia management, as well as commitment to change among learners.

Disclosure
S. Karandrea: None. N. Agarwal: None. A. Jamrogiewicz: None.

Funding
Sanofi US (IME-2017-12078)
636-P: A Process of Developing an Education Document Repository: A Quality Improvement Initiative
Authors: MILLAN-FERRO ANDREINA , HIGGINS LAURIE A. , RIZZOTTO JO-ANNE M. 
Published: June 2020

Diabetes Self-Management Education and Support is the foundation of any diabetes program. Providing consistent and up-to-date educational materials (EM) can be challenging for any diabetes program. In 2017, a Quality Improvement (QI) Initiative was started to ensure that all clinicians (&gt; 35 Certified Diabetes Care and Education Specialist and 60 diabetes care providers) across our network, had a standardized approach to development and maintaining patient EM.
The QI plan had three aims: person with diabetes (PWD) should receive the most current information, providers should have access to current EM for all diabetes related topics and PWD should receive a consistent message across the education disciplines. The need for a web based application to host EM was identified. An inventory of all EM showed a total of 351; a centralized process overseen by a multidisciplinary committee was developed, core EM aligned with the AADE7 Self-Care BehaviorsTM were identified. New standards included: Reviewing and updating EM every 2-3 years (or sooner reflecting the most current practice), format should be conducive to learning, and templates should be consistent within categories.
Results: Share Point was chosen as the web based application and the Education Document Repository (EDR) was built and launched in 2018. The percentage of EM that met the newly developed standards increased from 20% at baseline to 80%, and the work load of maintaining the EM decreased by 30%. The EDR hosts 250 EM, has 13 categories and the highest percentage of EM belong to: nutrition 30%, technology 19% (pumps and CGMs), pediatrics 12% and medications 10%. In addition to the AADE7, other categories were created; such as: pediatrics, young adults, pregnancy to address the need of our patient population and user experience. Through this initiative all diabetes programs within our network of 10 locations across 6 states, have access to high quality patient EM. As our network grows we will be able to provide EM without delay.

Disclosure
A. Millan-Ferro: None. L.A. Higgins: Consultant; Self; Eli Lilly and Company. J.M. Rizzotto: None.