bluuebunny/crossref_metadata_2025_split huggingface dataset:
617-P: Effect of Improving Postprandial Glucose by Eating with the Nondominant Hand in Japanese Patients with Type 2 Diabetes
Authors: NISHIMORI EITA , NAKA MOTOJI 
Published: June 2020

Background: Diabetes patients need to improve postprandial hyperglycemia. Eating slowly is effective for improving postprandial glucose (PPG), and a simple method is required in daily life. This study aimed to determine the effect of improving PPG by eating with the non-dominant hand in Japanese patients with type 2 diabetes (T2D).
Methods: This was a prospective, non-randomized, open-labeled, single-arm study that enrolled 10 patients of T2D who hospitalized in Asama General hospital for glycemic control. We measured glucose levels, C-peptide concentrations, and eating styles when subjects ate with the dominant hand and the non-dominant hand. Chopsticks were used for meals. The mean daily intake of energy, carbohydrate, protein, and fat was set individually and was unchanged during the period of this study. Participants were instructed to eat vegetables fast and carbohydrates last, and to chew 30 times per bite.
Results: Subjects (5F/5M) were average age 54 years, BMI 26 kg/m2, HbA1c 8.6%, of which 7 used only oral hypoglycemic drugs and 3 used injections. Each PPG and PPG AUC decreased with the non-dominant hand compared to the dominant hand, especially at breakfast (p&lt;0.001) and dinner (p=0.015). Delta PPG and delta C-peptide of breakfast were 76 mg/dl and 3.4 ng/ml for the dominant hand, and 39 mg/dl and 2.4 ng/ml for the non-dominant hand, both of which were significantly lower in the non-dominant hand (PPG p=0.002, C-peptide p=0.015). Each meal time was significantly extended from the dominant hand to the non-dominant hand (breakfast time 18 vs. 23, lunch 18 vs. 24, dinner 18 vs. 27 minutes, p&lt;0.01), and the number of chewing per bite at breakfast significantly increased (22 vs. 30 times/bite, p&lt;0.001).
Conclusions: Our findings suggested that eating with the non-dominant hand was effective in improving PPG in Japanese patients with T2D by prolonging the meal time and increasing the number of chewing per bite.

Disclosure
E. Nishimori: None. M. Naka: None.
618-P: Machine Learning in Predicting Poor Glycemic Outcomes
Authors: ALQUADAN HAMMAM , SIMINERIO LINDA M. , KRALL JODI T. , NG JASON 
Published: June 2020

With 1.5 million Americans diagnosed with diabetes mellitus (DM) annually, 84.1 million with prediabetes, and 245 billion in medical costs, efforts to characterize those at highest risk are warranted. Predictive modeling is a methodology that can proactively identify patients and allocate resources like a DM education intervention, known to ensure effective, cost-saving care.
Members of the University of Pittsburgh Medical Center (UPMC) endocrine division partnered with the Clinical Data Analytics Department to develop a predictive model using clinical data from patient electronic medical records (EMR), Medical and socioeconomic profiles were used to predict future glycemic control from any patient with a type 2 DM diagnosis or any patient with two HbA1c readings ≥6.5% within 1 year.
SHapley Additive exPlanations (SHAP), atheoretic approach used to explain output of a machine learning model, was used to analyze variables of 38,173 patients meeting inclusion criteria. Prior elevated HbA1C levels, younger age at presentation, and previous insulin therapy provided the highest prediction of future poor glycemic control.
Predictive modeling is a useful method to foretell future glycemic control. Identifying patients at “high risk” for poor outcomes can allow for efficient deployment early in the disease course for DE services proven to improve outcomes with the potential to reduce health care costs.

Disclosure
H. Alquadan: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. J. Ng: None.
622-P: Systematic Screening and Assessment of Diabetes Prevention and Self-Management Programs That Utilize Telehealth Technology
Authors: MENSA-WILMOT YVONNE , BONNER TIMETHIA , AYALA-PERALES MARIA M. , MENSA-KWAO AUGUSTINA , BOWEN SHELLY-ANN , GREENBERG MICHAEL , DAWKINS-LYN NICOLA , RUTLEDGE GIA E. 
Published: June 2020

Background: Remote delivery of health care services through telehealth technology holds promise for expanding access to and engaging individuals in underserved communities. Systematic Screening and Assessment and Evaluability Assessment methods were used to identify and evaluate promising CDC-recognized National Diabetes Prevention Program Lifestyle Change and Diabetes Self-Management Education and Support (DSMES) programs utilizing telehealth technology.
Objective: To describe how 8 Lifestyle Change and DSMES programs utilize telehealth technologies effectively to expand access to services in underserved communities.
Methods: Eight effective programs were selected to participate in an in-depth study. Information was gathered to understand activities, adaptations, and implementation challenges through in-depth interviews with stakeholders and on-site observation.
Results: In all program sites, telehealth technology seamlessly integrated into existing program models to increase patient engagement and experience. Programs offered various tailored products based on the curriculums to reinforce prevention and self-management education. Automation of several program processes reduced burden on health coaches and diabetes educators, and improved data quality and analysis capabilities. Bi-directional communication between providers and programs was key to gaining provider buy-in and increasing referrals. Understanding activities being implemented by effective programs is crucial for expanding use of telehealth technologies.
Conclusion: This project provides valuable practice-based evidence for planning and implementing diabetes prevention and management interventions.

Disclosure
Y. Mensa-Wilmot: None. T. Bonner: None. M.M. Ayala-Perales: None. A. Mensa-Kwao: None. S. Bowen: None. M. Greenberg: None. N. Dawkins-Lyn: None. G.E. Rutledge: None.
626-P: Online Patient/Caregiver Education on Practical Use of CGM Can Improve Knowledge and Confidence as well as Prompt Real-Life Changes
Authors: LARKIN AMY , LACOUTURE MICHAEL 
Published: June 2020

We sought to measure the impact of online education for patients/caregivers on knowledge and confidence as well as on prompting changes in daily life. The education was available online, and comprised of text and integrated visuals. Demographic questions were asked prior to starting the education. A knowledge question was asked both before and after the activity to assess learning gains, as well as intent to change and confidence questions at the end. Absolute improvements were calculated for pre/post questions. The activity launched August 31, 2019, and preliminary data collected through October 30, 2019. To date, 4,631 learners have participated in the patient/caregiver activity, “AGP: What Do I Need to Know?” Completers of all questions (included in outcomes analysis): 755 Demographics: 52% female; 63% white, non-Hispanic; 70% over the age of 54; 71% have diabetes, 18% were interested in learning more about diabetes and the AGP Knowledge changes: 10% improvement in recognizing the benefits of an AGP report (78% pre to 88% post) Intent-to-act: 80% plan to talk to their HCP about if CGM can help them better monitor their diabetes Confidence changes: 88% reported increased confidence using an AGP report to interpret trends in glucose levels The metrics and outcomes gathered in this assessment are a strong indicator that these patient/caregiver-focused online educational activities improved knowledge and confidence and prompted intent to act by patients/caregivers related to CGM use in diabetes management.

Disclosure
A. Larkin: None. M. LaCouture: None.

Funding
Abbott Diabetes Care
635-P: Message in an App: A Survey of Feedback Messages about Healthy Coping in Diabetes
Authors: YE QING , BOREN SUZANNE A. , KHAN UZMA Z. , SIMOES EDUARDO J. , KIM MIN 
Published: June 2020

Healthy Coping (HC) is a key component of self-management for people with DM. HC includes physical exercise/activity and mood. Mobile apps are a promising tool to promote DSME/S for people with DM. Feedback messages can motivate people to change self-management behaviors. This study reports a survey of HC-related feedback messages in DM apps.
We searched “diabetes,” “blood sugar,” “glucose,” and “mood” in iTunes and Google Play to capture apps in English from August-October 2019. We identified 89 out of 1749 DM apps. We tested the apps by entering a range of normal and abnormal values to generate 326 feedback messages. We analyzed the messages regarding DM control, physical exercise, and mood, as well as feedback purpose and timing (Table 1).
All apps provided messages acknowledging input in real time. Many apps allowed self-monitoring of blood glucose (65%), however, out of these 174 feedback messages, none suggested behavioral modification (0%) and few advised goal setting (11%). Only some apps allowed input regarding exercise (12%) and mood (35%). Similarly, few messages suggested behavioral modification (11% and 6% respectively) or goal setting (11% and 6% respectively).
These findings indicate a lack of focus on HC especially regarding physical activity and mood with goal setting and behavioral modifications. Future DM apps should incorporate purposeful messages to engage people with DM in self-management.

Disclosure
Q. Ye: None. S.A. Boren: None. U.Z. Khan: None. E.J. Simoes: None. M. Kim: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092950); University of Missouri Research Council (URC-19-153)
64-LB: Fourteen-Item Mediterranean Diet Score as Indicator for Prediabetes in Taiwan, a Cross-Sectional Study
Authors: HOU YI CHENG 
Published: June 2020

Background and Aims: Prediabetes is considered a high-risk state of type 2 diabetes and a reversible condition with lifestyle changes. The Mediterranean diet is one of the recommended dietary patterns for reducing the risk of type 2 diabetes. This study aims to find association between the degree of adherence to the Mediterranean diet and blood glucose level in prediabetes patients and healthy controls.
Methods: In this cross-sectional study 346 subjects were recruited between 2014 and 2019 at the Taipei Tzu Chi Hospital. The degree of adherence to the Mediterranean diet is measured by a 14-item Mediterranean diet adherence screener used in the PREDIMED trial. The blood glucose level is measured by fasting glucose (mg/dL) and glycated hemoglobin (%).
Results: The Mediterranean diet adherence score is significantly and inversely associated with both measures of blood glucose level. Adjusted data (95% confidence intervals) shows that each additional point in the Mediterranean diet adherence score decreases the risk of prediabetes with abnormal fasting glucose level by 60% and the risk of prediabetes with abnormal glycated hemoglobin by 22.4%.
Conclusions: The 14-item Mediterranean diet score is an effective indicator for prediabetes.

Disclosure
Y. Hou: None.

Funding
Taipei Tzu Chi Hospital; Buddhist Tzu Chi Medical Foundation (TCRD-TPE-109-RT-10)
640-P: Clinical Video Telehealth: An Effective Approach to Comprehensive Group Diabetes Self-Management Education and Support for Rural and Disabled Veterans
Authors: DINARDO MONICA , YOUK ADA O. , BEYER NICOLE , BEATTIE JANICE N. , OBROSKY D. SCOTT 
Published: June 2020

Veterans are three times more likely to have diabetes than the general population. Diabetes self-management education and support (DSMES) is a critical component of diabetes care that galvanizes more informed and engaged patients. Many Veterans are disabled or reside in rural areas and have limited access to comprehensive DSMES. Clinical Video Telehealth (CVT) extends access to specialty services from regional Veterans Affairs (VA) Healthcare Centers to Community-Based Outpatient Clinics where many Veterans receive healthcare. The purpose of this study was to examine and compare proximal (3-6 month) and distal (12 and 18 month) metabolic outcomes (A1C, lipids, BMI and blood pressure) of Veterans who received comprehensive group DSMES via CVT vs. in-person . Veterans who received DSMES from 2012 to 2017 by CVT (n=197) and in-person (n=359) were identified in the VA computerized medical record. The CVT group was similar to those that attended in-person, but were less racially diverse. A linear mixed model was used to compare changes in metabolic outcomes within and between groups over time. A1C improved at 3 months and was sustained for 12-18 months in both groups. Neither group showed changes in lipids, BMI, or blood pressure.
In conclusion, CVT is an effective means of improving A1C by expanding DSMES access to Veterans who receive community care.

Disclosure
M. DiNardo: None. A.O. Youk: None. N. Beyer: None. J.N. Beattie: None. D. Obrosky: None.
642-P: Identifying Value Propositions to Engage Patients with Type 2 Diabetes in Shared Medical Appointments
Authors: RITCHIE NATALIE D. , BEGUM ANOWARA , DAILEY-VAIL JENNIFER , REMENTER JENNY , KOREN RAMONA A. , TRUJILLO SHARON A. , PHIMPHASONE-BRADY PHOUTDAVONE , CASSIDY KRISTIN A. , WEARNER ROBYN , WAXMONSKY JEANETTE , KWAN BETHANY 
Published: June 2020

Objective: Type 2 diabetes (T2D) affects 12% of U.S. adults and is a major public health burden. Shared medical appointments (SMAs) are an effective strategy to deliver diabetes self-management education and support (DSMES) alongside medical care, yet recruitment is a common challenge. Enhanced communication strategies have been recommended, while identifying specific messaging to engage patients with T2D remains needed.
Methods: The Invested in Diabetes project is a cluster-randomized, pragmatic comparative effectiveness trial of two models of SMAs using an evidence-based DSMES curriculum. To aid recruitment at 22 primary care clinics, a group of patient, practice and research stakeholders used value proposition design strategies to develop tailored messaging on how SMAs can reduce pains and yield gains related to T2D. Patient stakeholders further refined messages to ensure patient-driven language. Here we describe value propositions for patients with newly diagnosed or uncontrolled T2D, diabetes distress, and comorbid conditions, plus concerned others.
Results: General messaging emphasized how SMAs may help patients with T2D through expert education, addressing concerns, behavior change strategies, problem-solving, stress-coping skills, normalizing, and peer support. Messaging emphasized respect for autonomy (“you are your best health advocate”) coupled with available support (“you don’t have to go it alone”). For uncontrolled T2D, messages further conveyed opportunities to “finally take control” of T2D. For diabetes distress, messages also conveyed how SMAs may reduce feeling overwhelmed by T2D. Concerned others were encouraged to show support by telling patients about diabetes SMAs.
Conclusions: Value proposition themes include how diabetes SMAs can improve T2D control and related stress, which may aid patient engagement. For clinics offering diabetes SMAs, messaging can be delivered by care team members and integrated into various recruitment activities.

Disclosure
N.D. Ritchie: None. A. Begum: None. J. Dailey-Vail: None. J. Rementer: None. R.A. Koren: None. S.A. Trujillo: None. P. Phimphasone-Brady: None. K.A. Cassidy: None. R. Wearner: None. J. Waxmonsky: None. B. Kwan: None.

Funding
Patient-Centered Outcomes Research Institute (IHS-1609-36322)
643-P: Positive Impact of Experience-Based Delivery Methods on Diabetes Education
Authors: GASTALDI GIACOMO , SANTOS MAMED MARCELO DOS 
Published: June 2020

Diabetes self-management education (DSME) favors health outcomes and health-related quality of life. Nevertheless, achievement of glycemic control often remains low despite DSME interventions. Current validated DSME group activities provide educational, psychosocial and behavioural support with or without experience-based delivery methods (EBDM). The aim of the study is to explore the impact of EBDM on the learning process. The facilitator transcribed and coded the data collected during filmed interview of participants to 3 different DSME group trainings: 1.Problem solving (expert logic, no EBDM) 2.Educational (informative logic, no EBDM) 3. DAFNE course (experiential logic/with EBDM). 22 participants with type 1 diabetes were included (n=5 for the expert logic field; n=7 for the informative logic field; n=10 for the experiential logic field) with a semi-structure plan based on three identical questions. Discourse analysis and content analysis of the interviews were organized to evaluate learning acquisition through participant’s discourses. The results have shown that the participants in the expert and informative logic define diabetes by the physiological aspects of the disease and testify about difficulties that are not addressed during the trainings or by describing the coordination of care (general practitioners, specialists, patient associations). They also report difficulties in relation to emotional management. The participants in the third field are able to link the definition of diabetes with individual experience and to associate their difficulties on the side of emotions. DSME intervention based on experience-based delivery method permits a reorganization of disease experiences with positive impact on the learning process which favors embodied diabetes.

Disclosure
G. Gastaldi: Consultant; Self; Medtronic, Novo Nordisk A/S. Other Relationship; Self; Dexcom, Inc. M. Dos Santos Mamed: None.
644-P: Social Media Campaign Raises Awareness of Diabetes Risks and Programs in Hispanic Communities
Authors: PHILIS-TSIMIKAS ATHENA , RUIZ MONICA , FORTMANN ADDIE L. , AGUILAR EFREN , JOHNSON RACHEL , KIENAST AMANDA , WALKER CHRIS 
Published: June 2020

Strong evidence for improving clinical outcomes exists for the Diabetes Prevention Program (DPP) and diabetes self-management education (DSME) yet traditional methods of education and outreach have been minimally effective at engaging high-risk Hispanics. Scripps Whittier Diabetes Institute, San Diego, CA, has delivered culturally appropriate DSME and DPP programs for over 25 years and was seeking an effective method to further engage diverse communities. Facebook is the number one platform for U.S. Hispanics’ communication. Nearly half (48%) of U.S. Hispanics’ Facebook friends are family members, compared to 36% for the total population. Hispanics are the most mobile and socially active group in the U.S. and converse in the language of their preference. On-line messaging developed in Spanish and English utilized patient stories to increase understanding of diabetes risk and encourage an online risk assessment. The audience included adults ages 40+ in Chula Vista; along the Mexican American border. The campaign landing page included calls to action, helpful information regarding diabetes risk factors and links to inspiring patient stories. Nurturing emails were sent to all leads with lifestyle tips and call to action to register for a diabetes program. Bi-lingual telephone outreach was conducted within one week of the risk assessment completion to make a personal connection and answer questions. In the first 75 days of the campaign, 92 assessments were initiated: 66 completed: 26 abandoned. Of the leads sent: 75% were from the Spanish language campaign; 0.67% click-through-rate from Facebook to the landing page; of the 1800 clicks, 75% came from the Spanish language ads; 60-75% of the clicks are from a female audience for both English and Spanish; and nearly 50/50 split between at risk and not at risk for T2DM.This social media campaign pilot was effective in increasing awareness of diabetes risks, DPP and DSME in Hispanic communities, especially in the Spanish speaking, female population.

Disclosure
A. Philis-Tsimikas: Advisory Panel; Self; Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. M. Ruiz: None. A.L. Fortmann: None. E. Aguilar: None. R. Johnson: None. A. Kienast: None. C. Walker: None.

Funding
Woltman Family Foundation
647-P: Short-Term Continuous Glucose Monitoring Use in Adolescents with Type 1 Diabetes Enhances Empowerment
Authors: ILKOWITZ JENIECE , RAISINGANI MANISH , WU FEN , CHEN YU , GERSON JESSICA , GALLAGHER MARY PAT , FRANKLIN BONITA 
Published: June 2020

Background: Studies in adults with type 1 diabetes (T1D) show Continuous Glucose Monitoring (CGM) significantly lowers HbA1c however, the benefit of CGM use in adolescents has been elusive. We asked if short-term CGM use would have an effect on adolescents with poorly controlled T1D.
Methods: In a randomized open label study we recruited 12 CGM naïve subjects with T1D, with an HbA1c &gt;8% and ages 13-18 years. Visit 1 (V1) entailed consent, survey completion (Stage of Change (SOC), Diabetes Empowerment Scale (DES-SF), Pediatric Quality of Life (PedsQL), diabetes knowledge) and randomization to treatment (T), CGM Dexcom G4 for 1 week, or control (C). Both groups received daily diabetes care communication for the 1 week between V1 and Visit 2 (V2). Visit 3 (V3) was 1 month later and Visit 4 (V4) was at 3 months. Surveys were completed at all visits and HbA1c at V1 and V4.
Results: Subjects (n=12) had an average age of 15.5 years and consisted of six Hispanic and five males. There were no significant (NS) differences between subject characteristics in the C (n=3) and T (n=9) groups. Compared to V1, there were NS changes in SOC and average number of boluses or blood glucoses (BGs) between the groups. The change in DES-SF from V1 to V4 was significant (p=0.04) for the T compared to the C. The decrease in HbA1c between V1 and V4 (-1.5%) in the T vs. an increase in the C (.4%) was NS (p=0.10) but clinically meaningful. Although NS, there was an increase in average BGs/day (+1.7) and a decrease in 7 day average BG (-81mg/dl) for T vs. the C (+0.1 BGs and -28mg/dl) from V1 to V2.
Conclusions: Research on CGM use or its emotional effects in adolescents with poorly controlled T1D is limited. This study demonstrated a significant impact on diabetes empowerment with short-term use of CGM. Although NS, this was associated with an increased number of BG checks and a decreased average BG during CGM use plus a decreased HbA1c at 3 months. Use of more advanced CGM systems may hold promise for adolescents with T1D through greater empowerment.

Disclosure
J. Ilkowitz: None. M. Raisingani: None. F. Wu: None. Y. Chen: None. J. Gerson: None. M. Gallagher: None. B. Franklin: None.