bluuebunny/crossref_metadata_2025_split huggingface dataset:
74-OR: The Effect of SERCA2 Activation on Liver Metabolism and Diet-Induced Steatohepatitis in Mice
Authors: BEDNARSKI TOMASZ , RAHIM MOHSIN , YOUNG JAMEY 
Published: June 2020

Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease, but its progression to the severe form of nonalcoholic steatohepatitis (NASH) is unpredictable. Hepatocyte steatosis alters endoplasmic reticulum (ER) calcium stores and induces mitochondrial dysfunction leading to hepatocellular inflammation and apoptosis. Moreover, obese mice have impaired sarco/endoplasmic reticulum Ca2+-ATPase (SERCA2) function, responsible for transporting Ca2+ from the cytoplasm to ER. We thus hypothesized that restoration of SERCA2 activity may improve hepatocyte function during lipotoxicity. To test this hypothesis, 8-week-old male C57Bl/6J (wild type, WT) or melanocortin-4 receptor knockout (MC4R-/-) mice were placed on either chow or Western diet (WD) for 8 weeks. Half of the WD-fed mice were also given injections of CDN1163 once every two weeks to activate SERCA2. Sodium [13C3]lactate was infused intravenously into conscious, unrestrained mice for 2 hours and 13C-enrichments of plasma glucose and liver metabolites were measured by GC-MS, then used to regress liver metabolic fluxes using the INCA modeling platform. CDN1163 treatment significantly decreased weight and fat mass of both WT and MC4R-/- WD-fed mice without affecting food intake or lean mass. Moreover, CDN1163 improved insulin sensitivity of WT and MC4R-/- mice. CDN1163 decreased NAFLD activity score in WT, but failed to reduce histological features of NASH in MC4R-/- mice. Liver free fatty acids, diglycerides and ceramides were not affected; however, CDN1163 decreased triglyceride content in WT mice. Liver metabolic fluxes analysis revealed that CDN1163 accelerated pyruvate cycling in WT and MC4R-/- mice, which may explain how CDN1163 helped hepatocytes adapt to an excess of energy substrates. Taken together, these data suggest that SERCA2 activation had a protective effect on liver when NAFLD was less severe (WT) but was insufficient to rescue lipotoxicity after progression to NASH had occurred (MC4R-/-).

Disclosure
T. Bednarski: None. M. Rahim: None. J. Young: Board Member; Self; Metalytics. Consultant; Self; Pfizer Inc.

Funding
National Institutes of Health (R01DK106348)
740-P: Effect of Family Support Intervention on Support Roles and Impact of Support on HbA1c among Adults with Type 2 DM
Authors: ZUPA MARGARET , HEISLER MICHELE , PIETTE JOHN , TRIVEDI RANAK B. , STOLL SHELLEY C. , OBROSKY D. SCOTT , LOVELACE ELIJAH Z. , MOR MARIA K. , ROSLAND ANN-MARIE 
Published: June 2020

Many adults with DM have a family supporter (FS) involved in their care. Informal support has been linked with better DM management and outcomes. We evaluated the effect of a patient and FS engagement intervention on FS roles in DM care, and the impact of those roles on HbA1c. Two-hundred and thirty-nine adult Veterans with type 2 DM and a FS were randomized to intervention vs. usual care for 12 months. Intervention dyads received one coaching session, biweekly automated calls to prompt action planning on new DM concerns, coaching calls to prepare for clinic visits, and summaries of primary care visits and DM complication risk. All models were controlled for baseline HbA1c, age, sex, insulin use, and FS cohabitation with patient. Over 12 months, participants in the intervention group were more likely to have increased involvement in several FS roles, including: deciding when to contact healthcare providers about concerns (AOR 2.080, 95% CI 1.137,3.804), remembering to go to appointments (AOR 2.852, 95% CI 1.503, 5.412), take (1.853, 95% CI 1.001, 3.428) and refill (AOR 2.193, 1.196, 4.019) medications, and perform (AOR 2.615, 95% CI 1.405, 4.867) and review (AOR 2.822, 95% CI 1.506, 5.290) home testing. Changes in help navigating the healthcare system, and encouraging healthy eating and exercise were not different by intervention arm. Help remembering to take medications at baseline was associated with 0.457% increase in HbA1c over 12 months (95% CI 0.107, 0.807, p=0.011), and no support roles were significantly associated with HbA1c decrease.
In conclusion, this intervention increased FS involvement in diabetes-specific self-management, with less impact on general lifestyle support. Patients with support for taking medication prior to the intervention had significant subsequent increases in HbA1c. This may indicate family are recognizing which patients have challenges with medication taking, but need more training to effectively help improve subsequent patient outcomes.

Disclosure
M. Zupa: None. M. Heisler: None. J. Piette: None. R.B. Trivedi: None. S.C. Stoll: None. D. Obrosky: None. E.Z. Lovelace: None. M.K. Mor: None. A. Rosland: None.

Funding
VA Health Services Research and Development (IIR 14–074-1); Michigan Center for Diabetes Translational Research (5P60-DK09292); Michigan Claude D. Pepper Older Americans Independence Center (AG-024824); VA Ann Arbor Center for Clinical Management Research; University of Pittsburgh (5T32DK007052-45)
741-P: Racial/Ethnic Disparity in Advanced Diabetes Technology Use in Type 1 Diabetes (T1D): Minority Young Adult (YA) Perspectives on Perceived Access
Authors: CRESPO-RAMOS GLADYS , MILLER VICTORIA , GONZALEZ JEFFREY S. , JANG ALYSSA , AGARWAL SHIVANI 
Published: June 2020

Previous research has documented racial/ethnic disparity in continuous glucose monitor and insulin pump use in people with T1D. It remains unknown whether disparities result from socioeconomic status or other factors. We recruited 17 YA with T1D from an underserved area (mean age 22, 5 non-Hispanic Black, 12 Hispanic, 88% Medicaid, duration 11 yrs, median HbA1c 9.6%) and conducted semi-structured individual interviews in English or Spanish. We asked questions about how YA were introduced to diabetes technology and what helped them make decisions for use. We developed a standard codebook to direct content analysis and achieved thematic saturation. Our results revealed 3 main themes surrounding information and decisions on technology use: 1) providers were the gateway for information and access; 2) patients were not typically included in decision-making, but were more likely to accept use when they were; and 3) cost was not an issue. Half of participants reported they were never offered or told about diabetes technology in the past despite long diabetes duration. For those with whom technology was discussed, most stated they were not included in the decision process to receive such technology. Some participants reported that providers refused prescription of technology due to lack of demonstration of self-management skills. Still, no alternative options or goal-setting to obtain technology were offered. Some participants desired to learn more about technology but refused to ever start because of perceived extra burden, skepticism of new equipment, or attachment concerns. Very few participants stated they could not afford the technology. Our results suggest that racial/ethnic disparity in technology use may originate at the patient-provider level. Deeper examination of implicit bias in prescribing practices is needed, as well as understanding of minority YA preferences and promotion of shared decision-making.

Disclosure
G. Crespo-Ramos: None. V. Miller: None. J.S. Gonzalez: None. A. Jang: None. S. Agarwal: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)
744-P: Racial Differences in the Contribution of Sociodemographic, Clinical, and Self-Care Factors on Glycemic Control in Adults with Type 2 Diabetes
Authors: OLUKOTUN OLUWATOYIN , WILLIAMS JONI S. , WALKER SHANNON L. , AKINBOBOYE OLAITAN J. , EGEDE LEONARD E. 
Published: June 2020

Background: This study evaluated the unique contribution of demographic, social determinants, clinical and self-care factors on glycemic control in a sample of adults with T2DM.
Methods: This analysis used data obtained from 615 adults with T2DM in the Southeastern U.S. Linear regression models were used to assess the incremental contribution of key variables (demographic, social determinants [socioeconomic status, psychosocial and built environment factors], clinical and self-care factors) at varying levels of influence, on glycemic control, after stratifying by race.
Results: For the entire sample, there were significant relationships between glycemic control and age (β = −0.02, p &lt; 0.05), Medicaid (β = −0.69, p &lt; 0.05), diabetes fatalism (β = −0.02, p &lt; 0.05), self-efficacy (β = −0.10, p &lt; 0.001), social support (β = 0.01, p &lt; 0.05), comorbidity (β = −0.09, p &lt; 0.05), insulin use (β = 0.95, p &lt; 0.001), and being a former smoker (β = 0.35, p &lt; 0.05). In the stratified regression model for Non-Hispanic Whites (NHW), there were significant relationships between glycemic control and Medicare (β = −1.27, p &lt; 0.05), “other” insurance type (β = −1.53, p &lt; 0.05), education (β = −0.95, p &lt; 0.05), self-efficacy (β = −0.06, p &lt; 0.001), neighborhood rating (β = −0.58, p &lt; 0.05), neighborhood comparison (β = 0.39, p &lt; 0.05), insulin use (β = 1.04, p &lt; 0.01). In the stratified regression model for Non-Hispanic Blacks (NHB), there were significant relationships between glycemic control and age (β = −0.02, p &lt; 0.05), diabetes distress (β = 0.44, p &lt; 0.05), self-efficacy (β = −0.11, p &lt; 0.001), social support (β = 0.01, p &lt; 0.01), comorbidity (β = −0.13, p &lt; 0.05), and insulin use (β = 1.02, p &lt; 0.001).
Conclusion: In this sample of adults with diabetes, there were racial differences in demographic, psychosocial, built environment and clinical factors associated with glycemic control. Interventions may need to be tailored by race or ethnicity to achieve optimal outcomes.

Disclosure
O. Olukotun: None. J.S. Williams: None. S.L. Walker: None. O.J. Akinboboye: None. L.E. Egede: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861 to L.E.E.); National Institute for Minority Health and Health Disparities (R01MD013826 to L.E.E., S.L.W.)
749-P: Parents’ Psychosocial Outcomes from the Strategies to Encourage New CGM Use in Early Childhood (SENCE) Trial at 12 Months
Authors: HILLIARD MARISA E. , KANAPKA LAUREN , LAFFEL LORI M. , ANDERSON BARBARA , MILLER KELLEE , LEVY WENDY , VAN NAME MICHELLE A. , COMMISSARIAT PERSIS V. , DIMEGLIO LINDA 
Published: June 2020

Objective: Parents of young children with type 1 diabetes report developmental and management challenges and diabetes-related distress. In the SENCE trial with children 2-&lt;8 yrs, we described improved parental psychosocial outcomes from baseline to 26 wks when continuous glucose monitoring (CGM) was combined with a family behavioral intervention (FBI), compared to CGM alone and to standard blood glucose monitoring. We now explore psychosocial outcomes in the CGM+FBI and CGM alone groups over the extension phase (observation without intervention, 26 to 52 wks post-baseline).
Method: Parents (N=143, children: 50% female, 68% non-Hispanic White, age=5.7±1.8 yrs, A1c=8.2±0.8%) completed validated surveys of diabetes burden, diabetes family impact, hypoglycemia fear, and treatment regimen impact at baseline, 26, and 52 wks. We analyzed 52 week outcomes using within-group t tests and between-group longitudinal models.
Results: Survey scores were stable from 26 to 52 wks, although differences from baseline to 52 wks were not significant (p&lt;.01) (Table).
Conclusion: Introducing CGM with FBI improves parental psychosocial outcomes for at least 6 mos; the similar results at 12 mos suggest durability to 1 yr. Importantly, adding CGM to diabetes regimens in young children, especially with behavioral support, does not appear to add to parents’ perceived burden or fear of low blood glucose.

Disclosure
M.E. Hilliard: None. L. Kanapka: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. B. Anderson: None. K. Miller: None. W. Levy: None. M.A. Van Name: None. P.V. Commissariat: None. L. DiMeglio: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
752-P: Effects of Diabetes and Menopause on Mood, Quality of Life, and A1C
Authors: SHARMA HIMANI , MYERS BARBARA A. , GROOT MARY DE 
Published: June 2020

Women with type 1 (T1D) and type 2 diabetes (T2D) are living longer than any other time in history. Little is known about the effects of diabetes and the menopause transition on psychosocial outcomes at mid-life. We conducted a cross-sectional survey to evaluate the emotional and behavioral correlates of menopause in women ≥ age 40 with and without diabetes (ND). 655 women completed an online survey querying demographics, A1c, diabetes distress (DDS), depressive symptoms (PHQ-8), health-related quality of life (HRQOL; SF-12), Menopause Specific Quality of Life (MenQOL), and Pittsburgh Sleep Quality Index (PSQI). Mean age was 53 years, 83% self-identified as White, 52% married, &gt;30% had a college degree and household income ≥$100,000/year. 55% (n=366) of had ND, 27% (n=181) T2D, 9% (n=60) TID and 7% (n=46) prediabetes. 6% (n=43) were premenopausal, 25% (n=167) perimenopausal and 67% (n=440) in menopause. Mean A1c in women with diabetes was higher in perimenopausal (7.8%) compared to menopausal women (7.1%, p=0.04). Depressive symptom levels were higher in T2D compared to ND (M=9.2 vs. 5.5, p&lt;0.05). DDS was not different in T1D vs. T2D. T2D had lower HRQOL for both SF-12 mental (M=46.0 vs. 48.6, p=.004) and physical components (PCS; M=40.6 vs. 48.3, p&lt;.05) compared to ND. T2D also had lower SF-12 PCS as compared to T1D (M=40.6 vs. 50.2) and prediabetes (M=40.6 vs. 42.7, all p&lt;0.05). T2D reported worse subjective sleep quality (M=1.5 vs. 1.2) and more use of sleep medication (M=1.1 vs. 0.8) compared to ND. They also reported worse sleep disturbance (M=1.6) than T1D (M=1.3) and ND (M=1.3; all p&lt;.05). MenQOL physical domain was worse in T2D (M=4.1) than T1D (M=3.6) and ND (M=3.1, p&lt;0.05). Psychosocial (M=3.9 vs. 2.9), vasomotor (M=3.8 vs. 2.8) and sexual (M=3.6 vs. 2.6) functioning were worse in T2D compared to ND (p&lt;0.05). T2D women had greater psychological and physical distress affecting HRQOL than T1D and ND across the menopause transition. Glycemic management appears to be more difficult in perimenopause than later in the menopause transition.

Disclosure
H. Sharma: None. B.A. Myers: None. M. de Groot: Consultant; Self; Kenner Family Foundation, Inc., LifeScan Diabetes Institute.
753-P: A Clinical Mixed-Methods Study of the Perceived Benefits of Using the Danish Diabetes Patient Reported Outcome Measure and Dialogue Support Tool in Routine Outpatient Diabetes Care
Authors: SKOVLUND SOREN E. , TROELSEN LISE , NØRGAARD LISE MELLERGAARD , KJAER PERNILLE H. , PIETRASZEK ANNA , LARSEN HANNE RAVN , HESSLER DANIELLE M. , JAKOBSEN POUL ERIK O. , EJSKJAER NIELS 
Published: June 2020

Aim: To characterize validity, acceptability and perceived impact of the national Danish Diabetes PROM IT tool (DiaProfile) in routine diabetes care among people with both type 1 and 2 diabetes (PWD) and their health care professionals (HCP). To inform the evaluation design of a national study.
Methods: 12 PWD were recruited using a purposive analytical consecutive method in a single-arm mixed-methods qualitative clinical design. PWD completed the PROM prior to their visit and DiaProfile was used in visit to collaboratively identify individual care needs and options. PWD and HCP completed psychometric PROM evaluation scales on acceptability, validity, relevance, usability and perceived impact of the PROM intervention. Semi-structured interviews were done with all PWD (45-60 min). Visits/interviews were tape recorded and transcribed for coding. Phenomenological, thematic analyses with both inductive and deductive methods were used and all data sources were combined for triangulation.
Results: 12 PWD: 8 female/4 male, 4 type 2/8 type 1, mean age 51 (24-79), 9 on insulin pens, 2 on pumps, 2 on glp-1, 2 on metformin. Complications ranged from 0 to 6 per PWD. 2 physicians and 2 nurses each treated 3 PWD. PWD consistently found PROM easy and acceptable to complete, relevant, understandable and with no major topics missing. Triangulation identified consistent PWD and HCP experiences of improved visit preparedness, dialogue quality, care quality and focus, patient participation, and care confidence and experience with PRO use across users. All advocated for use in standard care.
Conclusions: This is the first real-world study to characterize perceptions of context validity, relevance, acceptability, usability and value (patient participation, dialogue, care quality) of the Danish diabetes PROM in a routine care setting. Outcomes were used to inform design of a national large-scale PRO diabetes study.

Disclosure
S.E. Skovlund: None. L. Troelsen: None. L. Nørgaard: None. P.H. Kjaer: None. A. Pietraszek: None. H. Ravn Larsen: None. D.M. Hessler: Consultant; Self; Eli Lilly and Company. P.O. Jakobsen: None. N. Ejskjaer: None.

Funding
Region of Northern Denmark; Danish National Health Data Board
756-P: Socioeconomic and Self-Management Factors Do Not Explain Racial/Ethnic Disparities in Advanced Diabetes Technology Use among Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: AGARWAL SHIVANI , SCHECHTER CLYDE , GONZALEZ JEFFREY S. , LONG JUDITH A. 
Published: June 2020

Recent studies demonstrate wide racial/ethnic disparity in insulin pump and continuous glucose monitor (CGM) use in people with T1D. It remains unknown whether socioeconomic status (SES) or other factors drive disparities. We recruited 300 diverse YA with T1D from 6 diabetes centers across the U.S. (ages 18-28; 33% non-Hispanic White, 32% non-Hispanic Black, 34% Hispanic; 52% public/no insurance; median A1c 9.2%). We used logistic regression to examine how patient-reported and chart-extracted variables, including multiple socioeconomic and individual-level factors, accounted for racial/ethnic disparity in current pump or ever CGM use. Compared with White YA (71/72%), both Black (18/28%) and Hispanic (37/39%) YA had significantly lower pump and CGM use, respectively (p&lt;0.001). Pump and CGM users were more likely to have lower A1c levels, higher attained education, greater household income, lower neighborhood poverty, private insurance, higher diabetes numeracy and literacy, and receive care in a pediatric or combined pediatric-adult center (p&lt;0.001). They were also more likely to report frequent self-monitoring of blood glucose and diabetes medical visit attendance (p&lt;0.001). Full adjustment for these multiple SES, self-management, and care factors did little to explain racial/ethnic disparity. Compared with White YA, Black and Hispanic YA had persistent 50-80% lower odds of insulin pump use and Black YA had 70% lower odds of CGM use (OR (95% CI) Pump: Black 0.125 (0.050, 0.313), Hispanic 0.427 (0.176, 1.035); CGM: Black 0.291 (0.121, 0.702)). In contrast, these variables accounted for more of the CGM disparity between White and Hispanic YA (OR (95% CI) 1.007 (0.409, 2.483)). Exploration of factors other than SES and self-management is needed to examine disparity in diabetes technology use, especially in Black YA. Black and Hispanic YA preferences for technology and provider factors should be considered.

Disclosure
S. Agarwal: None. C. Schechter: None. J.S. Gonzalez: None. J.A. Long: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)
759-P: Telephonic Coaching Is Associated with Improved Glycemic Control in Many Individuals with Type 1 and Type 2 Diabetes
Authors: BIGGS WILLIAM C. , BUSKIRK ANN , BORSA LENA , LYDEN MAUREEN R. , PARKIN CHRISTOPHER , PETERSEN BETTINA 
Published: June 2020

Coordinated health coaching is associated with improved diabetes outcomes with lower cost vs. traditional diabetes management. Diabetes Health Partnership (DHP) is a telephonic coaching program designed to empower individuals with diabetes. This 12-month, observational, self-controlled multi-site study combined retrospective (6 mth pre-baseline) and prospective (6 mth post-baseline) data to assess the impact of the DHP program on A1C among 57 individuals with type 1 and type 2 diabetes. Mean change from baseline A1C (8.4±1.1%) was significant (-0.5 ± 0.9%, &lt;0.0001) within the full cohort (n=54) but notable differences in A1C between Responders (n=27, ≥0.5% reduction) vs. Non-Responders (n=27, &lt;0.5% reduction) were observed (Figure 1), with comparable medication changes with the exception of insulin. Differences in A1C between Responders and Non-Responders may be explained by a combination of differences in baseline A1C (8.5 ± 0.8% vs. 8.3 ± 1.2%), baseline body weight (191.2 ± 36.6 lbs vs. 201 ± 42.9 lbs) and change in body weight (-5.0 ± 10.1 lbs vs. 0.6 ± 6.7 lbs). Notably more Responders than Non-Responders had &gt;3 coaching sessions focused on diet/nutrition (9 vs. 3, respectively). Participation in the DHP program was associated with clinically-significant improvements in glycemic control in many individuals with suboptimally controlled diabetes.

Disclosure
W.C. Biggs: Consultant; Self; Roche Diabetes Care. Research Support; Self; Dexcom, Inc., Gan & Lee Pharmaceuticals, Mylan, Novo Nordisk A/S, Sanofi US. A. Buskirk: Employee; Self; Roche Diabetes Care. L. Borsa: None. M.R. Lyden: None. C. Parkin: Consultant; Self; Abbott, CeQur Corporation, Dexcom, Inc., DreaMed Diabetes, Novo Nordisk Inc., Onduo, Roche Diabetes Care, Valeritas, Inc. B. Petersen: Employee; Self; Roche Diabetes Care.
762-P: High Hypoglycemia Self-Confidence Is Related to Better Glycemic Control and Low Diabetes Distress Levels in a Brazilian Sample of T1D Adults from Public and Private Diabetes Clinics
Authors: KOELLE MARIA B. , PASTORE ANDREIA , PAVIN ELIZABETH J. , SILVEIRA MÔNICA S.V. 
Published: June 2020

Keeping blood glucose levels within 70% in range 70-180 mg/dl and HbA1c &lt; 7% are the main treatment goals for T1D patients. Recent studies have shown that hypoglycemia self-confidence (HC) has a major impact on self-care and diabetes outcomes and several studies demonstrated that diabetes-distress (DD) negatively affects glycemic control. This study aimed: 1- to measure HC and DD scores in T1D patients, and 2- to determine the association among HC, DD and glycemic control in a sample of T1D adults followed at the State University of Campinas and in a private diabetes clinic in Campinas, Brazil. In a cross-sectional study, 66 T1D adults were evaluated. Inclusion criteria were age &gt;18 and diagnosis of T1D &gt; 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders, and severe diabetes-related complications. The Hypoglycemia Self-Confidence Scale (HCS), assessed HC, and Type One Diabetes Distress Scale (T1DDS), assessed DD. Metabolic control was evaluated by HbA1c. Severe hypoglycemia and ketoacidosis episodes were obtained through interview and from medical records. Sixty-two percent were female, aged 35.33 ± 11.07 years, time of T1D: 21.21 ± 11.02 years, schooling: 15.24 ± 3.83 years. The mean HbA1c was 8.29% ± 1.32%. Thirty-three percent reported severe hypoglycemia and 19.70% had ketoacidosis in the last 12 months. T1DDS score was 2.39 ± 0.90, indicating clinically relevant distress and the HCS score was 2.97 ± 0.66, demonstrating moderate hypoglycemia self-confidence. HCS was significantly associated with HbA1c, DD, and masculine gender (p&lt;0.05). High HC is related to less DD and low HbA1c. Strategies to improve HC may contribute to improve glycemic control and to decrease psychological suffering in T1D patients.

Disclosure
M.B. Koelle: None. A. Pastore: None. E.J. Pavin: None. M.S.V. Silveira: None.