bluuebunny/crossref_metadata_2025_split huggingface dataset:
623-P: Phone-Based Diabetes Education Improves Diabetes Knowledge and Patient–Provider Conversations
Authors: WOOLLEY RYAN , WHITE ZACHARY , ROBINSON SHAMERA , MANDELSON JO , MUELLER KELLY 
Published: June 2020

Diabetes education and support has been shown to effectively improve health outcomes among people with type 2 diabetes (PWD). However, PWD report limited time with healthcare providers (HCPs) to have meaningful discussions about diabetes management and prevention of complications. Less than half of PWD have ever had a conversation with their HCP about their increased risk for heart attack and stroke. In addition, evidenced-based diabetes self-management education and support programs (DSMES) are considerably underutilized. A phone-based education series was created to connect PWD across the country with a new diabetes expert each month. Through the platform, listeners can ask their questions, hear the questions of others, and receive live responses. The program aims to increase knowledge of diabetes management, improve patient-provider conversations, and drive enrollment into DSMES. To assess the program’s impact, phone-based surveys were conducted one day prior to events, immediately following, and one-month post events. From November 2018 to November 2019, each event averaged 509 participants, with over 2,700 unique participants across all events. Wilcoxon signed-rank tests were performed to determine paired differences. Across events, diabetes-related knowledge increased 12% on average from before events to after events. Within a month following the program, 14% more participants had a conversation with their HCPs about the link between heart disease and diabetes. In addition, the percent of participants who enrolled in DSMES increased 10%. The evidence demonstrates that a phone-based platform provides an effective avenue for increasing diabetes knowledge and empowering PWD to have better conversations with their HCPs. The platform can serve as an important resource for reaching populations that face barriers in access to diabetes care and support. Short recordings from the live events are created into a free podcast series, further expanding program reach.

Disclosure
R. Woolley: Employee; Self; American Diabetes Association. Z. White: Employee; Self; American Diabetes Association. S. Robinson: Employee; Self; American Diabetes Association. J. Mandelson: Employee; Self; American Diabetes Association. K. Mueller: None.
627-P: Online CME Improves Knowledge and Understanding of CVOT Data for T2D Therapies
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE 
Published: June 2020

We sought to determine if online continuing medical education (CME) could improve the knowledge and confidence of multiple specialties related to CVOT data for T2D therapies. The CME activity was a 30-minute online video panel discussion. A repeated pairs pre-/post-assessment study design and chi-square test (P &lt;.05 is considered significant) assessed educational effect. The activity launched June 28, 2019 and data were collected through July 31, 2019. In total, 723 PCPs, 97 D/Es, and 130 cardiologists were included in the analysis. Overall, there were knowledge and confidence improvements seen among all groups from pre- to post-assessment: • 16% of PCPs (P=.06), 19% of D/Es (P=.24), and 26% (P&lt;.01) of cardiologists improved at identifying differences between CVOT patient populations • 25% of PCPs (P&lt;.001), 19% of D/Es (P=.19), and 20% (P&lt;.05) of cardiologists improved at recognizing nuances of CVOT patient populations of an ongoing CVOT that can assist in applying the data when available • 43% of PCPs, 37% of D/Es, and 42% of cardiologists reported increased confidence in understanding CVOT data Continued educational gaps: • 41% of PCPs, 39% of D/Es, and 37% of cardiologists failed to identify nuances of a CVOT patient population • 32% of PCPs, 20% of D/Es, and 28% of cardiologists failed to recognize guideline-based treatment recommendations based on CVOT data • 41% of PCPs, 39% of D/Es, and 37% of cardiologists failed to identify nuances of a CVOT patient population
This study demonstrates the success of online CME on improving knowledge and confidence of a multi-specialty group on CVOT data. Continued gaps were identified for future educational targets.

Disclosure
A. Larkin: None. J. Schrand: None. A. Le: None.

Funding
Merck & Co., Inc.
629-P: Factors Associated with Self-Management among Nepalese Adults with Type 2 Diabetes
Authors: SHRESTHA MONIKA , NG ASHLEY , GRAY RICHARD J. 
Published: June 2020

Background: Diabetes is a global public health problem. Optimal diabetes self-management is associated with decreased diabetes-related complications and improved glycemic control.
Objective: To identify the factors associated with diabetes self-management among adults with type 2 diabetes.
Methods: A hospital-based cross-sectional study was conducted among 384 adults with type 2 diabetes attending their routine outpatient appointment at Tribhuvan University Teaching Hospital in Nepal. Data was collected via face-face interviews and a medical record review. Self-management was measured using the Summary of Diabetes Self-Care Activities (SDSCA). A series of structured questionnaires were used to measure sociodemographic, clinical factors, social support, self-efficacy and depression. Multiple linear regression analysis with backward elimination method was used to assess factors associated with self-management.
Results: The participants’ mean score for diabetes self-management was 3.3 ± 1.3 on a mean range of 0 to 7. Multiple linear regression analysis showed that low (β= -0.984, 95% CI: -1.313, -0.656) and moderate perceived social support (β = -0.702, 95% CI: -0.991, -0.412), low or moderate self-efficacy (β = -0.515, 95% CI: -0.912, -0.118), rural residence (β = -0.484, 95% CI: -0.791, -0.177), poor glycemic control (β = -0.265, 95% CI: -0.504, -0.027) and presence of any diabetes complication (β = -0.248, 95% CI: -0.490, -0.006) significantly lowered the level of self-management, after adjusting for age, educational status, marital status, comorbidity, family history of diabetes, BMI, diabetes knowledge, alcohol consumption and depression.
Conclusion: The diabetes education programs should use strategies that enhance self-efficacy of people with diabetes. People with type 2 diabetes from rural areas, with diabetes complications, impaired glucose control and poor social support may need special attention from health professionals to improve their self-management.

Disclosure
M. Shrestha: None. A. Ng: Consultant; Self; Roche Diabetes Care, Ypsomed AG. R.J. Gray: None.
63-LB: Self-Reported Adherence among Cardiac Surgery Patients with Diabetes Mellitus
Authors: VELA ALYSSA , CARROLL ALLISON J. , MCCARTHY PATRICK , OSTERMAN GAIL , GRADY KATHLEEN , FEINGOLD KIM 
Published: June 2020

Successful cardiac surgery and recovery typically requires significant treatment adherence. For adults who undergo cardiac surgery and have diabetes mellitus (DM), the complex nature of behavior adherence is unique and especially demanding. Thus, we hypothesized that cardiac surgery patients with comorbid DM (CSDM) would report poorer treatment adherence than cardiac surgery patients without DM (CS).
In this secondary data analysis, we assessed self-reported adherence (diet, medications, appointments) among CSDM (N=51) and CS (N=240) pre- and 3 months post-operatively. Participants were predominately male (64%), middle aged (M=63, SD=14), and presented for valve (N=137), coronary artery bypass graft (CABG; N=42), valve + CABG (N=57), or another cardiac (N=55) surgeries. Chi-square analyses assessed differences in self-reported adherence (adherent/not adherent/not applicable) by DM diagnosis (yes/no). Pre-operatively, CSDM were more likely to endorse that following any specific diet was applicable to them (70% vs. 50%), yet reported higher rates of dietary nonadherence (42%) than CS (29%), x2(2)=7.2, p=.027. Rates of medication (p=.420) or appointment (p=.875) adherence did not differ by DM diagnosis. At follow-up, a greater proportion of participants reported that dietary adherence was applicable to them (CSDM: 94%; CS: 74%), still with greater rates of non-adherence for CSDM (81%) compared to CS (55%), x2(2)=7.7, p=.021. Medication adherence (p=.570) and appointment attendance (p=.054) did not differ between groups.
In this sample, CSDM seemed more aware of the importance of healthy diet, but were less likely to adhere to a diet (low sugar, sodium) than CS. This pattern may be due to greater awareness of dietary restrictions among patients with DM, as well as additional burden. Cardiac surgery patients with comorbid DM may benefit from additional support from dieticians and psychologists to address the complex psychosocial nature of dietary adherence in comorbid health conditions.

Disclosure
A. Vela: None. A.J. Carroll: None. P. McCarthy: None. G. Osterman: None. K. Grady: None. K. Feingold: None.
632-P: Challenges and Opportunities for Patient-Centered DSME/S for Older Adults: Finding the Key to the Patient Portal
Authors: KIM MIN , KHAN UZMA Z. , BOREN SUZANNE A. , YE QING , SIMOES EDUARDO J. 
Published: June 2020

Mobile apps, patient portals, and EHRs are promising tools to enhance recommended behaviors for DM. This study reports whether these technologies could effectively deliver patient-centered DSME/S for older people with DM.
We analyzed 179 of 1050 DM apps according to AADE7 self-care principles. Most DM apps included features of Monitoring (73%). Few apps supported Healthy Coping (9%), an essential principle for older adults with DM challenged with comorbid conditions. In addition, two focus groups (n=10, mean age=67) revealed a low usability score: 48/100. Participants had trouble using the apps due to poor navigation, visual and physical limitations.
We also analyzed 200 visit notes randomly selected from 2634 notes of adults with DM from an EHR that provides access to clinic notes via a patient portal. Notes were written at Flesch Kincaid level 9.6. Using AADE7 principles, we conducted a thematic analysis to determine patterns of DSME/S information. Out of 3735 codes, Monitoring (48%) was addressed most frequently, possibly due to insurance requirements. Healthy Coping (2%) was addressed least frequently, possibly due to time constraints. Generalized linear mixed models revealed no significant associations between DSME/S delivered and patient demographic/DM control measures. Many patients shared data about glycemic control (88%) and had active patient accounts (50%) allowing access to clinical data.
Our study shows that features and content of DM apps are not ideal for older adults. We found that patient notes in EHR were above NIH recommended readability levels (6th grade) and many older adults may not understand key points. We did find that older people have access to patient portals, and share information with providers. Patient portals are increasingly available through EHR. User-centered design process should be employed for patient-centered DSME/S to facilitate usability, readability, and information sharing through patient portals for older people with DM.

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

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092950)
638-P: Using Contact-Based Education to Improve Diabetes-Related Stigma among Medical Residents in a Military Health System
Authors: WAN WINGYEE , WARDIAN JANA L. 
Published: June 2020

Introduction: Healthcare provider-related stigma against patients with diabetes is related to worse doctor-patient relationships and may contribute to worse patient self-care. A previous feasibility study showed benefit in using a contact-based education approach to improve attitudes of medical students towards patients with diabetes. This study evaluated how diabetes-related stigma of internal medicine residents in a military health system was affected by a one-hour panel of people who have personal experience with diabetes.
Methods: Panel participants included a woman with two sons who have type 1 diabetes, an active duty male soldier diagnosed with type 2 diabetes, and a veteran with type 2 diabetes. Patients were asked to discuss their personal experiences with diabetes, common misconceptions regarding diabetes, and what they wish healthcare providers understood about diabetes. The validated Diabetes Attitude Scale-3 (DAS-3) questionnaire, which assesses diabetes-related attitudes based on a 5-point Likert scale (strongly agree = 5, strongly disagree = 1), was given before and after the panel. The survey also included a short-answer section to elicit individual opinions on diabetes-related stigma. Survey responses were linked with 3 identifier questions to preserve anonymity.
Results: Twelve participants completed both the pre- and post-panel survey. Seven were female (58%), 10 were white (83%), and 8 were from suburban communities (67%). Out of the 33 questions on the DAS-3 questionnaire, there were statistically significant changes regarding the belief that “diabetes affects almost every part of a diabetic person’s life” (mean increased from 4.33 to 4.92, p=0.012) and that “the important decisions regarding daily diabetes care should be made by the person with diabetes” (mean increased from 4.08 to 4.67, p= 0.046).
Conclusion: Contact-based education can be considered as a tool for reducing diabetes-related stigma among medical trainees.

Disclosure
W. Wan: None. J.L. Wardian: None.
641-P: Relative Contribution of Individual, Community, and Health System Factors on Glycemic Control among Inner-City African Americans with Type 2 Diabetes
Authors: CAMPBELL JENNIFER A. , EGEDE LEONARD E. 
Published: June 2020

Background: Health disparities are disproportionately impacting inner-city African Americans, however limited information exists on the contribution of individual, community, and health system barriers on diabetes outcomes.
Methods: A cross-sectional study collected primary data from 241 inner-city African Americans with type 2 diabetes. A theoretical model was used to specify measurements across the individual level, such as age and comorbidities, community level, such as neighborhood factors and support, and health systems level such as access, trust, and provider communication. Based on current best practices, four regression approaches were used: sequential, stepwise with forward selection, stepwise with backward selection, and all possible subsets. Variables were entered in blocks based on the theoretical framework in the order of individual, community, and health systems factors and regressed against HbA1c.
Results: In the final adjusted model across all four approaches, individual level factors like age (β=-0.05; p&lt;0.001); having 1-3 comorbidities (β=-2.03; p&lt;0.05) having 4-9 comorbidities (β=-2.49; p=0.001) were associated with lower glycemic control. Similarly, male sex (β=0.58; p&lt;0.05), being married (β=1.16; p=0.001), and overweight/obesity (β=1.25; p&lt;0.01) were associated with higher glycemic control. However, community and health system level factors were not significantly associated with glycemic control.
Conclusion: Individual level factors are key drivers of glycemic control among inner-city African Americans. These factors should be targeted for intervention development and delivery. Further research is needed to examine the indirect pathways via community and health system factors that may explain the relationships with glycemic control.

Disclosure
J.A. Campbell: None. L.E. Egede: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861 to L.E.E.)
657-P: The National Diabetes Prevention Program: Does Start Date Matter?
Authors: ELY ELIZABETH , BELL MIRIAM 
Published: June 2020

The National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations working together to build a nationwide infrastructure to deliver a lifestyle change program proven to prevent or delay onset of type 2 diabetes in adults with prediabetes. Much variability exists in the number of days participants stay in the 12-month program. Of the 217,585 eligible participants enrolled in in-person and online organizations as of October 2019, the average length of stay in the program was 163 days (210 for in-person, 134 for online) with interquartile range of 238 (231 for in-person, 161 for online). The reasons for leaving the program are not collected; only information such as participant demographics, type of program delivery (in-person or online), and date of the first session attended can be assessed. To determine whether retention is related to the time of year a participant enters the program, a seasonal model was applied, where the response variable was the number of days a participant stayed in the program. Separate models were run for all participants, and by sex and delivery mode, to look at the impact of start date on retention. Overall, participants who started the program on day 267 (September) were predicted to stay in the program longest: 178 days (95% CI: 176, 179). The range of predicted days was 137-178. Longest predicted number of days in the program for men and women was 161 (158, 164) and 182 (180,184), respectively, and was also associated with September start dates. In-person participants who started on day 270 (September) were predicted to have the longest stay, 218 (216, 220) with range of 192-218. Estimates for online participants showed a maximum of 142 days (140, 144), which was associated with start dates in June (day 163) and had a range of 128-142. All models predicted that the shortest stay in the program was associated with starting in November. Retention is strongly associated with enrollment timing; this information may be helpful as organizations plan future classes.

Disclosure
E. Ely: None. M. Bell: None.
66-OR: Effect of Time-in-Range over 14 Days on Glycaemic Controls and Hypoglycaemia Unawareness in Patients Using Freestyle Libre
Authors: DESHMUKH HARSHAL , WILMOT EMMA G. , HERRING ROSELLE , PATMORE JANE , SATHYAPALAN THOZHUKAT , RYDER ROBERT E. , WALTON CHRISTOPHER 
Published: June 2020

Objective: Time in range (TIR) is a novel measure of glucose control endorsed by an international consensus group. Given the increased use of FreeStyle Libre (FSL) in the UK, we wanted to investigate the effects of TIR over 14 days of FSL (TIR-14) use on glycaemic control, hypoglycaemia unawareness.
Methods: Clinicians from 101 National Health Service hospitals in the United Kingdom submitted FSL user data, collected during routine clinical care. TIR-14 was defined as the percentage of time the patients with type 1 diabetes spent in the individualised target range of blood sugar which ranged from 3.9 to 10 mmol/L(70-180mg/dl) over 14 days of FSL use. TIR-14 was divided into two categories &lt;= 50%, (Group 1) and TIR-14&gt;50% (Group 2). T-tests were used to compare the baseline and follow-up HbA1c, and GOLD score in the two groups.
Results: Data were available for 10,370 FSL users; age 38 (±18.7) years, 54% female, diabetes duration 16 (±49) years, and BMI of 25.2 (±16.5) kg/m2. TIR-14 data was available for 2191 patients who had at least one follow-up (1422 in Group 1 and 769 in Group 2). There were large variations in the individualised target TIR-14; however, more than 99% of patients had ranges in-between 3.9-10 mmol/mol with a median TIR-14 of 43%(27%-56%). The mean follow-up period was 7.6(±23) months. In Group 1 HbA1c dropped from 8.6% to 7.6% (P&lt;0.0001) while in Group 2 the HbA1c dropped from 7.6% to 7%. (P&lt;0.0001). In an analysis restricted to those with baseline HbA1c of &gt;8.5%, HbA1c dropped from 9.8% to 8.8% (P&lt;0.0001) in Group 1 while in Group 2 it fell from 9.6% to 7.7% (P&lt;0.0001). In the Group I the GOLD score fell by 0.25 (P=0.0005) units while in Group II the GOLD score fell by 0.45 units (P&lt;0.0001).
Conclusion: This population-based study of FSL users demonstrates that TIR-14 of more than 50% is associated with a significantly improved glycaemic control in especially in those with higher baseline HbA1c and is associated with a larger improvement in hypoglycaemia unawareness.

Disclosure
H. Deshmukh: None. E.G. Wilmot: Advisory Panel; Self; Abbott, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic. Speaker’s Bureau; Self; Abbott, Eli Lilly and Company, Insulet Corporation, Novo Nordisk Inc., Sanofi. R. Herring: None. J. Patmore: None. T. Sathyapalan: Research Support; Self; Amgen, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S. Other Relationship; Self; Ipsen Biopharmaceuticals. R.E. Ryder: Consultant; Self; GI Dynamics Inc. Other Relationship; Self; Novo Nordisk A/S. C. Walton: Speaker’s Bureau; Spouse/Partner; Celgene, LEO Pharma, Novartis Pharmaceuticals Corporation.
661-P: Do Diabetes Apps Deal with Blood Pressure; Do Blood Pressure Apps Deal with Diabetes?
Authors: WU GLORIA , WONG JONATHAN , LAU CHAP-KAY K. , MOMEN DONIA , ROTTENBORN REBECCA 
Published: June 2020

Background: Diabetic patients have high blood pressure and conversely, hypertensive patients have diabetes. Do eHealth apps meet the needs of these patients?
Purpose: Do Diabetes apps ask about blood pressure and do hypertension apps ask about diabetes parameters?
Methods: Using the search term “diabetes,” and “blood pressure” (BP), Google Play Store (Droid) and Apple App Store (iOS) were accessed for the most downloaded, free DM and BP mobile apps. Inclusion criteria: 1) downloads &gt; 100,000 for Droid and ratings &gt; 50 for iOS, 2) free. Diabetes apps were evaluated: DSMES, and ACC/AHA guidelines (120/80 mm Hg). BP apps: BP log, ACC/AHA guidelines, weight, height, BMI, medication log, and DSMES. Exclusion criteria: Apps with no data on downloads or rankings.
Results:

0/20 diabetes apps had correct ACC guidelines, 0/20 diabetes apps had podiatry guidelines. Of the 20 HTN apps, on average 3.6/11 DSME criteria were mentioned. 5/20 BP apps had medication log vs. 14/20 in DM apps. Both Droid and iOS apps are similar in the number of features offered.
Conclusion: Diabetes apps follow the DSMES guidelines more often than the Blood Pressure apps following the ACC/AHA guidelines. There is room for improvement for eHealth apps in the management of diabetes and hypertension.

Disclosure
G. Wu: None. J. Wong: None. C.K. Lau: None. D. Momen: None. R. Rottenborn: None.