bluuebunny/crossref_metadata_2025_split huggingface dataset:
768-P: Perceived Burdens and Benefits Associated with Continuous Glucose Monitor Use in Type 1 Diabetes
Authors: DIVAN VIDITA , GREENFIELD MARGARET , MORLEY CHRISTOPHER P. , WEINSTOCK RUTH S. 
Published: June 2020

Objective: To describe perceived burdens and benefits of continuous glucose monitor (CGM) use in CGM non-users vs. users with type 1 diabetes across the lifespan.
Research Design and Methods: The Burdens of CGM (BurCGM) and Benefit of CGM (BenCGM) questionnaires were completed at clinic visits from Feb 2019 to Nov 2019. Mean scores were calculated (scale 1-5; higher score reflects greater perceived burdens and benefits). Data collected from medical records included demographic information, CGM and insulin pump use, and HbA1c within 3 months of the visit.
Results: Participant characteristics (n=1143) and the 3 most common perceived CGM burdens (in non-CGM users) and benefits (in non-CGM users and CGM users) are shown in the Table. Individuals using real time (RT) and non-RT CGM described more benefits (mean scores 34.9 and 34.0) when compared to those who never used CGM (mean score 30.2) (p&lt;.001). There were no differences in burdens or benefits by sex or race. Mean HbA1C was lower in CGM users (8.2%) vs. non-CGM users (mean A1c 9.3%; p&lt;.001); 47.4% of non-CGM users vs. 29.3% of RT-CGM users and 30.6% of non-RT-CGM users had A1c&gt;9.0%.
Conclusions: Cost is a barrier to CGM use, particularly in adults. In non-CGM users (vs. users), CGM was perceived as having less benefit and to be associated with pain and concern that readings cannot be trusted. Advocacy (for lower cost) and education are needed to address these barriers.

Disclosure
V. Divan: None. M. Greenfield: None. C.P. Morley: 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
Type 1 Diabetes Exchange QI Learning Collaborative
769-P: Diabetes Distress Screening in an Academic Young Adult Diabetes Transition Program
Authors: RODEMAN KATHRYN , RAO AMITH , KONIGSBERG ANNA , ANG LYNN , THOMAS INAS H. , SOLEIMANPOUR SCOTT , IYENGAR JENNIFER J. 
Published: June 2020

Background: The transition from pediatric to adult care is a high risk time for young adults with diabetes associated with poor glycemic control and psychosocial challenges. However, little is known about how to prospectively identify patients most at risk during transition. Thus, we screened young adults for diabetes distress as part of a multidisciplinary diabetes transition program and identified correlations between distress and patient outcomes.
Methods: Diabetes distress was measured during enrollment in the Michigan Medicine Diabetes Transition Program (MMDTP) using the Problem Areas in Diabetes (PAID) questionnaire, a validated diabetes distress screening tool. Patients with high distress were referred to the program social worker. We performed a retrospective chart review on MMDTP participants who were screened from 7/2017 to 12/2018.
Results: Fifty-eight young adults (age 17-23 years) completed distress screening, with PAID scores ranging from 0 to 82.5 (median 11.9). 13.8% of patients had high distress (PAID&gt;40). Mean HbA1c prior to transition was 9.7 ± 2.3% and did not correlate with PAID scores nor did distress correlate with insulin pump or continuous glucose monitor use. Among 48 patients &gt;1 year from first adult endocrine visit, those attending at least 3 visits in the first year (n=35) had lower median PAID scores than those attending 2 or fewer visits (10.0 vs. 26.2, p=0.02). Those attending at least 3 visits also had significantly lower mean HbA1c prior to transition (9.0% vs. 12.2%, p&lt;0.01).
Discussion: Here we report the successful implementation of diabetes distress screening for young adults during the transition to adult care. While distress scores were lower than anticipated based on prior studies, we still found 13.8% of our patients had high distress levels. High distress and HbA1c levels at program entry both correlated with reduced visit frequency in the first year post-transition. Future interventions will aim to improve clinic attendance in patients with high distress.

Disclosure
K. Rodeman: None. A. Rao: None. A. Konigsberg: None. L. Ang: None. I.H. Thomas: None. S. Soleimanpour: None. J.J. Iyengar: None.
773-P: A Sleep Intervention to Improve Sleep Duration and Variability, Glucose, and Distress in Adults with Type 1 Diabetes
Authors: MARTYN-NEMETH PAMELA , REUTRAKUL SIRIMON , DUFFECY JENNIFER , QUINN LAURIE T. , STEFFEN ALANA D. 
Published: June 2020

Despite improvements in treatment regimens and technology, less than 20% of adults with type 1 diabetes (T1D) achieve glycemic targets. Sleep variability (variability in sleep duration) and insufficient sleep duration may adversely affect glycemic control, diabetes distress, and mood. This 8-week pilot RCT aimed to determine if a sleep intervention (Sleep Opt) would improve sleep variability and duration, glucose (A1C, time-in-range (TIR), glycemic variability), and patient-reported outcomes compared to an attention control intervention in adults with T1D.
Methods: Eight T1D subjects with inadequate (sleep duration &lt; 6.5 hr) or irregular sleep (standard deviation, SD, of sleep duration ≥1 hour) were randomized to Sleep Opt (n=5) or attention control (n=3) groups. Sleep Opt included use of a Fitbit, weekly digital content, interactive tools, and weekly coach delivered feedback, targeting insufficient and irregular sleep behavior. Sleep recording (7-day actigraphy) and continuous glucose monitoring (Abbott FreeStyle Libre®), questionnaires and A1C were performed at baseline and week 8.
Results: Sleep duration and A1C improved in both groups (Sleep duration: Sleep Opt +7 minutes vs. control +25 minutes, A1C: Sleep Opt -0.085% vs. control -0.9%). Glycemic variability (CV%) and TIR improved in the Sleep-Opt vs. control group (%CV -3.2 vs. +0.32, TIR +7.0% vs. -5.7%) respectively. Sleep regularity (SD of midsleep time) improved in Sleep Opt vs. control group (-26 vs. +1 minute). Fatigue, depressed mood and diabetes distress had a greater improvement in Sleep Opt vs. control group.
Conclusion: This pilot study provides preliminary evidence that the Sleep-Opt intervention improved sleep, glucose parameters and important patient-reported variables. Larger studies and more scalable intervention should be explored as means to improve sleep and glycemic control in T1D with inadequate or irregular sleep.

Disclosure
P. Martyn-Nemeth: None. S. Reutrakul: None. J. Duffecy: Consultant; Self; Kitchry Health. L.T. Quinn: None. A.D. Steffen: None.

Funding
Chicago Center for Diabetes Translation Research; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092949)
774-P: Fully Integrated Medical and Psychological Intervention for T1D Self-Management in Adolescents: Trial Design and Baseline Characteristics
Authors: ODONNELL HOLLY , ALONSO GUY T. , GOMER TARA , MAJIDI SHIDEH , SNELL-BERGEON JANET K. , REZNICK-LIPINA TYLER , WADWA R. PAUL , DRISCOLL KIMBERLY A. 
Published: June 2020

There is an urgent need to address medical and psychosocial needs of adolescents with T1D. Baseline sample characteristics and study progress data are presented from a combined in-person/telehealth RCT using multiphasic optimization strategy (2x2 factorial design) to improve A1C in 10-17 yr olds (≥1 A1C 9-12% in prior yr). During Phase 1, 88 adolescents (target N=100) with T1D (Mage=14.5 yrs; 50% female; 79.5% White, 10.2% Hispanic; 76.1% insulin pump) were randomized to Enhanced Standard Care (Medical visit only every 6 weeks) or Integrated Medical/Psychology (Enhanced Standard Care+Personalized Adherence Feedback Report). During Phase 2 (6-mo visit; N completed=75) all adolescents are re-randomized to another 6 months of intervention every 6 weeks: Enhanced Standard Care or Integrated Medical/Psychology (Enhanced Standard Care+Problem-Solving). During Phase 3 (12-mo visit; N complete=50), psychology support is withdrawn; participants are randomized to Enhanced Standard Care (Medical visit only every 6 weeks) or Standard Care (Medical visit only every 3 months) for 6 months). Adolescents and caregivers download devices and complete psychosocial questionnaires at visits (Table; no statistically significant group differences). N=25 completed the study (18-month visit) and 5 withdrew (94% retention to date); data collection is ongoing.

Disclosure
H. ODonnell: None. G.T. Alonso: None. T. Gomer: None. S. Majidi: Advisory Panel; Self; Companion Medical. J.K. Snell-Bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. T. Reznick-Lipina: None. R. Wadwa: Advisory Panel; Self; Eli Lilly and Company, Medtronic. Research Support; Self; Dexcom, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk Inc., Tandem Diabetes Care. K.A. Driscoll: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)
778-P: The Impact of Self-Management Blood Glucose (SMBG) Real-Time Decision Support on Glycemic Control in Adult with T1D in China
Authors: LIU ZIYU , WANG CHAOFAN , ZHENG XUEYING , LUO SIHUI , YANG DAIZHI , YAN JINHUA , WENG JIANPING 
Published: June 2020

Objective: To assess the effect of use frequency of SMBG real-time decision support in a diabetes app on glycemic control in adult with T1D.
Methods: T1D users from TangTangQuan® App meeting the following criteria will be selected: physician diagnosed T1D with aged≥18 years old, T1D duration ≥1 year. Frequency of uploading SMBG was be calculated in 2018. Patients were divided into two groups according to frequency of uploading SMBG (high engagement group (HE, ≥15 days/month; and control group&lt;15 days/month). The changes in HbA1c, incidence of hyper- and hypo-glycemia from baseline to 12 months after using app were compared.
Results: Of 3474 users over 1 year, 562 eligible patients had complete set of HbA1c records. At baseline, the mean age was 26.6±7.3 years, 33.5% were male, the mean HbA1c was 6.5±0.9%. Change in HbA1c from baseline improved in the HE group than that in control [-0.3 (-0.6, 0.2) vs. -0.1 (-0.8, 0.5) %, p=0.023]. Furthermore, Incidence of hyperglycemia at 12 months was significantly decrease in HE group than control, while no difference in Hypoglycemia between two groups (Table 1). Engagement intensity was significantly and independently associated with changes in HbA1c after adjustment by multiple regression analysis [-0.4 (-0.7, -0.0), p=0.036].
Conclusions: High engagement in SMBG real-time decision support may benefit for glycemic control in Chinese T1D adult.

Disclosure
Z. Liu: None. C. Wang: None. X. Zheng: None. S. Luo: None. D. Yang: None. J. Yan: None. J. Weng: None.

Funding
National Key Research and Development Program of China (2018YFC1314100)
78-LB: HbA1c Reduction Associated with a FreeStyle Libre System in People with Type 2 Diabetes Not on Bolus Insulin Therapy
Authors: WRIGHT EUGENE , KERR MATTHEW S.D. , REYES IGNACIO J. , NABUTOVSKY YELENA , MILLER EDEN 
Published: June 2020

Continuous glucose monitoring (CGM) in patients with diabetes using intensive insulin therapy has been well established, but there are limited data for CGM in other diabetes populations. We assessed HbA1c changes following a FreeStyle Libre prescription in people with type 2 diabetes (T2D) with poor glycemic control not using bolus insulin. IBM Explorys, a U.S. electronic health record database, was used in this retrospective, observational study. Cohort requirements included: FreeStyle Libre prescription in 2017 Q4-2020 Q1, de novo to CGM, T2D diagnosis, lack of rapid-/short-acting insulin, age &lt;65 years, baseline HbA1c ≥ 8%, and presence of HbA1c data before and after FreeStyle Libre prescription. Baseline HbA1c was defined as the value within 180 days pre-index closest to CGM prescription date and post-CGM HbA1c as the value closest to 180 days post-index and within 60-300 days after CGM prescription. The outcome of the study was change in HbA1c from baseline to post-FreeStyle Libre prescription. The cohort (n=1,183, age 52 (SD 9.2) years, 52% male) had a reduction in HbA1c from 10.16 (SD 1.75) to 8.78 (SD 1.92) (p&lt;0.001). Those starting with higher HbA1c and those on non-insulin therapy saw the greatest reduction. After receiving a prescription for a FreeStyle Libre system, people with T2D, poor glycemic control, and not using bolus insulin had a significant reduction in HbA1c.

Disclosure
E. Wright: Advisory Panel; Self; Abbott, Sanofi. Consultant; Self; Abbott, AstraZeneca, Bayer U.S., Boehringer Ingelheim Pharmaceuticals, Inc., MannKind Corporation, Merck & Co., Inc., Voluntis France. Speaker’s Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes. M.S.D. Kerr: Employee; Self; Abbott. I.J. Reyes: None. Y. Nabutovsky: Employee; Self; Abbott. E. Miller: None.
781-P: Exploring Concerns and Preventative Behaviors Regarding Reproductive Health (RH) Complications in Female Adolescents and Young Adults (AYA) with T1D
Authors: CHARRON-PROCHOWNIK DENISE , FISCHL ANDREA F. , KRALL JODI T. , FINNEY JESSICA , ABUJARADEH HIBA , BECKER DOROTHY J. , DIAZ ANA M. , LIBMAN INGRID 
Published: June 2020

Background: AYA women with T1D are vulnerable to poor glycemic control which could increase their risks of RH complications. ADA recommends starting preconception counseling (PC) at puberty. Purpose to explore concerns for and preventative behaviors regarding RH complications in AYA females with T1D.
Methods: New AYA patients attending a diabetes transition clinic at a pediatric teaching hospital completed a short survey on concerns for diabetes-related complications and preventative actions taken: ranking their concerns on a scale 1=most important to 5=least important from a list of five complications. They identified any actions ever taken to prevent complications by a list of items and an open-ended response. This reports on female participant (n=49; ages 17-22) responses regarding RH complications at baseline prior to any peer-group information sessions. Descriptive analyses were used for quantitative and qualitative data. Open-ended data were clustered and analyzed to identify themes with 2 researchers reaching agreement.
Results: Only 29% of AYA female participants (n=14) ranked RH complications as most important concern (rank of 1) and 12% (n=6) ranked it as important (rank of 2); while 20% (n=10) ranked RH complications as least important (rank of 5). Several participants (n=33) checked off one or more behaviors they have taken to prevent RH complications (e.g., control glucose, discussed family planning with health provider). Themes for ’other preventative actions’ remained broad, “healthy lifestyle” and “self-management.” Almost all (88%; n=29/33) believe RH complications can be prevented.
Conclusion: Less than half of AYA females ranked RH complications as an important concern, which could reflect unawareness. Although most have taken some general preventive actions, enhancing other more specific behaviors to decrease their risks that were not identified could be targeted for future interventions through PC.

Disclosure
D. Charron-Prochownik: None. A.F. Fischl: None. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. J. Finney: None. H. Abujaradeh: None. D.J. Becker: None. A.M. Diaz: None. I. Libman: Consultant; Self; Novo Nordisk A/S.

Funding
David Paul Diabetes Transition Care Research Initiative Fund
786-P: Describing and Comparing Mindfulness Practices on Diabetes Self-Management (DSM) and Glycemic Control in Adolescents with T1D
Authors: ABUJARADEH HIBA , CHARRON-PROCHOWNIK DENISE , GALLA BRIAN , SEREIKA SUSAN M. , DINARDO MONICA , FEELEY CHRISTINE A. , VISWANATHAN PUSHPA 
Published: June 2020

Adolescents with T1D often experience stress leading to poor DSM and suboptimal glycemic control. Mindfulness, as a trait or learned skill, is a protective factor against stress and is associated with positive wellbeing. Yet, little is known about mindfulness in adolescents with T1D. This study describes self-reported mindfulness practices and compares mindfulness on DSM and A1c in adolescents with T1D. Adolescents (12-18 yrs) completed questions on mindfulness practices [having mindfulness experience (yes vs. no), types, and duration] and a valid measure of DSM (Self-care Inventory) during routine diabetes clinic. A1c was obtained from medical record. Data were analyzed using descriptive analyses and group comparative analyses were used to examine the association between mindfulness experiences, type and duration on DSM and A1c.
Adolescents (n=128) were 59% male, 88% white, on average 15±2 yrs of age, mean diabetes duration of 7±4 yrs, mean moderate level of DSM of 57±8 (range:15-75), and A1c of 8.3±1.6%. About one third (30%; n=38) reported having mindfulness experience with 23 (61%) being formal (e.g., breathing, body scan, mindful meditation, mindful yoga); 19 (50%) being non formal (e.g., mindful walking); and 4 (11%) being religious. Almost half (45%, n=17) reported practicing mindfulness for &lt; 3 mos, 5 (13%) for (3 - 12 mos), and 16 (42%) for &gt; 1 yr. Several participants (n=8, 21%) reported using mindfulness mobile apps (e.g., Headspace, Calm, Pokémon Go) or YouTube. Adolescents with more than one type of mindfulness practice (e.g., formal with non formal or religious) and those with religious experience reported better DSM than those with one type of mindfulness practice [F(3, 34)= 5.2, p=0.005].
About a third adolescents have been exposed to some mindfulness practices. DSM was better among participants who reported practicing more than one type of mindfulness. Introducing mindfulness training tailored to adolescents with T1D could be beneficial.

Disclosure
H. Abujaradeh: None. D. Charron-Prochownik: None. B. Galla: None. S.M. Sereika: None. M. DiNardo: None. C.A. Feeley: None. P. Viswanathan: None.

Funding
National Association of Pediatric Nurse Practitioners; Sigma Eta Chapter; University of Pittsburgh School of Nursing
787-P: Mental Health Discussions during Routine Diabetes Care Visits with Adolescents and Young Adults
Authors: MONAGHAN MAUREEN , WONG CONNIE , POLYAKOV DIANE L. , ROSE MEREDITH 
Published: June 2020

Background: Adolescents and young adults (AYAs) with T1D are at risk for elevated depressive symptoms. Health care providers (HCPs) are in a unique position to discuss mental health (MH) and T1D self-care during routine diabetes medical visits.
Objective: Evaluate the frequency and content of MH discussions during medical visits.
Methods: Data were drawn from a longitudinal study of AYA-HCP communication and T1D care. Secondary analyses include evaluation of 108 medical visits (M duration=22.5 min; n=8 HCPs) with 33 AYAs with T1D (48.5% male; 45.5% non-Hispanic White; M age=17.5±1.1 yrs; M clinic visits=3.27). 22 AYAs self-reported elevated depressive symptoms using the Center for Epidemiologic Studies-Depression scale (M CES-D score=22.6±8.3); a matched sample of 11 AYAs without elevated depressive symptoms was selected for comparison (M CES-D score=5.7±3.9). Medical visits were audio-recorded, transcribed, and coded by trained coders to identify and characterize MH discussions.
Results: Coding of transcripts identified 43/108 medical visits (39.8%) with ≥ 1 MH discussion. AYAs with elevated depressive symptoms were as likely to have a MH discussion (42.6%) as AYAs without elevated depressive symptoms (35.0%; p=.43); the elevated group had 2.48 distinct MH conversations/visit compared to 1.64 distinct MH conversations/visit for the non-elevated group (p=.10). MH discussions were initiated most often by HCPs (67.4%), followed by AYAs (23.3%) and parents (9.3%). MH resources were provided in 60.5% of all visits with MH discussion, including: referral for MH services (76.9%), general MH education (30.8%), and recommendation to continue current MH services (26.9%).
Discussion: MH content is commonly discussed in routine T1D care. Results suggest a need to increase HCP-delivered resources for AYAs with MH concerns. Evaluation of MH discussions can improve the quality of AYA-HCP communication around MH symptoms and, ultimately, improve diabetes care.

Disclosure
M. Monaghan: Research Support; Self; American Diabetes Association. C. Wong: None. D.L. Polyakov: None. M. Rose: None.

Funding
American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.); National Institutes of Health (R03DK110259)
788-P: “That’s How You Connect with Someone”: Preferences of Minority Young Adults (YA) with Type 1 Diabetes (T1D) for In-Person Visits over Telemedicine
Authors: COMMISSARIAT PERSIS V. , CRESPO-RAMOS GLADYS , JANG ALYSSA , AGARWAL SHIVANI 
Published: June 2020

Objective: Telemedicine has gained popularity as an approach to improve health outcomes by enhancing care delivery to vulnerable populations. However, research is lacking on minority patient preferences for telemedicine, to whom these interventions would likely be offered. In this study, we explored opinions of ethnically diverse, underserved YA with T1D on the use of telemedicine videoconferencing for medical visits.
Methods: We conducted semi-structured interviews in 41 YA, ages 18-25, at a major diabetes center in the Bronx, NY. We audio-recorded, transcribed, and coded interviews using content analysis. We achieved thematic saturation.
Results: YA participants (53% female, 96% Black or Hispanic, 88% Medicaid) were 21±2.4 yrs, with T1D duration 11±2.3 yrs and mean HbA1c 9.6±1.2%. We found that the overwhelming majority of participants preferred to meet with their healthcare provider in person. Participants cited 3 major reasons for preference of in-person over telemedicine visits: 1) in-person visits felt more personal; 2) meeting in clinic helped YA feel more focused and accountable for past and future diabetes management (particularly if they liked their provider); and 3) it was easier to communicate diabetes issues person-to-person. Few stated a preference for telemedicine visits, however noted convenience and not having to navigate transportation as benefits. Notably, some participants would consider virtual communication with providers between visits, but preferred standard visits to remain in clinic.
Conclusions: In this sample of ethnically diverse, underserved YA with T1D, telemedicine visits were not well-accepted. Participants suggested that virtual visits would not provide the same comfort and investment in care as in-person visits. Future interventions using telemedicine as a new mode of care delivery in YA with T1D should consider minority patient preferences.

Disclosure
P.V. Commissariat: None. G. Crespo-Ramos: None. A. Jang: None. S. Agarwal: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896 to S.A.), (P30DK036836 to P.V.C.)