bluuebunny/crossref_metadata_2025_split huggingface dataset:
736-P: Diabetes Distress and Depression Are Reduced through Neighborhood Support in Peer Support Program in Shanghai
Authors: FISHER EDWIN B. , QIAN YIQING , TANG PATRICK Y. , LIU YUEXING , COUFAL MUCHIEH M. , JIA WEIPING 
Published: June 2020

Depression and diabetes distress (DD) are both important features of diabetes in China, as in other countries. A study of Chinese adults with type-2 diabetes, e.g., found 42% prevalence of moderate/high levels of DD. Here we examine whether peer support may increase neighborhood support and whether changes in neighborhood support may be associated with changes in depression and DD in Shanghai. In extension of the Shanghai Integration Model that links specialty/hospital care with primary care, trained volunteer peer leaders (PL) implemented varied supportive activities in 9 Community Health Centers (CHCs). In addition to diabetes education, PLs led activities to increase sense of solidarity among participants, such as walking or dance clubs. Neighborhood support for diabetes management was measured by 8 items (e.g., “other people understand the importance of diabetes management”) in an evaluation sample of 1284 before and after 12 months’ PL activity. Research staff unaware of outcomes rated the number of PLs working from each CHC and the extent to which they led activities and contacted individuals. Combining these ratings, PL activity predicted increased neighborhood support (ß = 0.187, p &lt; 0.001, controlling for baseline neighborhood support, gender, age, education, years with diabetes, and clustering within sites). Increases in neighborhood support in turn were associated with decreased DD and depression (partial correlations = -0.170 and -0.161, ps &lt; 0.001, controlling for gender, etc., baseline neighborhood support and baseline DD and depression, respectively). Neighborhood support may be an important path through which peer support programs reduce DD and depression. Research suggests Chinese individuals with diabetes experience DD in culturally unique ways. Further research might examine how benefits of peer and neighborhood support for DD and depression may also reflect Chinese culture and suggest approaches to tailoring peer support for other cultures.

Disclosure
E.B. Fisher: Research Support; Self; Merck Foundation, Sanofi China. Y. Qian: None. P.Y. Tang: Research Support; Self; Merck Foundation. Y. Liu: None. M.M. Coufal: None. W. Jia: None.

Funding
Shanghai Municipal Grants (GWIV-3.1 to W.J.); Shanghai 6th People’s Hospital (YNLC201812 to Y.L.); Shanghai Municipal Health Commission (20194Y0141 to Y.L.); Merck Foundation; Sanofi China; Michigan Center for Diabetes Translational Research; National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092926)
743-P: Examining the Intersection between Unmet Social Needs, Chronic Disease Comorbidities, and Emergency Room Utilization among Medicaid Beneficiaries with Diabetes
Authors: VERDECIAS NIKO , MCQUEEN AMY , LI LINDA , BADDAM CHANDRA DEEPAK R. , SMITH RACHEL E. , KREUTER MATTHEW 
Published: June 2020

Diabetes self-management (i.e., glucose control, medication adherence, healthy behaviors) is important but challenging, especially among low-income populations. Competing priorities such as social needs (i.e., food, housing, safety, financial) and managing comorbidities adds further burden and may affect healthcare utilization. A large Medicaid managed care plan in Louisiana assessed self-reported social needs among clients with type 2 diabetes from July 2018 - June 2019. We examined the number and pattern of social needs and their association with number of chronic disease comorbidities and emergency room (ER) visits from medical claims data in the 12-months prior to completing the social needs assessment. The sample (n=2902) was mostly female (69.2%), &gt;45 years old (71.2%), Black (61.0%), with ≥1 social need (59.9%; mean= 1.12 ± 1.33; range= 0-8), ≥1 comorbidity in addition to diabetes (97.3%; mean= 3.91 ± 2.14; range= 0-13), and a mean of 4.11 ± 5.83 ER visits. Findings revealed a positive association between social needs and comorbidities (χ2= 32.49; p &lt;0.05); the majority (36.8%) of those with 1 social need (n=929) had 3-4 comorbidities, while the majority (41.2%) of those with ≥2 social needs (n=809) had ≥5 comorbidities. GLM results showed positive associations between social needs (0, 1, ≥2) and ER visits (F=3.74, p=.02) and between comorbidities (0-1, 2-3, ≥4) and ER visits (F=61.17, p&lt;.001) but not the interaction of social needs and comorbidities. Post-hoc Tukey tests showed more ER visits for those with ≥2 social needs vs. 1 need and for those with ≥4 comorbidities vs. fewer. Findings suggest that having ≥2 unmet social needs creates an independent and added burden to the effect of comorbidities on ER utilization. Future research will examine whether addressing unmet social needs among Medicaid beneficiaries with type 2 diabetes and comorbidities can reduce ER utilization and improve health-related outcomes.

Disclosure
N. Verdecias: None. A. McQueen: None. L. Li: None. C.R. Baddam: None. R.E. Smith: None. M. Kreuter: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK115916-01A1)
748-P: Emergency Department Use and Social Vulnerability in Youth with T1D
Authors: HARTMAN ALEXANDRA , WAGNER DAVID V. , JENISCH CELESTE , BARRY-MENKHAUS SAMANTHA A. , LUZOD HANNAH , VAZ LOUISE E. , GOTTFRIED-LEE HANNAH , PHAN DAVID , HARRIS MICHAEL A. 
Published: June 2020

Objective: A subset of youth with T1D are at high risk of preventable acute events, such as DKA, and associated emergency department (ED) visits. Although studies have identified social factors associated with acute utilization risk between all youth with T1D, less is known about how to distinguish such risk amongst those already demonstrating poor health outcomes. This study examines the association between social risk and preventable complications in youth already struggling with self-management.
Methods: Youth (n=50) identified by medical providers as exhibiting chronic self-management difficulties were included in this study. Retrospective chart reviews of the year prior to medical provider referral included number of ED visits and identified social risk factors. Mean youth age was 14.6 years (SD=2.9); 38% were female; 90% were Caucasian.
Results: The relationship between frequency of ED visits and total number of social risks was nonsignificant; however, the presence of specific individual social risks was associated with presence of an ED visit (Table 1).
Conclusions: This is one of the first studies that identified the relationship between social risk and ED utilization in a high-risk pediatric population with T1D. While it is widely understood that social risk is associated with increased utilization, this study identifies key variables that may differentiate youth already at-risk for poor health outcomes.

Disclosure
A. Hartman: None. D.V. Wagner: None. C. Jenisch: None. S.A. Barry-Menkhaus: None. H. Luzod: None. L.E. Vaz: None. H. Gottfried-Lee: None. D. Phan: None. M.A. Harris: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
76-LB: Differences in Time-In-Range, Glycemic Variability, and the Glucose Management Indicator in Pregnant Women with Type 1 (T1D), Type 2 (T2D), and Gestational Diabetes (GDM)
Authors: POLSKY SARIT , LEVY CAROL J. , ZHANG XIAOHE , SHAH SALONI , HAROUSH GAL , NELSON KRISTEN , O’MALLEY GRENYE , OGYAADU SELASSIE J. , BRACKETT SCOTT J. , LEVISTER CAMILLA , CASTORINO KRISTIN N. 
Published: June 2020

Glycemic control varies among different cohorts of pregnant women with diabetes. Most studies examining differences between groups using continuous glucose monitoring (CGM) data were performed with older CGM systems worn for 2-7 days. We examined differences in glycemic control and glycemic variability (GV) between pregnant women (n=32) with T1D (n=20), T2D (n=3), or GDM (n=9) in the 2nd and 3rd trimesters using the Dexcom G6 CGM system, worn for 10 days as part of a pregnancy CGM accuracy trial. Pair-wise comparisons were made between groups and group heterogeneity testing was performed. No adjustments were made for multiple comparisons analyses. Most women required insulin therapy (26/32, 81%). The baseline HbA1C levels were similar between groups (Table). The glucose management indicator (GMI) was numerically similar to HbA1C for the T1D and GDM cohorts. Time spent &gt;140 mg/dL (p=0.009) was highest and time in range (63-140 mg/dL) was lowest (p=0.001) in women with T1D compared to the other groups. The coefficient of variation (CV) and mean amplitude of glycemic excursions (MAGE) were highest in the T1D group, lowest in the GDM group, and intermediate in the T2D group (p&lt;0.0001 for each). Glycemic control was better and GV was lower for pregnant women with T2D and GDM compared to women with T1D. CGM use in pregnancy helps elucidate GV.

Disclosure
S. Polsky: None. C.J. Levy: Consultant; Self; Dexcom, Inc. Employee; Spouse/Partner; Allergan plc. Research Support; Self; Abbott, Dexcom, Inc., Insulet Corporation. X. Zhang: Employee; Self; Dexcom, Inc. S. Shah: Employee; Self; Dexcom, Inc. G. Haroush: None. K. Nelson: None. G. O’Malley: Research Support; Self; Abbott, Dexcom, Inc. S.J. Ogyaadu: None. S.J. Brackett: None. C. Levister: None. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc.

Funding
Dexcom, Inc.
76-OR: UK 1st National Health Service (NHS) EndoBarrier (EB) Service for Uncontrolled Diabesity: 2-Year Outcomes for All 62 Treated Patients
Authors: RYDER ROBERT E.J. , YADAGIRI MAHENDER , IRWIN SUSAN P. , BURBRIDGE WYN , WYRES MELANIE C. , BASHIR TAHIRA , GANDHI HARDEEP , ALLDEN RACHAEL , BLEASDALE JOHN , FOGDEN EDWARD , ANDERSON MARK , GUPTA PIYA SEN 
Published: June 2020

EB, a 60cm endoscopically inserted proximal intestinal liner, reduces weight and HbA1c over 1 year. In the 1st NHS EB service, we provided EB to patients with sub optimally controlled diabesity and monitored outcomes in a registry. 46/62 (72%) completing 1 year post EB removal (age 51.5±7.7 years, 52% male, diabetes duration 14.5 (8-20) years, BMI 41.6±7.1 kg/m2) attended follow-up. During EB treatment, mean ± SD HbA1c fell by 1.9±1.8 %, from 9.2±1.8 to 7.2±1.0 % (p&lt;0.001), weight by 17.2±8.8 kg from 121.9 ± 29.4 to 104.7±30.1 kg (&lt;0.001), systolic BP from 139.0±14.0 to 126.0±14.6 mmHg (&lt;0.001), serum alanine aminotransferase (marker of liver fat) from 30.0±16.9 to 18.8±11.0 U/L (p&lt;0.001). Median (IQR) total daily insulin dose reduced from 104 (54-162) to 30 (0-62) units (n=31, p&lt;0.001); 10/31 (32%) insulin treated patients discontinued insulin. One year after EB removal 18/46 (39%) demonstrated sustained improvement, 18/46 (39%) partially sustained improvement and 10/46 (22%) reverted to baseline (Figure). Of those deteriorating, 9/10 (90%) had depression and/or bereavement. 10/62 (16%) had early EB removal for adverse events or symptoms; all 10 fully recovered after removal and most derived significant benefit. Our data demonstrates EB as highly effective in patients with refractory diabesity, with maintenance of significant improvement 1 year after removal in 78%.

Disclosure
R.E.J. Ryder: Consultant; Self; GI Dynamics Inc. Other Relationship; Self; Novo Nordisk A/S. M. Yadagiri: None. S.P. Irwin: None. W. Burbridge: None. M.C. Wyres: None. T. Bashir: None. H. Gandhi: None. R. Allden: None. J. Bleasdale: None. E. Fogden: None. M. Anderson: None. P. Sen Gupta: None.
760-P: Telephonic Coaching Is Associated with Improved Patient Activation in Diabetes Self-Management
Authors: BUSKIRK ANN , BIGGS WILLIAM C. , BORSA LENA , LYDEN MAUREEN R. , PARKIN CHRISTOPHER 
Published: June 2020

Appropriate diabetes self-management is essential to achieving optimal clinical outcomes. The Patient Activation Measure (PAM) is a validated, 100-item questionnaire that assesses patient activation (scored: 0=low, 100=high) and reveals four levels of activation relevant to diabetes self-management: Level 1 - disengaged and overwhelmed; Level 2 - becoming aware but still struggling; Level 3 - taking action and gaining control; and Level 4 - maintaining behaviors and pushing forward. This 12-month, observational, self-controlled multi-site study combined retrospective (6 months pre-baseline) and prospective (6 months post-baseline) to assess the impact of the Diabetes Health Partnership (DHP) program, a telephonic coaching program, on patient activation among 57 suboptimally controlled at baseline (8.4±1.1% A1C). Mean PAM total scores increased from 61.8±12.1 at baseline to 71.3±12.7 at study endpoint (p&lt;0.0001). The downward shift in Level 1 and upward shift in Level 4 were most notable. (Figure 1) Significant increases in participant confidence in managing their diabetes (p&lt;0.0001) and in having a clear plan for self-management (p=0.0004) were observed. Participation in the DHP program was associated with increased activation and greater confidence in participants’ ability to manage their diabetes.

Disclosure
A. Buskirk: Employee; Self; Roche Diabetes Care. W.C. Biggs: Consultant; Self; Roche Diabetes Care. Research Support; Self; Dexcom, Inc., Gan & Lee Pharmaceuticals, Mylan, Novo Nordisk A/S, Sanofi US. 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.
765-P: The Effects of CLC on Indirect Users: Sleep Improvement in Parents of Young Children with T1D
Authors: BISIO ALESSANDRO , BROWN SUE A. , MCFADDEN RYAN , BONNER HEATHER , YU PEARL L. , CHERÑAVVSKY DANIEL R. , DEBOER MARK D. , KHURSHID OMAR , KURTZ NICOLE , OLIVERI MARY C. , PAJEWSKI MICHAEL , SCHOELWER MELISSA , VOELMLE MARY K. , WAKEMAN CHRISTIAN A. , GONDER-FREDERICK LINDA 
Published: June 2020

Background and Aim: Studies have increasingly identified sleep disturbances in people with T1D. Parents of young children with T1D may also be a particularly vulnerable population to sleep disturbances. Anecdotally, it is reported that use of CLC improves sleep quality and quantity in users but objective data on indirect users are not available. This study assesses sleep outcomes of CLC compared to SAP therapy in parents of children with T1D.
Methods: Thirteen parents and their young children (ages 6-10) on insulin pump therapy were enrolled. Children completed an initial 4-week study with SAP using their own pump and a study CGM (Dexcom G6) followed by a 4-week phase of CLC (Control-IQ, Tandem Diabetes Care). Sleep was assessed in parents using actigraphy watches worn the last 10 days of each study phase. The Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Hypoglycemia Fear Survey (HFS) were administered at baseline (BL) and following each study phase.
Results: A statistically significant decrease was noted from BL to the end of the CLC phase of PSQI score (p=0.009) and the behavioral (p=0.005) and worry (p=0.045) HFS subscales. Even though statistical power was reduced by the number of participants, actigraphy data showed strong trends on several variables including an average increase of 14 minutes of total sleep time from SAP to CLC (p=0.068) and in people with high PSQI scores at BL (&gt;median) a higher sleep efficiency (p=0.098) and lower wake after sleep onset (p=0.100). Notably, children significantly reduced their time spent in hypoglycemia (&lt;70 mg/dl) at night from SAP to CLC (p=0.015).
Conclusions: Though preliminary, these results suggest that use of CLC has a positive impact on both the quality and quantity of sleep in parents of children with T1D. A decrease in fear of hypoglycemia, endorsed by fewer nocturnal hypoglycemic episodes, might be associated with sleep improvement since previous studies have reported poorer sleep quality in parents with high levels of fear of hypoglycemia.

Disclosure
A. Bisio: None. S.A. Brown: Research Support; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care, Tandem Diabetes Care, Tolerion, Inc. R. McFadden: None. H. Bonner: None. P.L. Yu: None. D.R. Cherñavvsky: Employee; Self; Dexcom, Inc. M.D. DeBoer: Research Support; Self; Tandem Diabetes Care. O. Khurshid: None. N. Kurtz: None. M.C. Oliveri: None. M. Pajewski: None. M. Schoelwer: Research Support; Self; Tandem Diabetes Care. M.K. Voelmle: Consultant; Self; Dexcom, Inc. C.A. Wakeman: Stock/Shareholder; Self; Dexcom, Inc., Tandem Diabetes Care. L. Gonder-Frederick: Other Relationship; Self; HFS-Global, LLC.

Funding
Virginia Research Investment Fund
766-P: Factors Related to Subjective Cognitive Symptoms in People with Type 2 Diabetes: A Quantile Regression Analysis
Authors: KIM MIN JUNG , PARK CHANG G. , ZHU BINGQIAN , FRITSCHI CYNTHIA 
Published: June 2020

Objectives: Early cognitive impairment is common in people with type 2 diabetes (T2DM). Subjective cognitive symptoms (SCS) have been associated with higher risks for early dementia and mild cognitive impairment and may be an early indication of further cognitive decline. Our goal was to identify factors related to SCS in people with T2DM to facilitate early screening for cognitive impairment in this population.
Methods: A convenience sample of 115 adults with T2D was included. The cognitive symptom subscale of the Diabetes Symptom Checklist-Revised was used. Potential factors were measured using the Patient-Reported Outcomes Measurement Information System including depression, fatigue, and sleep. Data were analyzed using quantile regression which accounts for non-normal distribution of the dependent variable. Quantile regression was useful to examine the relationships along the continuum of SCS severity that may be missed in traditional linear regression.
Results: The mean age of the participants was 58.64 (SD 8.64), and 53.9% were females. The mean score of the cognitive symptom subscale was 1.45 (SD 1.14, range 0 to 5). Using quantile regression, we found that increased sleep impairment (r = .02), sleep disruption (r = .02 to .05), and body mass index (r = .02) were significantly associated with increased SCS when the participants’ cognitive symptoms were in the lower quantiles (from .05 to .30). In contrast, increased depressive symptoms (r = .05 to .07) and fatigue (r = .04 to .06) were significantly associated with increased SCS in the higher quantiles of cognitive symptoms (from .70 to .95).
Conclusions: In adults with T2DM, the level of SCS is differentially associated with common diabetes factors and should be considered when screening and intervening for cognitive impairment. Sleep and weight should be considered for patients reporting fewer cognitive symptoms, whereas depression and fatigue should be considered for patients reporting more cognitive symptoms.

Disclosure
M. Kim: None. C.G. Park: None. B. Zhu: None. C. Fritschi: None.

Funding
National Institute for Nursing Research (K99R00NR012219); University of Illinois at Chicago College of Nursing
770-P: Behavioral Outcomes of High-Risk Spanish Speaking Latino Patients with Type 1 Diabetes Participating in a Novel Culturally Sensitive Shared Medical Appointment Model
Authors: JENSEN RYAN , SUTTIRATANA SAKINAH , NARANJO DIANA , GONZALEZ ANDREA GERARD 
Published: June 2020

Objective: Spanish speaking (SS), Latino patients (LP) with type 1 diabetes (T1D) face cultural, language and socioeconomic barriers that add to the risk of complications and higher distress. Shared medical appointments (SMAs) are effective models of care to help overcome these barriers. Behavioral outcomes of SS LP with T1D attending a novel culturally sensitive SMA pilot were analyzed.
Methods: Patients 1-20 years old and caregivers participated in the SMA pilot program. Pediatric Quality of Life (PedsQL), Diabetes distress (Problem Areas in Diabetes-PAID) surveys and satisfaction scores were obtain baseline and yearly. Higher scores on PedsQL indicate a better overall QoL.
Results: Mean A1C at baseline was 9.6% (sd=2.3). Mean distress scores for children and teens decreased from Baseline to Year 2 (47.4 vs. 37.9; p=0.21 and 54.1 vs. 51.8; p=.002, respectively) and showed improvement (not statistically significant) on mean overall QoL. Diabetes specific QoL improved from Baseline to Year 1 (78.4 vs. 81.5, p=0.46 and 68.2 vs. 73.2, p=0.24, respectively). For caregivers from Baseline to Year 2 there was significant increase in distress (39.5 vs. 65.1, p&lt;0.001), had no change in overall QoL, Diabetes specific QoL worsen from Baseline to Year 1 (64.5 vs. 57.9, p=0.04). Children, teens and parents all reported high levels of program satisfaction (means ranged from 41-46/50) with no significant change over time.
Conclusions: The novel culturally sensitive SMA model seems an effective strategy to lessen overall distress and increase QoL for High-risk SS LP youth. Parent’s final PAID scores correlated to children’s baseline A1C. It is likely that parent’s data was a result of increased education and awareness of disease seriousness. Sample size was small. Data from continued participation should be further analyzed.

Disclosure
R. Jensen: None. S. Suttiratana: Employee; Spouse/Partner; CVS Caremark. D. Naranjo: None. A. Gerard Gonzalez: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (2015PG-T1D060)
771-P: Impact of Maintenance Session Attendance and 6-Month Weight-Loss Goal Achievement on Weight-Loss Success in a One-Year Community Diabetes Prevention Program (DPP) Program
Authors: NAPOLEONE JENNA , MILLER RACHEL G. , DEVARAJ SUSAN , ROCKETTE-WAGNER BONNY , ARENA VINCENT C. , VENDITTI ELIZABETH M. , KRAMER KAYE , KRISKA ANDREA 
Published: June 2020

The DPP lifestyle intervention showed that meeting weight loss (WL) and activity goals can prevent/delay T2D. The success of community translated versions of it (e.g., Group Lifestyle Balance, DPP-GLB) has led to Medicare reimbursement based on session attendance (at 6 and 12 months) and participant success at meeting a 5% WL goal at 12 months. Although attendance has been suggested to be related to WL success, the impact of the 6 monthly maintenance sessions (mos 7-12) after the more frequent 16 core sessions (mos 0-6) on one-year WL is not known. This effort examines how maintenance session attendance and WL goal status at 6 months in DPP-GLB affects achievement of the 12-month 5% WL goal. Data were combined from two identical intervention trials that delivered the 12-month DPP-GLB in a community setting to overweight/obese adults (mean age 62 years, 76% women) with prediabetes and/or metabolic syndrome. Participants who attended ≥4 core sessions during the first 6 months and had complete data on maintenance attendance and WL were included (n=238). Meeting the 6-month WL goal was associated with greater odds of meeting the 12-month WL goal (p&lt;.0001). Odds of meeting the 12-month 5% WL goal were significantly greater for those who attended ≥4 maintenance sessions vs. those who did not (OR=6.0, 95% CI: 2.4-15.0). When stratified by achieving the 5% WL goal at 6 months, those who attended ≥4 maintenance sessions and met the 6-month WL goal were more likely to meet the WL goal at 12 months (OR=11.4, CI: 3.2- 40.7) compared to those who failed to meet the WL goal at 6 months (OR=1.5, CI: 0.3-7.5). Adjustment for age, gender and 6-month physical activity yielded similar results. Attending DPP-GLB maintenance sessions and meeting the 6-month WL goal increased the odds of meeting ≥5% WL at 12 months. For those who failed to meet the 6-month WL goal, attending maintenance sessions did not significantly improve their chance of 12-month WL success.

Disclosure
J. Napoleone: None. R.G. Miller: None. S. Devaraj: None. B. Rockette-Wagner: None. V.C. Arena: None. E.M. Venditti: None. K. Kramer: None. A. Kriska: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK100933, R18DK081323)