bluuebunny/crossref_metadata_2025_split huggingface dataset:
1239-P: University of California Diabetes Initiative: A Multi-institution Collaboration to Improve Diabetes Care
Authors: KOMPALA TEJASWI , CLARK MACKENZIE , KIM SARAH , KROON LISA , PETERSON THOMAS A. , MOWERS ROBERT M. , SURAMPUDI PRASANTH , FREEBY MATTHEW , HAN MARIA , LAMBRECHTS SYLVIA , OFFER THERESE M. , CHRISTIAN MARY JEAN , DAHM LISA , GIBBS LISA , BOUW JUSTIN , MEDDERS KATHRYN , MORN CASSIE , PATEL AYAN , SAK RACHAEL , CABRERA MARICEL , NEINSTEIN AARON B. 
Published: June 2020

Background: In Spring 2019, the University of California (UC) health system launched a UC Wide Diabetes Initiative. In response to the growing population of people with diabetes, as well as significant heterogeneity in diabetes care across five UC campuses, the UC Health Diabetes Initiative aims to increase alignment in methods of diabetes care delivery, and to improve clinical outcomes.
Methods: The UC Diabetes Initiative joins five financially and operationally independent academic medical campuses - UC Davis, UC San Francisco, UC Los Angeles, UC Irvine, and UC San Diego. Endocrinologists, primary care physicians, pharmacists, and program managers represent each campus, with data scientists and program leaders from the UC Office of the President. Powered by a central EHR data warehouse, we built a Diabetes Dashboard to show demographics, outcome (e.g., A1c) and process measures (e.g., eye exam) for more than 45,000 adults with diabetes cared for by more than 2,000 providers across the UC system.
Current Work: Our collaborative identified three focus domains for improvement: 1) Medical Neighborhood 2) Patient Education and 3) Pharmaceutical Use. Within each of these domains, we used a semi-structured approach based on local expertise and experience to narrow our focus. Specific interventions were selected based on potential impact, feasibility, and key stakeholder feedback. We focus on designing and delivering three UC-wide interventions to 1) increase use of A1c point-of-care testing 2) increase reach of diabetes education and 3) utilize a “UC-way” diabetes pharmaceutical algorithm. Implementation will begin in Summer 2020; our ongoing work will be the focus of subsequent evaluation.
Conclusions: The UC Health Diabetes Initiative provides a unique model of multi-institution collaboration joining independent health systems around a common mission, and using population-based real-world data to select, implement and measure best practices in diabetes care delivery.

Disclosure
T. Kompala: None. M. Clark: None. S. Kim: None. L. Kroon: None. T.A. Peterson: None. R.M. Mowers: None. P. Surampudi: None. M. Freeby: Research Support; Self; Abbott, Novo Nordisk Inc. M. Han: None. S. Lambrechts: None. T.M. Offer: None. M. Christian: None. L. Dahm: None. L. Gibbs: None. J. Bouw: None. K. Medders: Advisory Panel; Self; Lilly Diabetes. C. Morn: None. A. Patel: None. R. Sak: None. M. Cabrera: None. A.B. Neinstein: Consultant; Self; Steady Health.
1245-P: Maternal HbA1c Is Related to Childhood Fat Mass and Only Partially Mediated by Neonatal Fat Mass
Authors: FRANCIS ELLEN C. , RINGHAM BRANDY , GLUECK DEBORAH H. , PERNG WEI , DABELEA DANA 
Published: June 2020

Maternal diabetes during pregnancy impacts offspring body composition and has been associated with greater offspring adiposity across the life course. However, the extent to which the relationship between maternal glycemia and offspring adiposity during later life is independent of neonatal adiposity is unclear. In a prospective study of 544 mother-child pairs in the Healthy Start Study, we estimated the total effect of maternal HbA1c on childhood fat mass (FM) %, and the direct effect independent of neonatal FM %. We measured maternal fasting HbA1c at a gestational age of 20-34 weeks, and offspring FM % using air displacement plethysmography at birth and during childhood (age 4-7 y). We used multivariable linear regression with HbA1c tertiles (T1 [reference], T2, T3) as the exposure, neonatal FM % as the mediator, and childhood FM % as the outcome. A counterfactual-based approach was used to estimate total and direct effects, while also accounting for exposure-mediator interaction. Covariates were maternal race, education, gestational weight gain and smoking, and offspring sex and age. The medians (interquartile ranges) of the HbA1c tertiles were T1: 4.80 (3.70, 4.90), T2: 5.05 (5.00, 5.10), and T3: 5.30 (5.20, 6.30). The estimated total effect on child FM % was 1.27 (95% CI: 0.00, 2.54) units higher for T2 vs. T1, and 1.53 (0.23, 2.82) units higher for T3 vs. T1 (P-trend=0.02). After adjusting for pre-pregnancy BMI, the total effect was 1.18 (-0.09, 2.44) and 1.31 (0.00, 2.62) units higher for T2 vs. T1 and T3 vs. T1, respectively (P-trend=0.04). The direct effect after accounting for neonatal FM % was slightly attenuated (T2 vs. T1: 1.14 [-0.11, 2.39], T3 vs. T1: 1.20 [-0.11, 2.51]; P-trend=0.07). Excluding women with gestational diabetes mellitus (n=27) did not substantially impact the results. Our data suggest that maternal glycemia during pregnancy, even within normal levels, may influence childhood adiposity through pathways that are in part mediated by programming of neonatal adiposity.

Disclosure
E.C. Francis: None. B. Ringham: None. D.H. Glueck: None. W. Perng: None. D. Dabelea: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (5R01DK076648-10)
125-LB: Beta-Cell Antigen-Specific Chimeric Antigen Receptor Tregs for Type 1 Diabetes Prevention and Treatment
Authors: IMAM SHAHNAWAZ , DAR PERVAIZ , ALFONSO-JAUME MARIA A. , JAUME JUAN C. 
Published: June 2020

Background: Autoimmunity is a consequence of low/unfit antigen-specific Tregs. If antigen-specific Tregs could be produced on demand against a desire autoimmune target, suppression of autoimmune diseases would be achievable. Here, we developed pancreatic beta cell-specific GAD65 CAR Tregs and explored their therapeutic potential against T1D.
Methods: Two GAD65 B cell epitopes known to interact with two immunodominant regions in the N-terminal (CAR-N) and Middle (CAR-M) regions were selected for assembly onto T cell receptors (CD28 hinge-transmembrane-intracellular regions and CD3ζ intracellular domain) (1). These GAD65 CAR Tregs were used to prevent/treat diabetes in our humanized mouse model of T1D.
Results: Adoptive transfer of CAR-N Tregs to the diabetic T1D mice (2) revealed that administration of beta-cell specific Tregs leads to enrichment of Treg cells at the pancreas level. Confocal images demonstrated the homing of CAR Tregs to peri-insular areas 48 hours after intravenous immunization. 30-day follow up, fasting blood glucoses and GTT/insulin secretion tests significantly deteriorated in control Groups as compared with CAR-N/M Tregs treated Groups. The pancreatic islet localization of GAD65 CAR Tregs was still demonstrable at 30 days.
Conclusions: This is the first time a therapeutic approach is successful in abrogating the diabetes phenotype in T1D mice model. Conceivably, antigen-specific Treg redirection using antigen-specific CAR Tregs and consequent Teff downregulation will allow for recovery and reconstitution of beta cells in humans as well.
References: 1)S Imam, Jaume JC. “CAR T Preventive/Therapeutic approach for type 1 Diabetes” U.S. Provisional Patent #60439-US-PSP. http://utoledo.technologypublisher.com/technology/31853 (2019).
2)S Imam, M Alfonso-Jaume, JC Jaume Spontaneous Autoimmune Diabetes in Humanized Mice Carrying Human Type 1 Diabetes Susceptibility and Uses Therefor - US Patent App.16/530,452, 2020.

Disclosure
S. Imam: None. P. Dar: None. M.A. Alfonso-Jaume: None. J.C. Jaume: None.

Funding
University of Toledo (to J.C.J.)
1250-P: Lifestyle + Mindfulness Pilot Trial in Latinx Teens at Risk for Type 2 Diabetes (T2D)
Authors: SANCHEZ NATALIA L. , JIMENEZ VIRGINIA , HAEMER MATTHEW , SHOMAKER LAUREN B. , CASAMASSIMA MILENA , VERROS MEGAN M. , ANNAMEIER SHELLY 
Published: June 2020

Objective: Latinx teens have elevated risk for youth and adult-onset T2D, yet few preventive interventions have succeeded, in part due to inadequate cultural-tailoring and psychosocial stress. We conducted a pilot trial to determine feasibility/acceptability of a culturally-tailored, family lifestyle+mindfulness (life+mind) program, and explored effects on depression and glucose, vs. lifestyle only.
Methods: N=18 Latinx patients (14±1y) recruited from a FQHC, with BMI ≥85th%ile (97.7± 1.9%ile) and ≥1 T2D relative, participated. Families were randomized to a 6-wk, 12-session (24 total hrs) life+mind (n=11) or lifestyle only (n=7) program, delivered in the community by bilingual staff. Assessments were at baseline, 6-wks, and 6-mos. Feasibility was determined as recruitment rate/retention, and acceptability as program attendance and acceptability ratings. Depression was assessed with the CES-D, BMI from measured height/weight, and blood was sampled for fasting glucose (FG).
Results: Recruitment rate was 10 families/month; 61% of those eligible enrolled. Retention was adequate at 6-wks (life+mind vs. lifestyle: 72 vs. 75%), but suboptimal at 6-mos (62 vs. 71%). Median attendance for life+mind was 10/12 and for lifestyle, 11/12 sessions. Parent ratings were uniformly positive, but teens had mixed ratings and some discomfort with mindfulness. There was a non-significant trend for more reduction in depression rates in life+mind vs. lifestyle from baseline (36 vs. 43%; p=.78) to 6-wks (0 vs. 40%; p=.05) and 6-mos (14 vs. 40%; p=.31). There was a pattern for greater decreases in FG at 6-wks (Δ-5±2 vs. 0±3mg/dL; p=.17), with both conditions showing 6-mos decrease (Δ-2±1 vs. -2±2mg/dL; p=.93). BMI was stable (Δ6mos: 0.4±0.5 vs. -0.5±0.7kg/m2, p=.36).
Conclusions: A culturally-tailored family program with mindfulness for Latinx teens at-risk for T2D is feasible, acceptable to parents, and could reduce depression and FG. Yet, more work is needed to tailor mindfulness acceptability for Latinx teens.

Disclosure
N.L. Sanchez: None. V. Jimenez: None. M. Haemer: None. L.B. Shomaker: None. M. Casamassima: None. M.M. Verros: None. S. Annameier: None.

Funding
National Center for Advancing Translational Sciences; Colorado Clinical and Translational Science Awards (UL1TR002535)
126-LB: Glycemic Outcomes for People with Type 1 and Type 2 Diabetes Using Control-IQ Technology: Real-World Data from Early Adopters
Authors: HABIF STEPHANIE , CONSTANTIN ALEXANDRA , MUELLER LARS , SINGH HARSIMRAN 
Published: June 2020

The Food and Drug Administration recently cleared the t:slim X2 with Control-IQ technology in the United States. This advanced hybrid closed-loop system automatically adjusts insulin based on predicted sensor glucose (SG) levels to help increase sensor time in range (TIR) (70-180 mg/dL). The pivotal DCLP3 trial demonstrated noteworthy glycemic improvements in people with type 1 diabetes (PwT1D) using Control-IQ technology. However, DCLP3 did not include people with type 2 diabetes (PwT2D). We performed retrospective analysis of users who uploaded at least 14 days of pre and 14 days of post Control-IQ software usage data to Tandem’s t:connect® web application as of March 11, 2020 and had ≥75% CGM use during this time. Glycemic outcomes, total daily insulin (TDI), and time in closed loop were analyzed by diabetes type. Of the 3,278 PwDs included in the sample, 144 had T2D, 52% were female, mean age=43 years (SD=17.47), diabetes duration=23 years (SD=15). Wilcoxon signed-rank tests were used to examine pre-post differences in outcomes by diabetes type. Post 14-day Control-IQ technology use, PwT1Ds recorded 96% time in closed loop and showed significant improvements in their TIR (+9% from pre, p&lt;0.001), reduced time in SG&lt;70 (-0.04% from pre, p&lt;0.001), and SG&gt;180 (-8.45% from pre, p&lt;0.001). Median TDI at post was 48 units (pre=46 units, p&lt;0.001). Similar trends were observed for the type 2 sample, in that PwT2Ds recorded 96% time in closed loop and showed significant improvements in TIR (+6% from pre, p&lt;0.001) and reduced SG time &gt;180 (-5.8% from pre, p&lt;0.001). Median SG time &lt;70 remained unchanged (0.2%). Median total daily insulin for PwT2Ds increased to 82 units from pre-CIQ use of 73 units (p=0.003). These results from early adopters of Control-IQ technology confirm its efficacy in assisting both PwT1Ds and PwT2Ds achieve their recommended glycemic targets and improve their glycemic control.

Disclosure
S. Habif: Employee; Self; Tandem Diabetes Care. A. Constantin: Employee; Self; Tandem Diabetes Care. Other Relationship; Self; Bigfoot Biomedical. L. Mueller: Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. H. Singh: Employee; Self; Tandem Diabetes Care.
1262-P: Metabolic Flexibility across the Spectrum of Glycemic Regulation in Youth
Authors: BACHA FIDA , BARTZ SARA K. , JINDAL ISHITA , PUYAU MAURICE R. , ADOLPH ANNE , SHARMA SUSAN 
Published: June 2020

Metabolic flexibility (MF) refers to the ability to suppress lipid and increase glucose oxidation (as reflected by increase in the respiratory quotient [ΔRQ]) under insulin-stimulated conditions. It is not clear if youth with type 2 diabetes (T2D) and prediabetes have a defect in MF compared with controls. We investigated the determinants of MF in youth with normal weight (NW) and obesity (OB) across the spectrum of glucose tolerance. Youth (n=104; 15.6±1.8 yrs, Tanner stage (TS) II-V) had evaluation of body composition (DXA), visceral fat (VAT) in a subset (MRI), RQ (indirect calorimetry) fasting and during a hyperinsulinemic-euglycemic clamp for measurement of glucose disposal rate (GDR) and insulin sensitivity (IS). Youth with prediabetes and T2D had lower ∆RQ, and lower oxidative and non-oxidative GDR compared to NW with no significant difference in ΔRQ between NW and OB-NGT (Table). ∆RQ correlated with GDR, IS (r=0.3, p=0.02), VAT (r=-.23, p=0.04), and HbA1c (r=-.26, p=0.03) after adjusting for sex, race and TS, but not with % body fat. In multiple regression, Rd (or IS) (β=0.26, p=0.04) and race-ethnicity (β= -0.3, p=0.01) contributed to the variance in ∆RQ (R2=0.25, p=0.005) independent of % body fat, VAT, sex, TS and HbA1c. MF is impaired in youth with prediabetes/T2D compared with NGT-OB and NW in relation to a defect in glucose disposal and appears to be modulated by race-ethnicity (lower in Hispanics).

Disclosure
F. Bacha: Research Support; Self; AstraZeneca, Takeda Development Center Americas, Inc. S.K. Bartz: None. I. Jindal: None. M.R. Puyau: None. A. Adolph: None. S. Sharma: None.

Funding
U.S. Department of Agriculture
127-OR: Pharmacologic Management of Diabetic Peripheral Neuropathy
Authors: FAN JUNGWEI , JEFFERY MOLLY M. , HOOTEN W. MICHAEL , SHAH NILAY , MCCOY ROZALINA G. 
Published: June 2020

Approximately half of all people with diabetes develop diabetic peripheral neuropathy (DPN) and half experience pain. Guidelines recommend pregabalin, gabapentin, and duloxetine (a selective norepinephrine and serotonin reuptake inhibitor [SNRI]) due to their demonstrated efficacy and safety. Topical analgesics, tricyclic anti-depressants (TCA), and anti-convulsants may also be used. Opioids are discouraged due to lack of effectiveness, risk of addiction, and safety concerns. To promote safe evidence-based pain management, we examined pain medication use by adults diagnosed with DPN between 2002-2019 in an integrated healthcare system across 5 states. We identified 13,815 adults with newly diagnosed DPN; mean age 66 (SD, 13) years, 42% female, 93% white, 29% insulin-treated. Overall, 56% received a pain medication from DPN diagnosis (1 month prior or continued from baseline) to 2 years later. Limiting to treatment pathways observed in ≥1% of cases, opioids were the most used 1st line medication, followed by gabapentin and others (Figure). Opioids and gabapentin were also the most prevalent 2nd line drugs. High rates of opioid use by patients with DPN, a life-long pain syndrome, are concerning particularly as safer effective treatment options are available. Further research is needed to identify drivers of opioid use and barriers to evidence-based alternatives, and develop interventions to improve DPN management in clinical practice.

Disclosure
J. Fan: None. M.M. Jeffery: None. W. Hooten: None. N. Shah: None. R.G. McCoy: None.

Funding
National Institutes of Health (K23DK114497)
1270-P: Glycemic Control in Youth with Type 2 Diabetes Correlates with Weight Loss and Markers of Beta-Cell Function, but Not Intense Insulin Regimen
Authors: CHAO LILY , YEH MEIYU , RAYMOND JENNIFER , RYOO JI HOON , CHANG NANCY T. 
Published: June 2020

Background: Youth with type 2 diabetes develop early treatment failure to metformin and diabetes-related comorbidities.
Objective: To identify risk factors for glycemic failure in youth with type 2 diabetes.
Methods: Anthropomorphic measures, medication records, and laboratory studies were collected from patients attending a dedicated type 2 diabetes clinic. Repeat measures of HbA1c were averaged to prevent errors from unbalanced data points. Latent profile analysis (LPA) was performed to model longitudinal trajectory of HbA1c over 5 years.
Results: The registry includes 226 patients, of which 80% are Latinx. Analysis of the glycemic outcomes showed that the odds ratio (OR) for uncontrolled diabetes 5 years after diagnosis (HbA1c&gt;8%) is proportional to baseline HbA1c, with OR of 2.41 when diagnostic HbA1c &gt;8.5% (sensitivity 68%, specificity 54%, P=0.015). LPA modeling identified three HbA1c profiles, all demonstrating some improvement in HbA1c at 4-6 months: (A) HbA1c &lt;8% throughout the 5 years, (B) persistent elevation of HbA1c &gt;9%, and (C) mean HbA1c of 12% at diagnosis, rapid decline to 6.4% by 4-6 months, but rose to 11% by 18 months. At diagnosis, group A had lower HbA1c and higher fasting c-peptide levels than B and C, suggesting that baseline beta-cell function is a dominant variable in long-term glycemic control. Our analysis of medication regimen showed that amongst patients treated with metformin, the addition of multiple daily injections (MDI) did not improve HbA1c compared to those on basal insulin. Finally, weight loss correlated with improved HbA1c outcome in patients on metformin monotherapy, but not in patients prescribed insulin.
Conclusion: Patients with baseline HbA1c &gt;8.5% are at high risk for glycemic failure, irrespective of short-term improvement in HbA1c. Additional studies are needed to decipher if medication omission accounts for the comparable HbA1c outcome between patients on MDI and basal insulin.

Disclosure
L. Chao: None. M. Yeh: None. J. Raymond: None. J. Ryoo: None. N.T. Chang: None.

Funding
Good Hope Foundation; Saban Research Institute
1274-P: Prevalence of Addictive-Like Eating in Hispanic Adolescents with Obesity Seeking Weight Management Treatment
Authors: GONZALEZ JANELLE , FINK CASSANDRA , WEE CHOO PHEI , HEGEDUS ELIZABETH , LOPEZ KELLEEN , VIDMAR ALAINA 
Published: June 2020

Background: There is a growing body of literature exploring food addiction (FA) in adolescents with obesity and how it impacts treatment outcomes. Several studies have evaluated the prevalence of FA in youth with obesity as measured by the Yale Food Addiction Scale for children (YFAS-c) and rates vary from 4-22%. The rates of obesity in Hispanic youth is reported to be higher than in other ethnic groups however there is a paucity of literature exploring the prevalence of FA in this population. Due to our geographic location and our majority Hispanic patient population, we examined 1) the prevalence of FA in Hispanic adolescents with obesity and 2) the association between FA and demographic characteristics.
Methods: Baseline data from a RCT on behavioral weight management interventions was used. Participants who self-identified as Hispanic, were 14-18 years of age, and with a BMI &gt;95th% met criteria. Fisher’s exact test was used to assess the differences between adolescents with positive and negative YFAS-c scores and demographic characteristics.
Results: In a sample of 59 Hispanic youth, 29% met criteria for FA. There was no significant difference in age, gender, or household income between adolescents with positive YFAS-c at baseline compared to those with negative scores.
Conclusions: Hispanic youth with obesity have higher rates of FA than previous prevalence reports. This information is essential to consider prior to implementation of a weight management program as it may impact adherence, retention, and ultimately weight outcomes. Baseline behavioral phenotyping may be a strategy to ensure adolescents are receiving the services they require in conjunction with participation in a weight management program. These findings can help inform providers of the importance of screening for FA prior to intervention administration and possibly modifying the intervention content to address addictive like eating behaviors.

Disclosure
J. Gonzalez: None. C. Fink: None. C. Wee: None. E. Hegedus: None. K. Lopez: None. A. Vidmar: None.

Funding
eHealth International (CHLA 000193)
1278-P: Up All Night? Sleep in Parents of Young Children Newly Diagnosed with Type 1 Diabetes
Authors: AL-GADI IMAN , STREISAND RANDI , MONAGHAN MAUREEN , TULLY CARRIE , SINISTERRA MANUELA , HILLIARD MARISA E. 
Published: June 2020

Background: Parents of young children with type 1 diabetes (PYC-T1D) may be susceptible to poor sleep due to the 24/7 demands of diabetes care and concerns about overnight hypoglycemia, yet sleep patterns of PYC-T1D shortly after T1D diagnosis have not been reported. We aimed to describe the sleep of PYC-T1D in the first 2 months post-diagnosis and explore any differences with continuous glucose monitor (CGM) use.
Methods: Participants were 157 PYC-T1D (M child age=4.5±1.6 years, 90% mothers, 61% White/non-Hispanic) assessed at baseline (M duration=27±15 days) of a behavioral RCT. Parents self-reported about sleep (Pittsburgh Sleep Quality Index, PSQI), T1D-specific sleep disruptions, and children’s use of CGM (20%). We report descriptive statistics for the full sample and compared by CGM use (independent t-test, X2).
Results: Most (80%) PYC-T1D had PSQI≥5 indicating clinically significant sleep disturbance (M=8.3±4.1). Mean sleep duration was 5.9±1.4 hours/night. Table 1 shows over 2/3 reported T1D-related sleep disruptions and presents comparisons between CGM groups.
Conclusion: Sleep disruption is a pervasive problem among PYC-T1D soon after diagnosis, with the majority not meeting recommendations for sleep duration and having clinically elevated sleep disturbances. Though some aspects of sleep disruption were higher in CGM users, we cannot infer causality and poor sleep was prevalent regardless of CGM use.

Disclosure
I. Al-Gadi: None. R. Streisand: None. M. Monaghan: Research Support; Self; American Diabetes Association. C. Tully: None. M. Sinisterra: None. M.E. Hilliard: None.

Funding
National Institutes of Health (1R01DK102561)