bluuebunny/crossref_metadata_2025_split huggingface dataset:
78-OR: Glycaemia, Beta-Cell Function, and Incretin Hormones Post-OGTT One Year after Gastric Bypass and Sleeve Gastrectomy in Patients with Morbid Obesity and Type 2 Diabetes: An RCT (Oseberg Study)
Authors: FATIMA FARHAT , HJELMESÆTH JØRAN , BIRKELAND KARE I. , GULSETH HANNE L. , HERTEL JENS K. , SVANEVIK MARIUS , SANDBU RUNE , HARTMANN BOLETTE , HOLST JENS J. , HOFSØ DAG 
Published: June 2020

The Oseberg study demonstrated a higher one year remission rate of type 2 diabetes after Roux-en-Y gastric bypass (RYGB) than after sleeve gastrectomy (SG). To explore mechanisms for the superiority of RYGB we assessed changes in glucose, C-peptide and incretin hormones after a 25 g OGTT and an IVGTT and calculated Disposition Indexes (DI) of beta cell function (DIIVGTT and DIOGTT). We used linear mixed models for repeated measures. Patients randomized to either RYGB (n=54) or SG (n=55), had a mean (SD) age of 48 (10) years, BMI 42.3 (5.3) kg/m², HbA1c 66 (18) mmol/mol, and 72 (66%) were women. OGTT and IVGTT were performed in 97% and 91% of patients respectively. At one year, the OGTT-derived glucose levels at 60-120 minutes were significantly lower after RYGB than after SG (all p&lt;0.05). The OGTT-derived increase in measures of C-peptide, GIP and GLP-1 from 0 to 15 minutes were significantly higher in the RYGB group, mean (95% CI) between group difference: C-peptide 257 (66, 448) pmol/L, p=0.008; GIP 11 (4, 19) pmol/L, p=0.005; and GLP-1 29 (20, 38) pmol/L, p&lt;0.001. DIIVGTT and DIOGTT increased three- to fivefold in both groups with no significant difference between groups. Post-OGTT glucose levels were significantly lower after RYGB as compared with SG, possibly mediated by a greater increase in GIP, GLP-1 and C-peptide levels.

Disclosure
F. Fatima: Other Relationship; Self; South-Eastren Reagional Health Authority Norway. J. Hjelmesæth: Advisory Panel; Self; Novo Nordisk A/S. K.I. Birkeland: None. H.L. Gulseth: None. J.K. Hertel: None. M. Svanevik: None. R. Sandbu: None. B. Hartmann: None. J.J. Holst: Advisory Panel; Self; AstraZeneca, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Zealand Pharma A/S. Other Relationship; Spouse/Partner; Antag Therapeutics. D. Hofsø: None.
780-P: Novel Application of Patient-Centered Design in Minority Young Adults (YA) with Type 2 Diabetes (T2D)
Authors: PARK TINA , OSAKI MIYA Z. , QURESHI MAHAM , JANG ALYSSA , AGARWAL SHIVANI 
Published: June 2020

The current epidemic of youth-onset T2D in minority YA requires changes to lifestyle modification recommendations that are achievable and developmentally appropriate. We used a unique approach of combining patient-centered design and conventional qualitative methods to examine lived and healthcare experiences of minority YA with T2D from an underserved area. The design team used a journey map with probes for YA to use reflective storytelling to share their diabetes journey. YA recorded important events, persons, challenges, and achievements living with T2D (Figure 1), followed by videoconference interviews. Design phase themes were used to inform a conventional qualitative interview guide for semi-structured individual interviews in a larger ongoing study. We recruited five YA with T2D for the design phase (mean age 20 yrs; 3 female; 3 Black, 1 Hispanic, 1 Asian; median HbA1c 10.8%). The design approach revealed new themes versus traditional methods: 1) surprise of T2D diagnosis and difficulty prioritizing health despite understanding need; 2) competing priority of familial financial and childcare duties; and 3) lack of guidance from healthcare providers on realistic goals for diet and weight loss. Patient-centered design is a feasible, efficacious method that enhances qualitative research to uncover breadth of themes, and should be used more often in vulnerable groups with diabetes.

Disclosure
T. Park: None. M.Z. Osaki: None. M. Qureshi: None. A. Jang: None. S. Agarwal: None.
782-P: Diabetes Stigma and Associations with Medication Adherence and Glycemic Control
Authors: CAVANAUGH KERRI , BEACH LAUREN B. ,   ESQ., HACKSTADT AMBER J. , WALLSTON KENNETH , ELASY TOM , MAYBERRY LINDSAY S. 
Published: June 2020

Diabetes stigma is an emerging determinant of behaviors and outcomes. The theoretically-informed validated Comprehensive Diabetes Stigma Scale (CDSS), evaluates diabetes stigma and includes four subscales measuring enacted, perceived and self-stigma and concealment. This study tested associations between CDSS scores, medication adherence and HbA1c in a prospective cohort. We hypothesized that greater diabetes stigma would be associated with worse diabetes medication adherence and HbA1c. Pearson’s correlations and multivariable linear regression models adjusting for age, sex, race, education, insurance, partner status, diabetes duration and insulin use quantified the association of baseline CDSS scores and with ARMS-D scores and HbA1c assessed 3-6 months after enrollment. Participants (n=254) were 60 (SD 11) years old, 53% female, 80% White, 61% used insulin, mean HbA1c 7.7% (SD 1.6), and were living with diabetes for 14 (SD 9) years. CDSS scores and bivariate correlations shown in the Table. In adjusted models, CDSS overall score was associated with worse medication adherence (β 95%CI: 0.70, 0.01 - 1.39; p=0.05), but not with HbA1c (0.21, -0.05- 0.47; p=0.45). Only concealment was associated with worse HbA1c (0.48, 0.18-0.78; p=0.01). Prospective adjusted associations underline the importance of addressing concealment as a behavioral response to stigma leading to worse clinical outcomes in diabetes.

Disclosure
K. Cavanaugh: None. L.B. Beach: None. A.J. Hackstadt: None. K. Wallston: None. T. Elasy: None. L.S. Mayberry: None.

Funding
National Institutes of Health (P30DK92986-09, P30DK020593, UL1TR002243, K12HL143959)
783-P: Can Mood and Energy Levels Be Predicted by Preceding Glucose Values? Combining Ecological Momentary Assessment (EMA) and Continuous Glucose Monitoring (CGM)
Authors: EHRMANN DOMINIC , SCHMITT ANDREAS J. , RUBERTUS PAULA , KULZER BERNHARD , HERMANNS NORBERT 
Published: June 2020

For association with glycemic control, psychosocial research almost exclusively used retrospective questionnaire data to assess psychosocial outcomes. Little is known about the immediate, real-time effects of glucose values on psychosocial outcomes. In an observational study, 152 people with type 1 diabetes were equipped with CGM and completed a Smartphone-based EMA-survey 4-times a day over 18 days. Participants rated their mood and energy level separately on a single-item scale from 0 (very poor) to 10 (very good). Glucose data 90 minutes prior to each rating was extracted and mean glucose, time in range, time in hypoglycemic ranges (&lt;70, &lt;55 mg/dl), time in hyperglycemic ranges (&gt;180, &gt;250 mg/dl), and the mean absolute difference (MAD) of consecutive glucose values were calculated. Multilevel regression analyses were conducted with mood and energy levels as dependent variables and each parameter of glycemic control (90min prior) as independent variable, controlled for the overall level of glycemic control. Better mood was significantly predicted by lower mean glucose levels (p=.003), higher time in range (p=.003), and less hyperglycemic values (&gt;180 mg/dl: p=.021; &gt;250 mg/dl: p=.002). No significant associations were found for hypoglycemic values and MAD. Higher energy levels were significantly predicted by lower mean glucose levels (p=.012), higher time in range (p=.001), less hypoglycemic values (&lt;70 mg/dl: p&lt;.001; &lt;54 mg/dl: p=.023), less values in the severe hyperglycemic range (&gt;250 mg/dl: p&lt;.001). Lower MAD predicted higher energy levels (p=.047). Ratings of mood and energy were significantly affected by immediately preceding glucose levels. While hyperglycemic values were more important for mood, hypoglycemic values were more important for energy. These preliminary findings have important implications for our understanding of real-time effects of hypo- and hyperglycemic glucose levels.

Disclosure
D. Ehrmann: Speaker’s Bureau; Self; Abbott, Berlin-Chemie AG, Glooko, Inc. Other Relationship; Self; Dexcom, Inc., Roche Diabetes Care. A.J. Schmitt: None. P. Rubertus: None. B. Kulzer: Research Support; Self; Abbott, AstraZeneca, Berlin-Chemie AG, Roche Diabetes Care. Speaker’s Bureau; Self; Abbott, Ascensia Diabetes Care, Berlin-Chemie AG, Eli Lilly and Company, Medtronic, Novo Nordisk Inc., Roche Diabetes Care. N. Hermanns: Advisory Panel; Self; Roche Diabetes Care. Research Support; Self; Abbott, AstraZeneca, Berlin-Chemie AG.

Funding
German Center for Diabetes Research (FKZ82DZD1102A)
785-P: Number of Years Lost within 30-Year Work Life Spans of People with Type 1 and Type 2 Diabetes
Authors: NEXO METTE A. , PEDERSEN JACOB , CLEAL BRYAN , ANDERSEN INGELISE , BJORNER JAKOB B. 
Published: June 2020

Background and Aims: To our knowledge, no study has yet examined diabetes related work disability from a life course perspective. This study estimated the number of years people with type 1 and type 2 diabetes lost in a 30-year work life span compared to people without diabetes.
Method: Individuals aged 18-65 years, diagnosed with type 1 (n=33,188) or type 2 diabetes (n=81,930) were identified from national registers from the entire Danish population and age and gender matched with controls without diabetes (n=663,656), for period 2000-2017. Work Life Expectancies (WLE) in years were estimated as time in employment from age 35 to 65. We used a life table approach with multi-state Cox proportional hazard modelling (95% Confidence Intervals: CI). Age was the underlying time-axis. Inverse probability weights accounted for differences between populations. Analyses were performed separately for sex, educational status, and types of diabetes in 5-year age intervals.
Results: Individuals with type 1 diabetes and type 2 diabetes had significantly shorter WLE compared to people without diabetes in the 30-year span. Type 1 diabetes: WLE ranged from 8 years shorter among women with low education [-8.0; CI: -11/-5.0] to 4 years shorter [-4.4; CI: -6.6/-2.3] with high education; WLE in men ranged from -6.4 [CI:-8.7/-4.0] with low education to -3.0 [CI:-4.5/-1.5] with high education. Type 2 diabetes: WLE ranged from -6.5 [CI: -8.9/-4.0] in women with low education to -2.9 [CI:-4.5/-1.3] with high education. WLE in men ranged from -7.0 [CI: -9.4/-4.5] with low education to -3.7 [CI: -5.4/-2.0] with high education.
Conclusion: The substantial number of years lost in 30-year work life span of people with type 1 or type 2 diabetes highlight needs to prevent individual and societal consequences of diabetes related disability. Preventive strategies are particularly relevant for people with low education.

Disclosure
M.A. Nexo: None. J. Pedersen: None. B. Cleal: None. I. Andersen: None. J.B. Bjorner: None.
802-P: Barriers to Medication Taking in African American Patients with Comorbid Diabetes and Hypertension: The Potential Role of Mild Cognitive Impairment
Authors: CUMMINGS DOYLE M. , SINGH SUNIDHI , ADAMS ALYSSA , PATIL SHIVAJIRAO P. , HART STEPHANIE , CHERRINGTON ANDREA , HALLADAY JACQUIE , RINGEL JOANNA B. , BAQUERO ELIZABETH , SAFFORD MONIKA 
Published: June 2020

Both diabetes and hypertension increase risk for mild cognitive impairment (MCI) and both rely on medications for control. MCI may impede medication adherence, but this has not been well studied. We examined the association between MCI, defined as missing ≥3 items on the validated Six-Item Screener (SIS), and 19 self-reported barriers to medication taking. Negative binomial logistic regression adjusted for demographic characteristics, physical and mental health, social support, depressive symptoms, and total medication count. Participants in a cluster randomized trial (n=1243; all African Americans with persistently uncontrolled hypertension; 62% female; 43% with diabetes) testing interventions to improve BP control, were studied at baseline. Patients with diabetes were older (59 vs. 56 yrs.), took more medications (14 vs. 9), and were significantly more likely to report too many daily doses (20% vs. 14%; p&lt;0.01) and difficulty affording medications (29% vs. 22%; p&lt;0.01) than those without diabetes. The prevalence of MCI was similar in those with (15.2%) and without (13.4%) diabetes (p=0.35). Regardless of MCI status, 29% of patients with diabetes reported medication side effects and 32% reported allowing medications to run out. In patients with diabetes, those with MCI were significantly more likely to report concern over too many daily doses (30 vs. 18%; p=0.02) and not knowing what their medications were for (25% vs. 12%; p&lt;0.01). In fully adjusted models in patients with diabetes, those with MCI were at high risk for not knowing what their medications were for (OR 2.06; 95% CI 1.09-3.89) and reported modestly more medication barriers although this did not achieve statistical significance (PR = 1.12; 95% CI 0.92-1.36, p=0.26). These findings suggest that patients with diabetes report multiple barriers with medications and those with MCI, which may not be clinically apparent, may require more assistance to optimize adherence.

Disclosure
D.M. Cummings: Research Support; Self; Novo Nordisk Inc. S. Singh: None. A. Adams: None. S.P. Patil: Research Support; Self; Novo Nordisk Inc. S. Hart: None. A. Cherrington: None. J. Halladay: None. J.B. Ringel: None. E. Baquero: None. M. Safford: None.

Funding
National Heart, Lung, and Blood Institute (4UH3HL130691)
813-P: The Use and Effectiveness of Incentives in Chronic Disease Lifestyle Change Programs
Authors: ATKINS CHARISMA , HULBERT LASHONDA , SKEETE RENEE , MICHAEL SHANNON L. , SMITH BRYCE , CANNON MICHAEL 
Published: June 2020

The National Diabetes Prevention Program (National DPP) helps individuals with prediabetes make lifestyle changes to prevent type 2 diabetes. Some lifestyle change programs use incentives to promote health goals, but the impact of incentives in these settings has not been systematically assessed. We conducted a systematic literature review to assess the effectiveness of incentives in programs similar to the National DPP lifestyle change program. Manuscripts were included if they focused on the use of incentives in chronic disease lifestyle change programs in adults; occurred in high-to-middle income countries; were published in 2008-2019; and were written in English. Manuscripts were excluded if they focused on diet- or walking-only programs; medical interventions; screenings, pharmaceutical treatments, or one-time services; or had no comparison group. We examined the effectiveness of incentives for improving the following measures: weight, BMI, blood pressure, cholesterol, and HbA1c. We identified 21 studies that met our inclusion/exclusion criteria. Nearly all studies were randomized controlled trials, with general wellness programs in the workplace being the most common. The most common incentive characteristics by category were: type—cash (10/21); amount--$1-$25 (10/21); frequency—multiple times (17/21); amount variability—fixed (8/21); and certainty—criteria-based guaranteed (12/21). The direction of effect for incentives was favorable for 94/111 (85%) comparisons for the five health-related measures, of which 47/94 (50%) were statistically significant (p&lt;0.05). Only 2/111 (2%) comparisons were unfavorable and statistically significant. We did not identify particular incentive characteristics that were predictive of effectiveness, and we did not assess cost-effectiveness of incentives. Incentives may be useful for reaching health goals in lifestyle change programs and should be evaluated for cost-effectiveness if they are used.

Disclosure
C. Atkins: None. L. Hulbert: None. R. Skeete: None. S.L. Michael: None. B. Smith: None. M. Cannon: None.
822-P: Diabetes Prevention Care Preferences among People with Severe Mental Illness Taking Antipsychotic Medications
Authors: ITURRALDE ESTI , JONES ASHLEY L. , SLAMA NATALIE , KLINE-SIMON ANDREA H. , STERLING STACY , SCHMITTDIEL JULIE 
Published: June 2020

Background: People with severe mental illness (SMI), i.e., psychotic and major affective disorders, face twice the risk for developing type 2 diabetes. Antipsychotic medication treatment contributes to elevated risk through weight gain and other metabolic side effects. Although clinical trial evidence supports both lifestyle and pharmacological approaches to mitigate medication-induced weight gain and diabetes risk in SMI, research on patient preferences is lacking.
Methods: We conducted semi-structured interviews with adults who had SMI, were on antipsychotic medications, had no diagnosed diabetes, and were receiving psychiatric care in a large nonprofit health care system.
Results: A total of 36 individuals participated (72% women; ages 19-63 years; 42% non-White; 17% Medicaid). They were prescribed quetiapine (53%), olanzapine (31%), or risperidone or iloperidone (17%). Metabolic risk factors were common (obesity 67%, prediabetes 28%); 64% rated physical health as poor to fair; 89% cited excess weight or weight gain as a major health concern. Most (86%) reported past efforts at lifestyle modification to manage weight, with a third pursuing related health services (nutrition counseling, health classes). Barriers to lifestyle modification included time constraints, fluctuating motivation, and excess costs. We found low patient awareness of pharmacological strategies to manage diabetes risk (e.g., metformin), despite the majority of participants describing interest in this option. Participants perceived a role for both psychiatrists and primary care physicians in helping them manage diabetes risks.
Conclusions: Patients with SMI are receptive to multiple evidence-based diabetes prevention strategies that span primary care and specialty mental health care domains, including both medication and motivational supports, available at low cost and at convenient times.

Disclosure
E. Iturralde: None. A.L. Jones: None. N. Slama: None. A.H. Kline-Simon: None. S. Sterling: None. J. Schmittdiel: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases; Health Delivery Systems- Center for Diabetes Translational Research (NIDDK HDS-CDTR)
825-P: Effects of Family-Related Factors on Diabetes Self-Management Behaviors
Authors: LIN KEKE , QUINN LAURIE T. 
Published: June 2020

Many diabetes self-management behaviors (DSMB) take place in family settings, which highlights the importance of examining family-related factors associated with DSMB. Most current research has focused on the impact of family support on DSMB. Yet, how multiple family-related factors collectively affect DSMB remains unknown. The purpose of our study is to examine effects of positive family support, attitudinal familism, and perceived role demands associated with house chores and caregiving responsibilities on DSMB among a group of Chinese adults with type 2 diabetes mellitus (T2DM). A convenience sample of 210 patients with T2DM was recruited from a community health center in Beijing, China. Instruments included Diabetes Self-management Scale, Self-efficacy Scale for Patients with T2DM, Perceived Role Demands Scale, Attitudinal Familism Scale, and Diabetes Family Behavior Checklist-II. Findings from structural equation modelling showed that attitudinal familism, perceived role demands associated with house chores and caregiving responsibilities, and self-efficacy had direct impacts on DSMB. Attitudinal familism and positive family support both also had indirect effects on DSMB through self-efficacy (X2=3.31, p&gt;0.05; RMSEA=0.022, CFI=0.998, SRMR=0.013). The indirect effect of positive family support on DSMB was 0.24, Bootstrap standard error=0.13, z=5.08, p&lt;0.001; The indirect effect of attitudinal familism on DSMB was 0.15, Bootstrap standard error=0.04, z=3.44, p&lt;0.01. Our findings suggest that it will be beneficial to improve patients’ self-efficacy in order to achieve optimal DSMB, especially for those who have less family support and lower attitudinal familism scores. It also indicates that more perceived role demands associated with house chores and caregiving responsibilities leads to less adherence to DSMB, and this relationship cannot be mediated by self-efficacy. Other strategies should be developed to help those with heavy role demands to achieve optimal DSMB.

Disclosure
K. Lin: None. L.T. Quinn: None.
828-P: Challenges in Care Relationships in Diabetic Setting: The Diabetologists’ Perspective
Authors: MARCHINI FRANCESCO , LANGHER VIVIANA , CAPUTO ANDREA , GIULIANI CHIARA , CONVERTINO ALESSIO , NAPOLI ANGELA 
Published: June 2020

Purpose: Poor medication adherence in persons with diabetes is a well documented issue, overall leading to worse glycemic control and quality of life. Previous studies have shown that the quality of the patient-provider relationship is a crucial factor for patient diabetes management and self-care. Most of research has focused on patient perspective, with poor attention to providers’ relational skills to handle interpersonal difficulties concerning care challenges. The purpose of the present study was to explore providers’ subjective perspective about care relationship so to detect some clues that may contribute to better manage patient medication adherence.
Methods: A purposive sample of 18 Italian diabetologists participated in the study. Face-to-face interviews on providers’ emotional experience about care relationship were collected, digitally recorded, and transcribed. A computer-aided text analysis based on word co-occurrences was performed through T-Lab software, by using the conceptual model of Emotional Text Analysis. This allowed the identification of thematic domains pertaining to implicit sense-making processes, beyond the cognitive discourse organization.
Results: Six thematic domains were identified across interviews, which respectively referred to: (1) preoccupation, in terms of separation anxiety and desire for contact; (2) control, focused on hypervigilance and conflict management; (3) fear for excessive closeness and effort to distance; (4) proud self-affirmation in opposition to care burden; (5) guilt feelings and over-involvement; (6) strive for achievement and satisfaction gain.
Conclusions: The findings suggest the importance of providers’ awareness about potential defensive strategies in facing care challenges, from distancing to intrusive reactions, which may interfere patient health engagement and capacity to self-regulate in care behaviors, respectively.

Disclosure
V. Langher: None. A. Caputo: None. C. Giuliani: None. A. Convertino: None. A. Napoli: None.