bluuebunny/crossref_metadata_2025_split huggingface dataset:
48-LB: Associations between Health Literacy and Patient Perceptions of Care in Poorly Controlled Diabetes
Authors: KOBE ELIZABETH A. , GERMAN JASHALYNN , SOLIMAN DIANA , ALEXOPOULOS ANASTASIA-STEFANIA , JEFFREYS AMY S. , EDELMAN DAVID , COFFMAN CYNTHIA , CROWLEY MATTHEW 
Published: June 2021

Background: Low health literacy (HL) is a barrier to improving health outcomes in patients with type 2 diabetes (T2DM). The Newest Vital Sign (NVS) is a validated, short questionnaire for assessing HL. The relationship between NVS HL and patient-reported diabetes behavioral and patient-provider interaction measures, particularly among patients with poor glycemic control, is currently unknown.
Methods: Cross-sectional analysis of baseline data of 248 Veterans with poorly controlled T2DM (maintenance of hemoglobin A1c (HbA1c) ≥8.5% despite engagement with diabetes care) from a randomized trial of a telehealth intervention. NVS was collected at baseline, along with other demographic, clinical, and psychosocial metrics. We used multivariable regression with restricted cubic splines for continuous covariates to explore associations between baseline NVS and four measures (Diabetes Knowledge Questionnaire (DKQ), Diabetes Self-Management Questionnaire (DSMQ), Perceived Competence Scale (PCS), and Healthcare Climate Questionnaire (HCCQ)).
Results: The sample had a mean age of 58.1 (SD = 8.3) years, was 78.6% male and 76.2% non-White. Average HbA1c was 9.8 (SD = 1.5) and average NVS was 3.4 (SD = 2.0). After adjusting for demographic, clinical, and psychosocial factors, NVS was significantly associated (linearly) with DKQ and PCS scores, but not DSMQ or HCCQ scores. For every 1-point increase in NVS, the DKQ score increased by 0.33 (95% CI 0.13, 0.52, P = 0.0010) and PCS score decreased by 0.11 (95% CI -0.21, -0.0081, P = 0.034), indicating that higher HL is associated with higher diabetes knowledge and lower perceived competence.
Conclusions: The direct association of NVS HL with DKQ scores is consistent with literature using other HL metrics among general T2DM populations; however, the indirect association of NVS HL with PCS scores is less intuitive, suggesting a possible misplaced confidence among patients with higher HL yet poor glycemic control despite diabetes care engagement.

Disclosure
E. A. Kobe: None. J. German: None. D. Soliman: None. A. Alexopoulos: None. A. S. Jeffreys: None. D. Edelman: None. C. Coffman: None. M. Crowley: None.

Funding
National Center For Advancing Translational Sciences (TL1TR002555 to E.A.K.); U.S. Department of Veterans Affairs (IIR 16-213 to M.C.)
483-P: Remote Diabetes Care, Education, and Support Encounters in Adults with Type 1 Diabetes
Authors: GREENFIELD MARGARET , STUBER DIANA L. , STEGMAN-BARBER DANIELLE , KEMMIS KAREN , WELLS BETH A. , MCARTHUR TERESA S. , MATTHEWS BELINDA , MORLEY CHRISTOPHER P. , WEINSTOCK RUTH S. 
Published: June 2021

Aim: To understand how remote Certified Diabetes Care and Education Specialists (CDCES) helped adults with type 1 diabetes (T1D) transition from provider in-person to tele-visits.
Methods: Adults with T1D were referred to remote CDCES to fulfill needs from 4/16/2020 - 8/14/2020. Pertinent information from the EMR was provided to the CDCES who were not previously known to the patients. A summary of the remote CDCES encounter was communicated to the provider. Data analysis used t-tests to assess differences in means and Pearson correlation coefficients to assess relationship between the number of encounters and insurance and age. SPSS v. 27 was used.
Results: Adults (n=1089) with T1D [mean age 46 (range 18-90 yrs); 50% female; 20% Medicaid, 23% Medicare, 54% private coverage; mean A1c 8.4% (range 4.6 to &gt;14.0%); 52% pump and 61% CGM users], had 1662 encounters with remote CDCES. Of those referred, 232 (21%) could not be reached or did not receive education/support. Older age was associated with more encounters (r=0.126, p&lt;0.001) as was coverage with Medicare (mean 1.9) vs. private insurance (mean 1.3; p&lt;0.001) vs. Medicaid (mean 1.6; NS). A1c was negatively correlated with age (r=-0.195, p&lt;0.001). During remote encounters the most frequently discussed topics were CGM (64%), insulin pumps (48%), tele-visit preparation (37%) and hypoglycemia (24%); device download training (46%) and CGM education/data review (58%) was provided to participants. Lack of access to a computer, tablet, smartphone or internet was seen in 14%; mean age of those without vs. with access was 51 vs. 45 yrs (p&lt;0.001).
Conclusions: Most remote CDCES encounters in adults with T1D were successfully completed, assisting the majority with CGM education/data review and nearly half with device download training in preparation for their provider tele-visit. Older adults and those with Medicare required more encounters to fulfill needs. Future study could assess whether remote encounters result in improved glycemic control or quality of life.

Disclosure
M. Greenfield: None. D. L. Stuber: None. D. Stegman-barber: None. K. Kemmis: None. B. A. Wells: None. T. S. Mcarthur: None. B. Matthews: None. C. P. Morley: None. R. S. Weinstock: Research Support; Self; Boehringer Ingelheim International GmbH, Diasome Pharmaceuticals, Inc., Eli Lilly and Company, Insulet Corporation, Kowa Research Institute, Inc., Medtronic, Tolerion, Inc.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust; T1D Exchange QI Learning Collaborative
489-P: Facilitating Collaboration through TeleECHO Education in Diabetes
Authors: ALLEN RUSSIE , WELCH LAUREN K. 
Published: June 2021

Project ECHO is a collaborative model of medical education that engages clinicians in a continuous learning system via real-time, interactive videoconferencing. During TeleECHO sessions, expert specialist teams at an academic ‘hub’ are linked with care teams in local communities throughout the world. Each session is case-based, with learners and faculty presenting their patient experiences in a HIPAA compliant manner, promoting collaboration and competence building. As an official ECHO hub, MLG recently completed a large-scale, TeleECHO series on treating to guidelines and managing cardiovascular and renal risk in patients with T2DM, consisting of 47 sessions that reached 1976 healthcare professionals. With the ongoing COVID-19 pandemic, these sessions provided a unique way to facilitate a case-based dialogue among community-based practitioners and a national expert, sharing best practices that to apply to the care of individual patients. MLG recorded each session and used the most informative cases to create an enduring activity that is available for one year online. To further support the translation of education into practice and encourage HCP-patient dialogue, MLG also provided learners access to an online Personalized Poster Portal. Learners could choose a variety of images and design a poster that was shipped to their practice setting. There have been 613 poster orders thus far. The outcomes that MLG has collected regarding this unique program and its point-of-care tools indicate how CME can lead to not only improved knowledge but can also translate to practice behavior. While learners demonstrated significant gains across learning objectives, baseline knowledge of the latest data on the use of GLP-1 receptor agonists and SGLT2inhibitors to reduce cardiovascular events demonstrated a need for such education. MLG proposes to partner with Project ECHO to share these results via a poster at the ADA Scientific Sessions.

Disclosure
R. Allen: None. L. K. Welch: None.
490-P: Success of a Multidisciplinary Approach Strategy to Reach Target Glycemic Control in Patients with Uncontrolled Diabetes in a Rural Hospital in Thailand
Authors: LIMPIJANKIT VARISA , CHOTTHUNYAPAT SASINUN , KRUACHAI PETCH , KHAMPETDEE SUNANTA , OP-UN PANIDA , WANTHONG DUANGRAT , AUNLAMAI NUTTAYA , PETCHAI DONLAYA , NOORAPAN JUTARAT , MATIDTO SUNISA , TECHATHAWEERIT PATTARAPORN , LIMPIJANKIT THOSAPHOL 
Published: June 2021

Background: To prevent the late complications, achieving a target glycemic control is crucial and challenging, especially in a remote area with limited resource. We aimed to evaluate the efficacy of a multidisciplinary approach strategy to control blood sugar in these uncontrolled diabetes patients.
Method: During July 2019, we set up a team of volunteer including a diabetic educator and local healthcare providers such as doctors, nurses and pharmacists at a hospital in Northeast of Thailand. Forty patients with uncontrolled diabetes (HbA1c &gt;7%) were selected to participate. Baseline characteristic, background knowledge and blood tests were obtained. All patients participated in a one day program learning hands on using blood sugar meter (Contour plus™) to monitor during diet control, medication issue, foot care and complication prevention. Two weeks later, we revisited and reviewed the daily blood sugar record at home and gave more advice. At 1 year, we collected the blood tests, medication list, and complication from medical records.
Results: Most participants were female (89.7%), age &lt;60 years (61.5%) and overweight with BMI&gt;23 kg/m2 (53.8%). Comorbid disease including hypertension, dyslipidemia and chronic kidney disease were found in 66.7%, 23.1% and 25.6%, respectively. At 1 year, there was a significant improvement of blood sugar control (HbA1c &lt;7%) compared to the baseline (18.2% vs. 64.9%, p&lt;0.0001). The number of medication use mostly unchanged (64.4%), with 20.5% decrease and 12.8% increase. Of noted, there was improvement of renal function (GFR&gt; 60 mL/min/1.73 m2) after better glycemic control (71.8% vs. 74.4%, p=0.032) and no new complication at 1 year.
Conclusions: Applying a short program of multidisciplinary approach strategy in uncontrolled diabetes patients at a rural hospital has proven an efficacy to improve target glycemic control. To make it sustainable is feasible by the local healthcare providers.

Disclosure
V. Limpijankit: None. S. Matidto: None. P. Techathaweerit: None. T. Limpijankit: None. S. Chotthunyapat: None. P. Kruachai: None. S. Khampetdee: None. P. Op-un: None. D. Wanthong: None. N. Aunlamai: None. D. Petchai: None. J. Noorapan: None.
502-P: Introduction of a Gluten-Free Diet in Children with Type 1 Diabetes and Coeliac Disease Did Not Impact Glycemic Control, Nutrient Intake, or Quality of Life at Three Months
Authors: MARLOW ALEXANDRA L. , KING BRUCE R. , JOHNSON SHAUN E. , BINKOWSKI SABRINA K. , FAIRCHILD JAN , DAVIS ELIZABETH A. , SMART CARMEL E. 
Published: June 2021

Studies on how a gluten free (GF) diet in youth with T1D and CD impacts glycemic control, quality of life (QoL) and nutrient intake are limited. The study aim was to determine the effects of the introduction of a GF diet in children with T1D and newly diagnosed CD on glycemic control, nutrient intake, QoL and body mass index (BMI). Subjects wore a continuous glucose monitor for 12 days and completed a 4-day food record at baseline and 3 months after implementing a GF diet. Participants and one parent completed the PedsQL questionnaire at baseline and 3 months. Ten children participated (age 10.8y ± 3.3, 40% male, BMI Z-score 0.5 ± 0.6, diabetes duration 2.2y ± 2.6 (50% with diabetes duration of &lt;12 months), 60% on multiple daily injections, 20% on insulin pump therapy and 20% on twice-daily injections, HbA1c 6.0 ± 1.1%). BMI Z-score (0.4 vs. 0.5, p=0.73), glycemic variability % CV (40.4% vs. 40.2%, p=0.94), HbA1c (6.0% vs. 5.8%, p=0.56), percentage glucose time above target range &gt;180mg/dL (30.3% vs. 36.1%, p=0.09) and below target range &lt;70mg/dL (7.2% vs. 7.9%, p=0.76) did not change significantly from baseline to 3-months, however time in range (TIR) 70-180mg/dL (62.6% vs. 56.0%, p=0.02) was significantly lower at 3 months. Intake of fibre (18g vs. 16g, p=0.40), iron (9g vs. 8g, p=0.35), calcium (826mg vs. 791mg, p=0.75) and saturated fat (13.5% vs. 14.0%, p=0.77) were not significantly different from baseline to 3 months. QoL score was not significantly different for parents (63.2 vs. 67.4, p=0.08) or children (56.8 vs. 63.5, p=0.08) from baseline to 3 months. This study suggests that implementation of a GF diet in children with T1D does not adversely impact glycemic control, nutrient intake, QoL or BMI Z-score. The only change in glycemic control reduced TIR at 3 months which may represent changing insulin requirements with gut healing and the end of the remission phase of T1D.

Disclosure
A. L. Marlow: None. B. R. King: None. S. E. Johnson: Consultant; Self; Medtronic. S. K. Binkowski: None. J. Fairchild: None. E. A. Davis: None. C. E. Smart: None.

Funding
Australasian Paediatric Endocrine Group; Pfizer Inc. (WI205278)
52-OR: Risk Factors and Incidence over Time for Lower Extremity Amputations in Persons with Type 1 Diabetes: An Observational Cohort Study of 46,008 Patients from the Swedish National Diabetes Registry
Authors: HALLSTRÖM SARA , SVENSSON ANN-MARIE , PIVODIC ALDINA , OLAFSDOTTIR ARNDIS F. , LONDAHL MAGNUS , WEDEL HANS , LIND MARCUS 
Published: June 2021

Background: Lower extremity amputations in people with diabetes is a major source of disability and distress and it constitutes a significant financial burden for the healthcare system. Risk factors and current risks for amputation in persons with type 1 diabetes have not been extensively studied.
Methods: Persons with type 1 diabetes registered in the Swedish National Diabetes Registry with no previous amputation from 1998 and followed until 2019 were included. Time-updated Cox regression and gradient of risk per SD were used to evaluate the impact of risk factors on the incidence of amputation. Age and sex adjusted incidences were estimated over time.
Findings: Of 46,008 persons with type 1 diabetes with no previous amputation and a mean age of 32.5 years (SD 14.5) and 25 354 (55%) male, 1,519 (3.3%) underwent amputation. Median follow-up was 12.4 years. The age and sex adjusted incidence for any amputation decreased over time. The standardized incidence was 1998-2001 2.84 (95% CI 2.32-3.36) per 1000 patient years and decreased to 1.64 (95% CI 1.38-1.90) in 2017-2019 along with improved glycaemic control (0.02% [95% CI 0.02-0.02] per year) and renal function (0.23 ml/min/1.73m² [95% CI 0.21-0.24] per year). Risk factors for amputations were hyperglycemia, renal dysfunction, older age, male gender, cardiovascular comorbidities, smoking and hypertension.
Interpretation: Prognosis has improved considerably regarding the risk of amputations in persons with type 1 diabetes while glycaemic control and renal function improved which were the most prominent risk factors.

Disclosure
S. Hallström: None. A. Svensson: None. A. Pivodic: None. A. F. Olafsdottir: None. M. Londahl: Advisory Panel; Self; Abbott, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk, Sanofi. H. Wedel: None. M. Lind: Consultant; Self; AstraZeneca, Eli Lilly and Company, Other Relationship; Self; Novo Nordisk, Research Support; Self; Dexcom, Inc.

Funding
Novo Nordisk Foundation; Swedish State
536-P: Resilience in Real Time: Parents of Youth with Type 1 Diabetes (T1D) Summer 2020 Psychosocial Experiences
Authors: JONES JASMINE N. , CARREON SAMANTHA A. , ROONEY KELLYANN , WANG CHRISTINE H. , TULLY CARRIE , MONAGHAN MAUREEN , STREISAND RANDI , HILLIARD MARISA E. 
Published: June 2021

Objective: The COVID-19 pandemic disproportionately impacts parents, people with health risks like diabetes, and those with fewer financial resources. Minorities face particularly negative outcomes of the pandemic, and racial tensions after George Floyd’s murder may have worsened effects. We examined group differences by race/ethnicity and socio-economic status (SES) in depressive symptoms and protective factors in parents of children with T1D in summer 2020.
Methods: Participants were n=100 parents (98% mothers) of youth with T1D (60% female, M age=6.7±1.6 yrs, M T1D duration = 2.9±.5 yrs), who completed a behavioral RCT ≥6 months prior. In July/July 2020, parents self-reported on awareness of how to obtain housing/financial/food resources (Protective Factor Survey Concrete Support [PFS-CS] subscale) and depressive symptoms (Center for Epidemiological Studies -Depression [CES-D]). Race/ethnicity (66% non-Hispanic white, 12% non-Hispanic Black, 11% Hispanic, 11% other) and health insurance (33% public, 67% private) were reported at RCT enrollment. We ran ANOVAs and Pearson correlations to compare CES-D and PFS-CS by demographic groups.
Results: PFS-CS scores differed significantly by race/ethnicity and insurance status, both p&lt;.01. Hispanic (M=1.6±0.5) and non-Hispanic Black (M=1.6±0.6) parents had higher CS than non-Hispanic white parents (M = 1.3±0.3). Those with public insurance (M = 1.6±0.5) had higher CS than those with private insurance (M = 1.3±0.3). Higher CS correlated with lower CES-D, r = -.26, p = .05. CES-D did not differ across groups.
Conclusion: Racially/ethnically diverse and lower SES parents of children with T1D reported more knowledge about how to access useful resources. This may have buffered against elevated mood symptoms during co-occurring major societal and public health stressors in 2020. Highlighting sources of support and resilience may be a useful strategy in strength-based interventions for parents of children with T1D.

Disclosure
J. N. Jones: None. S. A. Carreon: None. K. Rooney: None. C. H. Wang: None. C. Tully: None. M. Monaghan: None. R. Streisand: None. M. E. Hilliard: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK102561)
570-P: Impact of Psychosocial Factors, Self-Efficacy, Knowledge, and Nutrition Using 12-Week Courses on Diabetes Management for Veterans
Authors: FARRELL NANCY , SHAHEED JENNIFER S. , DAVIS JANEL , VALENCIA GEMARIAH , CLARK RALPH , COLELLA DANIEL J. 
Published: June 2021

Background: Approximately 25% of U.S. veterans have diabetes and suffer from psychosocial complications. The Diabetes Empowerment Group (DEG), developed by Loma Linda VA Hospital’s Behavioral Medicine Service, is a 12-week interdisciplinary group to help veterans manage their diabetes. Curriculum included values assessment, SMART goal setting, stress management, problem solving, mindful eating and nutritional education.
Methods: Veterans attended their respective 12-week DEG group. Hemoglobin A1c levels were measured and participants completed QI measures at the beginning and end of their group cycles. Scores on QI measures were used to determine if group content impacted veterans’ HbA1c levels, diabetes-related psychosocial self-efficacy, knowledge, emotional distress, confidence to perform management behaviors and depressive symptoms. Paired sample t-tests compared pre- and post-group values.
Results: Eighty veterans completed lab work and QI measures. Significant mean differences were found between scores on pre- and post-treatment measures for A1c levels, depressive symptoms, diabetes knowledge, distress, psychosocial self-efficacy and confidence to manage their diabetes. Post-treatment scores were significantly lower than pre-treatment scores for A1C levels, depressive symptoms, and diabetes distress. Post-treatment scores were significantly higher than pre-treatment scores for diabetes knowledge, psychosocial self-efficacy, and confidence.
Conclusion: Findings expand on a previous QI study and demonstrate the efficacy of the DEG group at helping manage diabetes, reducing biopsychosocial complications and increasing knowledge. Future options for QI include evaluation of future programs (e.g., Diabetes Support Grp and DEG mobile app) to support current and alumni group members with maintenance of diabetes management skills learned.

Disclosure
N. Farrell: None. J. S. Shaheed: None. J. Davis: None. G. Valencia: None. R. Clark: None. D. J. Colella: None.
571-P: Motivation, Self-Efficacy, Social Support, and Patient Activation among Racially/Ethnically Diverse Adults with Prediabetes
Authors: RODRIGUEZ LUIS A. , THOMAS TAINAYAH , FINERTIE HOLLY , TURNER CASSIE D. , HEISLER MICHELE , SCHMITTDIEL JULIE 
Published: June 2021

Background: Black, Latino, and Asian Americans experience higher diabetes incidence rates compared to White adults. According to self-determination theory, psychosocial factors such as autonomous motivation, self-efficacy, perceived social support and patient activation influence the likelihood of initiating and engaging in health behaviors that prevent diabetes. Whether these psychosocial factors differ by race/ethnicity among adults with prediabetes and if these may contribute to observed racial/ethnic disparities in diabetes incidence is unknown.
Methods: Using baseline survey data from a diabetes prevention intervention study at Kaiser Permanente Northern California and Michigan Medicine, we measured autonomous motivation and self-efficacy on a 1-7 scale, perceived social support on a 12-72 scale, and activation on a 0-100 scale. Multivariable linear regression models estimated mean racial/ethnic differences, adjusting for age, sex and clinic.
Results: Of 296 prediabetic adults, 40% were White, 37% Black, 10% Latino, and 6% Asian American. Mean autonomous motivation was high (6.6/7) and did not differ by race/ethnicity (all p-values &gt;0.05). Self-efficacy was higher for Black vs. White adults (6.1 vs. 5.7; p-value &lt; 0.05). Black and Latino adults had higher values of perceived social support compared to White adults, and Asian American adults had the lowest (all p-values &lt; 0.05). Mean activation was higher in Asian American and Latino compared to White adults, but lower in Black adults (p-values &lt; 0.05).
Conclusion: Autonomous motivation was high in adults with prediabetes, underscoring the opportunity to address diabetes prevention efforts at the population level. However, Asian American adults reporter lower social support and Black adults reported lower patient activation than other groups. Differences in these psychosocial factors should be considered when tailoring diabetes prevention efforts and outreach.

Disclosure
L. A. Rodriguez: None. T. Thomas: None. H. Finertie: None. C. D. Turner: None. M. Heisler: None. J. Schmittdiel: None.

Funding
Permanente Medical Group; National Institute of Diabetes and Digestive and Kidney Diseases (T32DK11668401)