bluuebunny/crossref_metadata_2025_split huggingface dataset:
461-P: A Day in the Life of a Person with Diabetes Mellitus: An Experiential Learning Initiative
Authors: GOLTZ JOSEPH D. , MORSI AMR , LIBMAN INGRID , ISMAIL HEBA M. 
Published: June 2021

Background: Despite the increased use of diabetes related technology, patient outcomes remain suboptimal and there remains a gap in the understanding of these devices among medical trainees as well as a gap in relating to patients’ experiences. We aimed to improve understanding of diabetes technology as well as increase empathy for patients among trainees. In this pilot study, we proposed a novel model of diabetes teaching through experiential learning to address these deficits.
Methods: Participants (medical trainees) followed simulated type 1 diabetes (T1D) clinical management scenarios for 2 days designed to replicate the typical daily life of individuals with T1D. They wore and used insulin pumps (using saline) and continuous glucose monitors (CGMs). We evaluated their understanding of diabetes technologies and empathy for patients via mixed-method surveys (on a Likert scale) administered before and after following these scenarios.
Results: Pediatric endocrine fellows (n=7), pediatric residents (n=2), and 1 medical student participated. Trainees’ confidence in diabetes management and self-perceived capability of answering questions pertaining to insulin pumps were enhanced following participation [(3.10±0.99 vs. 3.90±0.57) and (2.80±0.92 vs. 3.80±0.92), respectively]. Trainees’ knowledge of diabetes management and self-perceived capability of answering CGM questions increased marginally [(3.30±0.82 vs. 3.80±0.42) and (3.14±1.07 vs. 3.57±0.98), respectively]. Participation positively changed their understanding, empathy, and overall perspective of patients’ daily challenges in 90% of participants.
Conclusions: Our experiential learning model provides an effective template and basis to address deficits in understanding of diabetes care and enhance empathy for those living with T1D. Future research could integrate this learning model into medical training programs across multiple centers in order to further assess its feasibility among a larger cohort.

Disclosure
J. D. Goltz: None. A. Morsi: None. I. Libman: Advisory Panel; Self; Novo Nordisk. H. M. Ismail: None.

Funding
National Institutes of Health (T32DK06446, KL2TR002530, UL1TR002529); National Center for Advancing Translational Sciences; University of Pittsburgh
463-P: Fuel Expenditure and Deposition in Tissues after Exercise or Low-Fat Diet in Obese Female and Male Mice
Authors: AN JULIA , ZHU LIN , YU SOPHIA , EDINGTON EMERY , LITTS BRIDGET , STAFFORD JOHN M. 
Published: June 2021

We hypothesized that a healthy diet and exercise improve energy metabolism through different pathways in males and females. Understanding the mechanism for a how healthy diet vs. exercise improves metabolic outcomes is important for intervention through lifestyle change to target risk factors for obesity-associated diseases in specific populations. Mice were fed a high-fat diet (HFD) for 12 weeks, then divided into 4 groups, followed for 6 weeks: a. HFD; b. HFD + exercise; c. the diet was switched to chow; d. diet-switch + exercise. Instead of acute metabolic effects, we investigated sustained effects of exercise by examining tissue glucose uptake and metabolism 48 hours after the last exercise session. Diet-switch and exercise reduced obesity and fat contents in tissues in both sexes. Muscle glucose uptake was higher in males than females and not different between treatments 48 hours after exercise session. Liver glucose uptake was higher in males than females. Exercise, but not diet-switch, lowered liver glucose uptake, which effect was greater in males than females. Glucose uptake in subcutaneous, visceral, and brown adipose tissues was higher in females than males. Diet-switch, but not exercise, reduced glucose uptake in brown fat, which effect was greater in females than males. Furthermore, Diet-switch decreased the pathways for adipocyte differentiation (PPARγ) and lipogenesis (DGAT1/2) in subcutaneous adipose tissues in females. Muscle protein levels of CPT1β and pACC were increased by diet-switch in both sexes, and by exercise in males only. Our data indicate: 1) adipose tissue nutrient storage is the major energy reservoir that protects against obesity-related metabolic changes in females; 2) with regard to improving metabolic outcomes, diet-switch benefits females more and exercise benefits males more; for both sexes 3) exercise training is more effective in preventing fatty liver than diet-switch, and 4) both diet-switch and exercise promote fat oxidation in muscles.

Disclosure
J. An: None. L. Zhu: None. S. Yu: None. E. Edington: None. B. Litts: None. J. M. Stafford: None.

Funding
National Institutes of Health (R01HL144846)
464-P: Does the Referral Source Influence Retention in Community Diabetes Prevention Programs
Authors: KOEPPEN HALLIE , TYSK SONJA , HOUSE MELISSA , FERNANDES JESSIE , HARWELL TODD S. , HELGERSON STEVEN D. , GOHDES DOROTHY M. 
Published: June 2021

The Montana Diabetes Prevention Program (DPP), with over 20 community sites, has tracked participants in a statewide registry since the inception of the program in 2008. Montana’s DPP sites conduct the standard lifestyle intervention in the fall and the spring of each year, recruiting group participants who have been referred from the surrounding community. Because retention in the program is key for success, we used data from the registry to ascertain if the referral source influenced the hazard of dropout among DPP participants. From the 2015 fall cohort through the fall cohort of 2019, 3,030 participants were eligible for analyses and referral information was available for 75.2% (2,280). The three primary referral methods were: physician referral (n=914), referral by a former DPP participant (n=422), and referral by a friend or family member (n=393). We conducted a survival analysis using the last DPP session attended as a measure for dropout. Backwards selection was used to identify significant covariates for inclusion in the adjusted model. A significant difference in time to dropout by type of referral was observed (p=0.0045). When compared to participants referred by a friend or family member and after adjusting for age, income, and distance traveled, the hazard of dropout was 17.4% higher for participants who were referred by a physician (HR: 1.174, 95% CI: 1.014, 1.395, p=0.0321) and 26.5% higher for participants who were referred by a former DPP participant (HR: 1.265, 95% CI: 1.057, 1.513, p=0.0103). These findings suggest that enlisting support from friends and family members may be helpful in retaining participants referred by physicians or former DPP participants.

Disclosure
H. Koeppen: None. S. Tysk: None. M. House: None. J. Fernandes: None. T. S. Harwell: None. S. D. Helgerson: None. D. M. Gohdes: None.

Funding
Centers for Disease Control and Prevention (NU58DP006517)
47-LB: Patient Factors Associated with Diabetes Distress among Veterans with Poorly Controlled Type 2 Diabetes
Authors: GERMAN JASHALYNN , KOBE ELIZABETH A. , SOLIMAN DIANA , LEWINSKI ALLISON , JEFFREYS AMY S. , COFFMAN CYNTHIA , EDELMAN DAVID , CROWLEY MATTHEW J. 
Published: June 2021

Diabetes distress (DD), the psychological distress specific to living with diabetes, is associated with poor glycemic control. This study sought to examine the association of diabetes distress with demographic, clinical, and psychosocial factors in a vulnerable population. The Diabetes Distress Scale (DDS), a validated patient questionnaire that assesses perceived problems and burdens associated with diabetes management, yields a total diabetes stress score plus 4 subscale scores: emotional burden (EB), physician distress (PD), regimen distress (RD) and interpersonal distress (ID). We conducted a cross-sectional analysis of baseline data from a randomized telehealth trial in a population of Veterans with persistently poor T2DM control (HbA1c ≥8.5) (N= 248). Multivariable linear regression models were used with baseline patient characteristics as independent variables and DD score as the dependent variable, and separate models for the 4 subscales of the DDS were created. Mean age of the cohort was 58 years (SD 8.3); 21% of patients were female, 79% non-white with 14 being Latinx/Hispanic. Prevalence of moderate to severe DD was 37.5% (mean DDS 1.19 (SD 0.82). In the multivariable model, Latinx/Hispanic ethnicity β 0.4 (95% CI: .01, 0.8) and higher HbA1c 0.1 (.01, 1.3) were associated with higher total DD. With respect to the DDS subscales, higher HbA1c 0.14 (0.1, 0.2) was associated with higher RD. Latinx/Hispanic ethnicity 0.8 (0.2, 1.3) was associated with higher ID. Use of basal insulin was associated with higher PD 0.3 (.001, 0.6). Depression was associated with higher total DD 0.1 (0.1, 0.1), EB 0.1 (0.1, 0.1), PD .02 (.001, 0.1), RD 0.1 (0.1, 0.1) and ID .05 (0.03, 0.1). The knowledge gained from this study has implications for practice, particularly in developing interventions targeting modifiable barriers, including patient attitudes and beliefs regarding treatment regimens and diagnoses and treatment of depression.

Disclosure
J. German: None. E. A. Kobe: None. D. Soliman: None. A. Lewinski: Consultant; Self; Otsuka America Pharmaceutical, Inc., Other Relationship; Self; PhRMA Foundation. A. S. Jeffreys: None. C. Coffman: None. D. Edelman: None. M. J. Crowley: None.
475-P: School Nurses Report Low Confidence in Many Skills with Diabetes Devices
Authors: MARCH CHRISTINE , HILL AMBER L. , KAZMERSKI TRACI M. , SWITZER GALEN E. , WALLACE EILEEN , SIMINERIO LINDA M. , MILLER ELIZABETH , LIBMAN INGRID 
Published: June 2021

New diabetes devices are increasingly standard of care for pediatric type 1 diabetes management. Youth often need caregiver assistance to use these devices, including at school. The aim of this study was to assess school nurse confidence with devices, which, to our knowledge, no study has previously evaluated. School nurses in Pennsylvania were recruited to complete a questionnaire, designed by our group and demonstrating content validity, evaluating confidence in specific skills. Each item was scored on a 5-point scale with low confidence considered a response of 1-2, moderate confidence 3, and high confidence 4-5. Respondents (n=269) were 99% female, 96% white, and mean age was 52 years. The majority had experience with insulin pumps (95%) and continuous glucose monitors (CGM, 92%), but not sensor-augmented pumps (34%). Primary forms of device training were informal learning from parents (68%), other nurses (49%), or web searches (49%); fewer (37%) received formal training from a medical center. Median response for insulin pump-related items was 3.1/5 and for CGM items 3.5/5, suggesting moderate confidence overall. We found a moderate positive correlation between confidence with pumps (0.47, p&lt;0.001) or CGM (0.48, p&lt;0.001) with confidence in general nursing skills; we did not find a significant association (p&gt;0.05) between device confidence and years of experience as a school nurse, grades covered, or geographic region. A high proportion of nurses reported low confidence with certain skills, including operating a sensor-augmented pump (63%), setting a temporary basal rate (58%), changing the pump site (54%), knowing when CGM calibration is appropriate (48%), overriding pump calculations (42%), monitoring a CGM tracing (42%), or suspending insulin delivery (40%). Our findings suggest that school nurse confidence with diabetes devices varies by type of skill. Further validation of this questionnaire may help identify gaps in skills and tailor education as newer technology continues to emerge.

Disclosure
C. March: None. A. L. Hill: None. T. M. Kazmerski: None. G. E. Switzer: None. E. Wallace: None. L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. E. Miller: None. I. Libman: Advisory Panel; Self; Novo Nordisk.

Funding
Cochrane Weber Endowment Award
477-P: The National Diabetes Prevention Program (National DPP): What the New Variables Are Telling Us about Outcomes
Authors: ELY ELIZABETH , BELL MIRIAM 
Published: June 2021

In 2018, the Centers for Disease Control and Prevention (CDC) began requiring organizations recognized through the National DPP Diabetes Prevention Recognition Program (DPRP) to collect new information from participants at the time of enrollment: referral source (ENROLL), payer source (PAYER), and highest level of completed education (EDU). Of the 354,616 participants who enrolled in, and had the opportunity to complete, the National DPP lifestyle change program as of October 2020, analyses were restricted to the 63,598 who enrolled from March 2018 through February 2019 to ensure that information was complete. With respect to referral source, participants who decided on their own to enroll (option of “self”), or who reported the option of “primary care provider/office or specialist”, attended the most sessions on average (17.6 and 17.5 sessions, respectively). The least number of sessions attended (mean of 13.7) was associated with those who reported the option of “employer or employer’s wellness program.” While most participants reported a PAYER option of “private insurer”, they attended a mean of 14.2 sessions. The mean number of sessions attended by those reporting a PAYER of “Medicare” was 19.2. College graduates reported attending the most sessions, on average, 15.1, yet 50% attended at least 12. Fifty percent of those with less than a high school education attended at least 15 sessions. With respect to mean weight loss % and referral source, the highest (5.6%) was achieved by those who chose the ENROLL option of “media.” Those who chose “employer or employer’s wellness program” lost the least, 3.7%. When stratified by PAYER, those who chose “Medicare” lost the most weight (6.9% on average). Level of education did not have much impact on mean weight loss with a range of 4% to 4.5% across the four options. The collection of this additional information provides important insights into who is currently meeting programmatic goals.

Disclosure
E. Ely: None. M. Bell: None.
482-P: Comprehension of Medicare Program and Participation of Diabetes Self-Management Training among Medicare Beneficiaries with Diabetes
Authors: NG BOON PENG , TOWNE SAMUEL D. , LAMANNA JACQUELINE B. , KIM KIYOUNG 
Published: June 2021

Poorly managed diabetes can lead to complications which account for a large portion of diabetes costs. Although diabetes self-management programs have been shown to be effective in reducing the risk of complications, low uptake of diabetes self-management training (DSMT) has been reported. Identifying factors associated with participation in DSMT among Medicare beneficiaries (MBs) with diabetes can provide information to improve uptake of these programs. DSMT is a Medicare-covered benefit. We analyzed the nationally representative 2018 Medicare Current Beneficiary Survey PUF of MBs aged ≥ 65 years with reported type 2 diabetes (n=1,056). A survey-weighted logistic model, adjusted for socio-demographics and co-morbidities, was performed to examine the relationship between participation of DSMT and two binary variables including: 1) whether providers gave instructions on how to take care of one’s health; and 2) whether the Medicare program was easy/difficult to understand. Of study MBs, 49.6% self-reported participation in DSMT (a rate higher than other studies analyzing claims data). DSMT participants had higher rates of reporting the Medicare program was easy to understand (73.3% vs. 66.1%), and that providers gave instructions on how to take care of one’s health (68.0% vs. 64.0%) than non-DSMT participants. Among the study MBs, those reporting the Medicare program was easy to understand were more likely to participate in DSMT (odds ratio (OR)=1.40, p&lt;0.046). Surprisingly, those reporting that providers gave instructions on how to take care of one’s health were not significantly associated with the participation of DSMT (OR=1.12, p&lt;0.506). Our finding highlights that a better comprehension of the Medicare Program has a positive impact on the participation of DSMT. Interventions to improve MBs’ understanding of the Medicare program and associated benefits may increase participation in DSMT.

Disclosure
B. Ng: None. S. D. Towne: None. J. B. Lamanna: None. K. Kim: None.
486-P: Does Racial Homogeneity within an Organization Affect Non-Hispanic Black Participant Performance Outcomes in the National Diabetes Prevention Program (National DPP)
Authors: LANDAU ERIN O. , ELY ELIZABETH 
Published: June 2021

The National DPP is a partnership of public and private organizations working together to build a nationwide infrastructure to deliver a lifestyle change program proven to prevent or delay onset of type 2 diabetes in adults with prediabetes. As of October 2020, there have been 444,087 eligible participants, in 1,342 organizations, ever enrolled in the National DPP lifestyle change program. This analysis only included participants who met the requirements of program completion prior to March 1, 2020 (82,021 in 1,013 organizations). Of these participants, 10,612 were classified as Non-Hispanic/Black Only (N-HB) based on their reported race identification. The N-HB participants were divided into 2 groups: Primarily N-HB organization enrollment (more than half of participants in the organization identify as N-HB: 3,344 in 122 organizations) and non-Primarily N-HB organization enrollment (≤ half of the participants in the organization identify as N-HB: 7,268 in 891 organizations). Primarily N-HB organizations achieved at least preliminary recognition at a slightly higher rate (93.4%) than non-Primarily N-HB organizations (90.6%). However, Primarily N-HB organizations were less likely to meet the requirements for full recognition (51.6%) than non-Primarily N-HB organizations (67.5%). For Primarily N-HB organizations that achieved preliminary recognition, 85% missed the requirement of 5% weight loss. For most, this was the only missed requirement. However, despite the failure to achieve 5% weight loss, N-HB participants in Primarily N-HB organizations lost more weight (4.7%) than N-HB participants in non-Primarily N-HB organizations (4.3 %), and more than N-HB participants overall (4.4 %). These results could indicate that N-HB participants perform better with regards to weight loss when they enroll in Primarily N-HB organizations as opposed to non-Primarily N-HB organizations.

Disclosure
E. O. Landau: None. E. Ely: None.
49-OR: Changes in Regional Cerebral Blood Flow during Hypoglycemia in T1DM
Authors: SIMONSON DONALD C. , BOLO NICOLAS R. , THEBERGE JEAN , MUSEN GAIL , JACOBSON ALAN M. 
Published: June 2021

Regulation of cerebral blood flow (CBF) during hypoglycemia (HYPO) is critical for maintaining adequate glucose delivery to the brain; however, specific changes in regional CBF during HYPO are not well defined. We measured CBF in 14 T1DM (mean ± SD age 31 ± 7 yrs, DM duration 16 ± 5 yrs, A1c 7.2 ± 1.0 %) and 13 healthy controls (CON; age 35 ± 11 yrs, A1c 5.2 ± 0.5 %) using 3.0 T MRI continuous arterial spin labeling during fasting baseline (BAS), a hyperinsulinemic (2 mU/kg/min) euglycemic clamp (EUG; 90 mg/dl), followed by a hypoglycemic clamp (HYPO; 50 mg/dl). Global and regional changes in CBF were measured in 15 regions of interest (ROI). At BAS, gray matter CBF was similar in CON and T1DM (58 ± 16 vs. 61 ± 11 ml/100 gm brain/min). No significant changes in CBF were observed from BAS to EUG in any brain region in either CON or T1DM. However, during HYPO in T1DM, CBF increased by 10% in gray matter and 16% in brainstem, both p &lt;0.05. CBF also increased by 10% - 18% in specific ROIs involved in awareness of internal states, reward and emotion (orbitofrontal cortex, insula, anterior cingulate cortex, thalamus, and substantia nigra; p&lt;0.01 to p&lt;0.05). Minimal increases in CBF (1% - 6%) were observed in regions primarily involved in sensory or motor function, (occipital cortex, motor cortex, cerebellum, caudate, putamen) or in the posterior cingulate (all p &gt; 0.30). In CON, no significant global or regional changes in CBF occurred during HYPO. In all subjects, higher A1c correlated with greater increases in CBF during HYPO (p&lt;0.05).
Conclusions: 1) Hyperinsulinemia per se does not alter CBF in T1DM or CON, 2) During HYPO, brain blood flow increases more in T1DM vs. CON, especially in regions involved in integration of internal awareness, reward and emotion, compared to sensory or motor function, and 3) Greater increases in CBF in subjects with higher A1c suggest that compensatory physiologic mechanisms enable subjects with chronic exposure to hyperglycemia to maintain adequate cerebral glucose supply when plasma glucose levels are suddenly reduced.

Disclosure
D. C. Simonson: Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc. N. R. Bolo: None. J. Theberge: None. G. Musen: None. A. M. Jacobson: None.

Funding
National Institutes of Health (DK073843)
491-P: Severe Muscle Insulin Resistance in Inuit Homozygous Carriers of the Common Greenlandic P.Arg684Ter TBC1D4 Variant Is Improved by a Single Bout of Exercise
Authors: KRISTENSEN JONAS M. , LARSEN TRINE L.J. , CARL CHRISTIAN S. , THORUP ANETTE , HINGST JANNE , ONSLEV JOHAN , OLESEN JESPER S. , PEDERSEN MICHAEL L. , RICHTER ERIK A. , HANSEN TORBEN , JØRGENSEN MARIT E. , WOJTASZEWSKI JØRGEN F.P. 
Published: June 2021

In the Greenlandic Inuit population a common nonsense TBC1D4 p.Arg684Ter variant in muscle is found with an allele frequency of 17%. Homozygous carriers of this variant have impaired glucose tolerance, and a 10-fold increased risk of type 2 diabetes. Here we investigate whether the TBC1D4 p.Arg684Ter affects regulation of skeletal muscle glucose uptake during exercise and during insulin stimulation in the post exercise period. Inuits carrying zero (n=8) or two (n=8) alleles of TBC1D4 p.Arg684Ter were recruited from population surveys in Greenland. Glucose tolerance was measured during a 6 hour oral glucose tolerance test (OGTT). Skeletal muscle glucose uptake was measured by applying arterial-venous balance technique across the legs during one-legged exercise and during subsequent euglycemic hyperinsulinemic clamp. Glucose uptake was measured in both the rested and the exercised leg. During the OGTT blood glucose was similar at fasting but markedly elevated (by 4.4 mM) in TBC1D4 p.Arg684Ter carriers compared to matched controls at 2 hours, and variants became hypoglycemic at 4 hours (3.3 vs. 4.7 mM) and similar to controls at 6 hours. During exercise, TBC1D4 variant carriers and controls displayed similar glucose uptake in skeletal muscle. During insulin clamp, glucose uptake in the previously rested leg was lower (~50%) in TBC1D4 variant carriers compared to controls. In the prior exercised leg, glucose uptake during the insulin clamp was higher in both groups compared to the rested leg. However, glucose uptake in the previously exercised leg from TBC1D4 variant carriers was comparable to the previously rested leg in controls and thus still markedly lower than controls.
In conclusion: TBC1D4 p.Arg684Ter carriers have impaired insulin stimulated but normal exercise stimulated glucose uptake in skeletal muscle. A single bout of exercise improves muscle glucose uptake in carriers to levels seen in non-exercise muscle of controls.

Disclosure
J. M. Kristensen: None. T. Hansen: None. M. E. Jørgensen: Research Support; Self; Boehringer Ingelheim International GmbH, Sanofi-Aventis, Stock/Shareholder; Self; Novo Nordisk A/S. J. F. P. Wojtaszewski: None. T. L. J. Larsen: None. C. S. Carl: None. A. Thorup: None. J. Hingst: None. J. Onslev: None. J. S. Olesen: None. M. L. Pedersen: None. E. A. Richter: None.

Funding
Novo Nordisk Foundation (NNF14OC0013057, NNF17OC0028136); Independent Research Fund Denmark (FSS802000288B5855628)