bluuebunny/crossref_metadata_2025_split huggingface dataset:
444-P: Rates and Reasons for 30-Day Readmissions in Hospitalizations among Patients with Diabetes Mellitus Who Underwent Below-Knee Amputation: Analysis of the Nationwide Readmissions Database
Authors: CORPUZ CARLOS GABRIEL D. , SHAKA HAFEEZ , RAMIREZ MARCELO , AGUILERA MARIA C. , YAP SARA ELIZABETH T. , KICHLOO ASIM , MURTHI MUKUNTHAN , ATLURI RAMTEJ , GONAKOTI SRIRAM 
Published: June 2021

Introduction: Diabetes mellitus (DM) is the commonest cause of nontraumatic amputation worldwide. With increasing prevalence of DM, there has been an increase in the rate of below the knee amputations (BKA), usually in the setting of severe soft tissue infections and osteomyelitis. Readmissions are often related to prior admissions and account for significant and usually preventable healthcare cost burden. This study assessed the rate and reasons for 30-day readmissions (30DR) in DM patients with BKA with the aim of identifying preventable factors for readmissions.
Methods: The National Readmission Database for 2018 was queried for hospitalizations involving adult patients with DM who had BKA from January 1 to November 30, 2018. Elective and traumatic admissions were excluded. Outcomes assessed were 30DR rates, mortality, length of stay (LOS), hospitalization costs (THC) and top principal diagnosis for readmitted patients following BKA.
Results: A total of 15,090 hospitalizations involved adults with DM who had DKA as index admissions. The 30DR rate was 13.79%. The most common reasons for readmission were sepsis unspecified (18.4%), hypertension with CKD and heart failure (7.0%), DM angiopathy with gangrene (4.2%), acute renal failure (3.0%), and hypertension with heart failure (2.1%). Readmission was associated with higher odds of mortality (6.1% vs. 4.3%, OR: 1.45, 95% CI: 1.11 - 1.89, p=0.007) compared to the index admission. In patients with DM with BKA, readmissions accounted for a cumulative 18,078 days of hospitalization, which cost patients over $40 million within the period.
Conclusion: A significant proportion of patients with DM with BKA are readmitted for various complications. 30DR is associated with higher mortality and result in a significant cost burden to the patient and healthcare system. Mitigating the rate or readmissions would significantly improve patient outcomes.

Disclosure
C. D. Corpuz: None. H. Shaka: None. M. Ramirez: None. M. C. Aguilera: None. S. T. Yap: None. A. Kichloo: None. M. Murthi: None. R. Atluri: None. S. Gonakoti: None.
456-P: Ongoing Knowledge Gaps in Antiplatelet Therapy for High-Risk Diabetes Patients with CAD
Authors: KARANDREA SHPETIM , AGARWAL NEHA , JAMROGIEWICZ AMANDA 
Published: June 2021

Patients with diabetes and coronary artery disease (CAD) are at increased risk for atherothrombotic events compared to CAD patients without diabetes. Current antiplatelet therapy may not be adequate in these high-risk patients, and several recent clinical trials have evaluated the use of more potent agents in this setting. Therefore, it is crucial to educate clinicians about their results and clinical practical implications. CMHC organized a CME virtual symposium to educate multi-disciplinary clinicians and assessed the changes in knowledge and competence using pre-/post assessment questions. A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p &lt;0.05). The activity took place on Oct. 23, 2020, with participation of 263 healthcare professionals (MD/DO, PAs, RNs, NPs, PharmDs) representing specialties that treat high-risk diabetes patients with CAD (including 48% PCPs, 24% cardiologists, 23% endocrinologists). A slight increase in knowledge about recent clinical trial results was observed, though not statistically significant (9.2% relative increase in knowledge compared to baseline, p = 0.5). Conversely, a significant increase in competency in selecting correct treatment regimens to prevent adverse CVD events in high-risk diabetes patients with CAD was demonstrated (58% relative increased to baseline, p=.0002); however, only ~60% of participants opted for the correct option. According to post-activity evaluation (n=208), 29% identified insurance and financial issues, 28% identified formulary restriction, and 9% not knowing treatment-related adverse events as the primary barriers to implementing change in their practices. It is evident from the outcomes of this educational activity that there was a noticeable gap in attendee’s knowledge about advances in antiplatelet therapy in patients with diabetes and CAD. A series of educational activities is imperative to increase awareness and improve patient outcomes.

Disclosure
S. Karandrea: None. N. Agarwal: None. A. Jamrogiewicz: None.

Funding
AstraZeneca (62051961)
46-LB: Humor and A1C: The Interaction between Humor and Diabetes Control
Authors: GREENE DAVID S. 
Published: June 2021

Humor and A1C: The Interaction Between Humor and Diabetes Control There is increasing evidence of specific medical and psychological benefits associated with humor within diabetes populations. The benefits of maintaining good diabetes control are also well established. The more general relationship between humor and diabetes control however remains unexplored. The purpose of this study was to examine if there was a difference between people with diabetes with an A1C ≤ 6.99% versus those ≥ 7.0% on four disparate types of humor. The sample consisted of 284 participants, 65.5% with type 1 diabetes, 68.3% female, 89.1% Caucasian, and 68.7% college educated. Participants completed the Humor Styles Questionnaire (HSQ) and were divided into two groups, A1C ≤ 6.99% and A1C ≥ 7.0%. The A1C ≤ 6.99% group scored significantly higher on both types of positive humor, affiliative humor (P &lt; 0.01) and self-enhancing humor (P &lt; 0.05). There was no significant difference between participants on either type of negative humor, aggressive humor (P &gt; 0.05) or self-defeating humor (P &gt; 0.05). Results indicate that good control (A1C ≤ 6.99%) is associated with positive humor. These findings provide evidence that there is an association between American Diabetes Association recommended levels of control and positive humor styles. Implications are extensive and important. Regardless of if humor contributes to better control, or better control leads to a better sense of humor, humor is the common denominator. In either case the existence of positive humor is connected to reduced medical complications, psychological complications, and successful diabetes management. Since humor is free, readily available, and can be developed and strengthened, it is suggested as a viable treatment component. Furthermore, results confirm and add support to the evidence that including humor in diabetes education leads to improved diabetes education outcomes.

Disclosure
D. S. Greene: None.
465-P: Applying the Ancestral Knowledge System Framework to Interviews with Key Stakeholders Regarding a Gestational Diabetes Mellitus Risk Reduction and Reproductive Health Planning Program for American Indian Adolescent Females
Authors: CHARRON-PROCHOWNIK DENISE , SOON RENI , STOTZ SARAH A. , FISCHL ANDREA F. , GONZALES KELLY L. , MAU MARJORIE , MOORE KELLY R. 
Published: June 2021

Gestational Diabetes Mellitus (GDM) is the most common complication of pregnancy and potentially causes problemsfor both mother and baby, including risks of developing type 2 diabetes (T2D). Compared to other Americans, Indigenous youth have more risk factors and higher rates of GDM. We developed Stopping GDM a GDM risk reduction and reproductive health program for American Indian adolescent females. To further deepen the cultural strengths of the program we draw on constructs from Indigenous ways of knowing, such as Ancestral Knowledge System (AKS). We conducted a secondary analysis on an existing qualitative dataset collected during the Stopping GDM study using AKS as a secondary framework. Key constructs from AKS include: relationships, place-based knowledge, generational networks, holistic approaches, language, cultural heritage, and critical reflection. This dataset includes focus groups with AI adolescent girls (age 12-20) (n=13); their adult female caregivers (n=9); and AI women with a history of GDM or T2D (n=5) from two urban sites. All focus groups were moderated by a trained qualitative researcher with a notetaker and semi-structured moderator guide and analyzed using Atlas.ti. Four primary themes supported by the AKS framework constructs emerged: 1) the important and unique role of women in Native communities; 2) traditional ways as they relate to women, reproductive health, and wellness; 3) support for women’s wellness and reproduction; 4) social determinants as challenges for Indigenous communities in promoting healthy behaviors. These findings will be used to support expansion of Stopping GDM to increase its cultural relevance for a broader Indigenous priority audience which includes Native Hawaiian and Alaska Native communities.

Disclosure
D. Charron-prochownik: None. R. Soon: None. S. A. Stotz: None. A. F. Fischl: None. K. L. Gonzales: None. M. Mau: None. K. R. Moore: None.

Funding
National Institutes of Health (UL1TR001857 to D.C-P.); National Institute of Nursing Research (1R01NR014831-01A1 to D.C-P., K.R.M.)
466-P: Cultural Adaptation of a Diabetes Self-Management Education and Support Telehealth Intervention for Rural Colorado
Authors: OSER TAMARA , LITCHMAN MICHELLE L. , KWAN BETHANY , NEUBERGER JULIE , CURCIJA KRISTEN , BURKE SHAWNECCA , ZITTLEMAN LINDA K. , SIMONETTI JULIANA S. 
Published: June 2021

Diabetes impacts rural populations at higher rates compared to their urban counterparts. Diabetes self-management education and support (DSMES) is an evidence-based standard of care for people with diabetes. Yet, in rural areas, DSMES is often not available, culturally relevant, or integrated into primary care practices where many people receive diabetes care. This study uses a community-based participatory research (CBPR) approach to adapt the language, tools, and delivery of a DSMES program for use in Spanish and English-speaking populations in the High Plains Research Network in rural eastern Colorado. Boot Camp Translation (BCT) is a CBPR method that combines medical, research, and local community member expertise to create locally relevant language, messages and materials to promote discussion and action around a medical condition. For this study, community partners included 13 diverse community members (including bilingual Spanish-speakers, patients, caregivers, and healthcare providers). The group identified a particular need to increase awareness of the connection between diabetes and mental health, specifically depression, and diabetes burnout. Language and tools to address stigma and normalize the connection, talking points to initiate discussions with care teams, and calls for practices to increase screening for depression among patients with diabetes, are under development. Additional themes identified include incorporating nutrition information for food that is culturally appropriate and locally available, and integrating DSMES within the primary care practices where people with diabetes receive their care. Community engagement is crucial to support DSMES program adoption in rural communities.

Disclosure
T. Oser: Advisory Panel; Self; Cecelia Health, Dexcom, Inc., Advisory Panel; Spouse/Partner; Cecelia Health, Dexcom, Inc. M. L. Litchman: Research Support; Self; Abbott Diabetes. B. Kwan: None. J. Neuberger: None. K. Curcija: None. S. Burke: None. L. K. Zittleman: None. J. S. Simonetti: Consultant; Self; Rhythm Pharmaceuticals, Research Support; Self; Rhythm Pharmaceuticals .

Funding
National Institute of Nursing Research; National Institutes of Health (1R56NR019466-01)
470-P: Usability and Satisfaction of a Mobile Application to Support Individuals with Insulin Therapy Management
Authors: SIMINERIO LINDA M. , BEDNARZ LORI L. , DEJESUS CARLA , NG JASON , REYNOLDS SHARI L. , KRALL JODI S. 
Published: June 2021

People with type 2 diabetes mellitus (T2DM) continue to be reluctant to begin insulin therapy. Methods to assure education access and support are critically important. To supplement health care provider efforts, the BD Diabetes Care App was developed to offer information on injection administration and self-management strategies. Ongoing support is built into the app in the form of articles and videos related to starting and using insulin. The purpose of this study was to evaluate patient and educator usability of and satisfaction with the app.
Methods: Patients &gt;18 years with T2DM, new to or identified as having issues with insulin therapy were recruited from in- and outpatient settings. Participants received insulin education according to standard practice and were then introduced to the app. Over the study period, participants were able to use the app as much or as little as preferred; use was tracked with app analytics. HbA1c was measured at baseline and 3 months and satisfaction surveys were administered.
Results: Participants (n=22) were 27% female, 73% White Non-Hispanic, mean age 55 years, with baseline mean HbA1c of 11%. Glycemic control significantly improved during the study period, with an average reduction in HbA1c of 3.2±2.9%. All participants used the app; 86% launched it within one day of enrollment. Average use was 11 times over the course of the study, 55% were considered highly engaged (consistently used app over the course of study). Participants were most likely to access curriculum (articles and videos) about insulin pen therapy followed by living with diabetes. Most participants found the app easy to use (75%), visually appealing (81%), to contain helpful content, especially articles (77%); 73% said that they would recommend the app to another person with diabetes. Educators reported high satisfaction and a positive experience in using the app.
Conclusion: The BD Diabetes Care App offers a promising approach to support patients starting and using insulin.

Disclosure
L. M. Siminerio: Advisory Panel; Self; Abbott Diabetes, Bayer U. S., Research Support; Self; Becton, Dickinson and Company. L. L. Bednarz: Other Relationship; Self; Medtronic, Tandem Diabetes Care. C. Dejesus: None. J. Ng: Research Support; Self; Sanofi-Aventis. S. L. Reynolds: None. J. S. Krall: Research Support; Self; Becton, Dickinson and Company, Sanofi.

Funding
BD
5-OR: Health Disparities in People with and without Diabetes during the COVID-19 Pandemic
Authors: MYERS BARBARA A. , KLINGENSMITH RACHEL , DE GROOT MARY 
Published: June 2021

Purpose: To characterize the psychosocial experiences of adults with (PWD) and without diabetes (ND) during the COVID-19 pandemic. US adults (2176) completed a web-based survey in May-June, 2020 and November-December, 2020, including demographics, COVID-19 exposure, diabetes-related distress (DDS-17), depressive symptoms (PHQ-8) and anxiety (GAD-7). At baseline, mean age was 49.6 years (S.D. = 16.9), 80% female, 88.3% White, with an annual household income of ≥ $60,000 (57.6%), type 2 diabetes (T2D; 301,13.9%), 145 prediabetes (145, 6.6%) and type 1 (T1D, 100, 4.6%). One-third (29.7%) reported decreased income due to the pandemic. T2Ds had more medical comorbidities and COVID risk factors than T1Ds and NDs (all p &lt; 0.01). Mean PHQ-8 scores were 7.1 (S.D. = 5.8; mild), with the T2Ds (M = 7.7; S.D. = 5.9) exceeding NDs (M = 6.9; S.D. = 5.7; p&lt;.001). Mean DDS-17 and GAD-7 scores were comparable for T1Ds and T2Ds (moderate level; p=NS). At 6 months (6MFU), 1,345 (62.6%) completed follow up surveys. Completers were more likely to be older, male, White, married, with higher education levels, and homeowners, with a greater proportion of medical comorbidities and lower A1cs at baseline than non-completers (all p&lt;.05). 6MFU completers had lower baseline depressive symptoms and diabetes distress, lower household COVID-19 rates and less difficulty paying bills than non-completers (all p&lt;.05). At 6MFU for all groups, depressive symptoms decreased (p&lt;.0001) and financial strain improved (p&lt;.001), while COVID exposure increased (personal and household, p&lt;.001). Diabetes distress remained at a moderate level for T1Ds and T2Ds. T1Ds and T2Ds showed comparable levels of depressive symptoms to NDs but were more likely to report financial hardship (p&lt;.05) and difficulty paying bills than NDs (p&lt;.001).
Health outcomes were worse for PWDs compared to NDs during the COVID-19 pandemic despite high SES protective factors. Persistent financial strain and diabetes distress increase the risk for future poor health outcomes.

Disclosure
B. A. Myers: None. R. Klingensmith: None. M. De groot: Consultant; Self; Johnson & Johnson.
500-P: Determinants of Exercise-Induced Increase in Insulin Sensitivity
Authors: KUMAR ARATHI PRABHA , DASARI SURENDRA , PATAKY MARK W. , CROOK JULIA , BALL COLLEEN T. , KLAUS KATHERINE , LANZA IAN R. , ROBINSON MATTHEW M. , NAIR K. SREEKUMARAN 
Published: June 2021

Exercise training enhances insulin sensitivity (Si) in humans. However, it is to be determined which phenotypic and muscle molecular changes underwrite this change in Si. We sought to understand the mechanisms behind increased Si following 12 weeks of high intensity aerobicinterval (HIIT), resistance (RT), or combined (CT) exercise training in 30 young and 24 old humans. Measurements included Si estimated from a two-stage hyperinsulinemic-euglycemic clamp, and a host of independent variables including VO2 peak, muscle mitochondrial respiration, Liver FWF (Fat-Water-Fraction), visceral and subcutaneous fat, and gene expression from muscle biopsies. We performed a univariate and multivariate analysis of Si vs. phenotypic changes induced by training. After adjusting for age, sex and exercise group, VO2max was positively associated with an increase in Si from pre to post exercise (p=0.032). Interestingly, within the RT group alone, positive association between VO2max and Si (p=0.05) and negative association between liver FWF and Si (p=0.034) were observed. Within the HIIT group, there was a positive association between muscular strength and Si (p=0.04). Separate multivariate models assessed the effect of muscle gene expression changes on Si while adjusting for age, training type, response to training, VO2max, and mitochondrial function. Enrichment Analysis of genes associated with Si showed upregulation of genes in Branched-Chain Amino Acid (BCAA) and Lysine metabolism, although the latter was specifically upregulated with HIIT. Products of lysine metabolism, such as alpha-aminoadipic acid have been implicated in development of insulin resistance and BCAA are involved in signaling of insulin response. A strong positive association of Si with both BCAA (FDR 0) and lysine metabolism (FDR 0.008) following HIIT and a weaker correlation between Si and BCAA metabolism (FDR 0.002) following RT indicates the role of muscle AA metabolism as a common factor contributing to enhanced Si following exercise training.

Disclosure
A. Prabha kumar: None. S. Dasari: None. M. W. Pataky: None. J. Crook: None. C. T. Ball: None. K. Klaus: None. I. R. Lanza: None. M. M. Robinson: Stock/Shareholder; Self; GE Healthcare. K. Nair: None.

Funding
National Institutes of Health (R01AG09531)
510-P: Prevalence of Mental, Behavioral, and Developmental Disorders among Youth with Diabetes, United States (2016-2019)
Authors: BARRETT CATHERINE E. , BULLARD KAI M. , PARK JOOHYUN , KOYAMA ALAIN , MERCADO CARLA , CLAUSSEN ANGELIKA H. , NEWSOME KIM , PAVKOV MEDA E. 
Published: June 2021

Diabetes (DM) is among the most common chronic diseases diagnosed in youth in the United States. In adults, a bi-directional relationship has been demonstrated between DM and mental, behavioral, and developmental disorders (MBDD). Such comorbidities may significantly impact the quality of life of patients with DM and disease management. However, little is known about the association of DM and MBDD in youth. To examine the magnitude of overlap between these chronic conditions, we calculated prevalence estimates using the 2016-2019 National Survey of Children’s Health, an annual, cross-sectional survey of non-institutionalized US children aged 0-17 years (N = 131,774). Parents were asked if their child was ever diagnosed with DM or with any of the following MBDDs: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, learning disability, intellectual disability, developmental delay, anxiety, depression, behavioral or conduct problems, Tourette syndrome, or speech disorder. We present crude prevalence estimates and predictive margins adjusted for age, sex, and race/ethnicity, both weighted to be representative of the US youth population. Among US youth, prevalence estimates were 0.45% (95%CI: 0.36-0.55) for DM and 22.7% (22.2-23.2) for any MBDD. Crude prevalence of any MBDD varied by DM status (DM: 43.7% [34.5-53.4]; no DM: 22.6% [22.1-23.1]). Compared with youth without DM, those with DM had a higher adjusted prevalence of any MBDD (prevalence ratio: 1.55 [1.20-2.00]) and individual MBDDs (p &lt;.05), except for ADHD, Tourette syndrome and speech disorder. These results suggest a significant health burden with more than 2 out of 5 youth with DM having any MBDD. Future work examining potential causal pathways could be beneficial. Understanding associated factors may ultimately lead to future preventative strategies for MBDD and DM in youth.

Disclosure
C. E. Barrett: None. K. M. Bullard: None. J. Park: None. A. Koyama: None. C. Mercado: None. A. H. Claussen: None. K. Newsome: None. M. E. Pavkov: None.