bluuebunny/crossref_metadata_2025_split huggingface dataset:
856-P: Long-Term Benefits of Multicomponent Integrated Care Program Participation on Diabetes Care Goals: The DIABEMPIC Program
Authors: SILVA-TINOCO RUBÉN , DELATORRE-SALDAÑA VIRIDIANA , CUATECONTZI-XOCHITIOTZI TERESA , GONZALEZ-CANTU ARNULFO , CASTILLO-GALINDO CARMEN , PIMENTEL-HERNÁNDEZ BLANCA , ROMERO-IBARGUENGOITIA MARIA ELENA , NÚÑEZ-RODRÍGUEZ ADRIÁN , OROZCO-GUTIÉRREZ FRANCISCO , GALLARDO-HERNÁNDEZ ALBERTO , OCHOA-MORENO JORGE 
Published: June 2021

Diabetes burden is greater in low- middle-income countries, where large gaps exist in achieving diabetes care goals. We examined a quality initiative multicomponent integrated care (MIC) program (DIABEMPIC, DIABetes EMPowerment and Improvement of Care) on diabetes care goals in adults with type 2 diabetes (T2D) implemented in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa. DIABEMPIC is a 5-month empowerment-based program that includes an interdisciplinary case management team, diabetes self-management education, shared medical appointments, a patient-centered approach, and audit and feedback. At the end of the program patients continue routine care in public primary care units. We report the effect of the intervention on diabetes care goals at the end of the program and 18 months after the initial recruitment (long-term evaluation). Results: 704 patients with T2D completed the program, and 182 already have a long-term evaluation. The mean (SD) age of this subgroup was 57 (10.9) years, 67% female, 61% had elementary or less education, 68% had medium-low or lower socioeconomic status, mean diabetes duration was 13 (8) years, and mean A1c was 9.5% (2.2). After the program (n=182) systolic and diastolic blood pressure (-11, -4 mmHg respectively), A1c (-2.6%), and non-HDL cholesterol (-29 mg/dl) decreased significantly (p&lt;0.0001). Clinical benefits persisted in long-term evaluation in systolic and diastolic blood pressure (-9, -3 mmHg respectively, p&lt;0.0001), A1c (-1.4%, p&lt;0.0001), and non-HDL cholesterol (-11 mg/dl, p=0.018). Conclusions: This quality-of-care initiative had valuable short and long-term effects on diabetes care goals in a real-world setting. The long-term impact is smaller than the impact observed at the end of the intervention. This work suggests further replication of the intervention and enhances the need to improve routine follow-up in primary health units after the participation in MIC programs.

Disclosure
R. Silva-tinoco: None. A. Gallardo-hernández: None. J. Ochoa-moreno: None. V. Delatorre-saldaña: None. T. Cuatecontzi-xochitiotzi: None. A. Gonzalez-cantu: None. C. Castillo-galindo: None. B. Pimentel-hernández: None. M. Romero-ibarguengoitia: None. A. Núñez-rodríguez: None. F. Orozco-gutiérrez: None.
859-P: Impact of a Prediabetes Clinical Decision Support System on CV Risk Factor Control in Primary Care: Randomized Trial
Authors: DESAI JAY R. , CRAIN A. LAUREN , SAMAN DANIEL , SPERL-HILLEN JOANN M. , ALLEN CLAYTON , WARING STEPHEN , OHNSORG KRIS , APPANA DEEPIKA , DEHMER STEVEN P. , EKSTROM HEIDI , O’CONNOR PATRICK J. 
Published: June 2021

Purpose: We designed, implemented, and evaluated impact of a prediabetes clinical decision support system on identification of prediabetes and control of major cardiovascular (CV) risk factors in adults with prediabetes receiving care in primary care clinics.
Methods: We randomized 34 primary care clinics with 18,229 study-eligible patients age 40-75 years at index encounter with laboratory evidence of prediabetes to usual care (UC) or a prediabetes clinical decision support (PreD-CDS) intervention condition. Study-eligible patients and their primary care clinician (PCC) were given patient-specific treatment suggestions to support diagnosis of PreD and control of systolic BP (SBP), low-density lipoprotein cholesterol (LDL), smoking, and Body Mass Index (BMI, Kg/m2). Electronic medical record (EHR) and other data were analyzed using linear and logistic mixed models to account for nested data structures.
Results: At index visit study subjects were 50.7% female, 97.1% white, mean age 60.9 years, 56.7% not diagnosed with PreD, 17.2% current tobacco smokers, and mean age 60.9 years, BMI 33.6 Kg/m2, SBP of 151 mmHg, and LDL 118 mg/dl. Compared to UC clinics, those receiving care at PreD-CDS clinics had no significant change in likelihood of PreD diagnosis, mean SBP, mean LDL, mean BMI, or smoking (all p &gt;.05).
Conclusions: This point-of-care EHR-linked web-based clinical decision support system had no statistically significant impact on diagnosis of prediabetes or CV risk factor control. Alternative methods of improving care for these vulnerable patients are needed.

Disclosure
J. R. Desai: None. H. Ekstrom: None. P. J. O’connor: None. A. Crain: None. D. Saman: None. J. M. Sperl-hillen: None. C. Allen: None. S. Waring: None. K. Ohnsorg: None. D. Appana: None. S. P. Dehmer: None.

Funding
National Heart, Lung, and Blood Institute (R01HL128201)
879-P: Dropout Risk and Effectiveness of Retention Strategies: A Substudy of the Memory Advancement by Intranasal Insulin (INI) in Type 2 Diabetes (MemAID)
Authors: KHAN FAIZAN , ISAZA-PIEROTTI DANIEL F. , NOVAK PETER , MANTZOROS CHRISTOS , NGO LONG H. , NOVAK VERA 
Published: June 2021

Effective recruitment and retention strategies in clinical trials are essential to achieve the enrollment goals. We aimed to identify baseline characteristics predicting dropouts and analyze the effect of retention strategies within the MemAID elderly cohort. The trial consisted of 12 visits during 24 weeks of INI/placebo treatment and 24 weeks of follow-up. Retention strategies were implemented 2 years after the beginning of the study and included incentives (meals, stipend, transportation), revised eligibility criteria, and flexibility in scheduling. A total of 244 participants (122 female; 65.8 ± 9.1 years old, 115 diabetes (DM)) were randomized, and completed baseline (223), treatment (174), and follow-up (156). After randomization, 65 participants (27%, 30 DM [46%]) dropped out. Dropouts occurred earlier in the study (19.6% cumulative failure at 100 days) as compared to later (25.3% cumulative failure at 300 days). Cox models showed no risk of dropout with DM diagnosis, but increased risk (p&lt;0.05) with less education, unmarried status, longer DM duration, higher HbA1c, and no antidiabetic drugs. After retention strategies, the dropout rate per month decreased from 4.1 to 1.8% (p=0.04). These strategies attenuated the risk of dropping out of unmarried status and higher HbA1c. Baseline characteristics allow to predict a risk for dropping out in elderly participants. Retention strategies that increase incentives and lessen the study burden on older participants may be effective to minimize the impact of dropout-related risk factors. Further research into efficacy of retention strategies in elderly DM population is needed (NCT02415556).

Disclosure
F. Khan: None. D. F. Isaza-pierotti: None. P. Novak: Other Relationship; Self; Dysimmune Foundation, Endonovo Therapeutics, Oxford Press. C. Mantzoros: Advisory Panel; Self; Amgen Inc., GENFIT, Intercept Pharmaceuticals, Inc., Novo Nordisk, Regeneron Pharmaceuticals Inc. L. H. Ngo: Consultant; Self; Five Islands Consulting, Other Relationship; Self; Radiological Society of America. V. Novak: Advisory Panel; Spouse/Partner; Endonovo Therapeutics, Inc., Consultant; Spouse/Partner; Dysimmune Foundtation, Other Relationship; Spouse/Partner; Oxford University Press.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK103902); U.S. Food and Drug Administration (IND107690); Novo Nordisk (ISS-001063), Medtronic (NERP15-0310); World Health Organization (UTN-U111-1175-1588)
88-OR: Evaluation of a New Neural Network Classifier for Diabetic Retinopathy
Authors: KATZ OR , PRESIL DAN , COHEN LIZ , NACHMANI ROI , KIRSHNER NAOMI , OWENS DAVID R. , LEV TSVI H. , HADAD AVIEL 
Published: June 2021

Background: Medical image segmentation is a well-studied subject within the field of image processing. The goal of this research is to create an AI retinal screening grading system that is both accurate and fast. We introduce a new segmentation network which achieves state-of-the-art results on semantic segmentation of colour fundus photographs. By applying the network to identify anatomical markers of diabetic retinopathy (DR) and diabetic macular edema (DME) including: micro-aneurysms, haemorrhages, etc., we collect sufficient information to classify patients into R0 (no DR) and R1 or above (DR), as well as M0 (no DME) and M1 (DME).
Methods: The AI grading system was trained on public and private screening data to evaluate the presence of DR and DME. The system’s core algorithm is a novel deep learning segmentation network (W-net) that locates and segments relevant anatomical features in a retinal image. Both eyes of the patients are graded individually, based on the detected features and classified according to the standard feature-based grading protocol used in the NHS Diabetic Eye Screening Programme.
Results: The algorithm performance was evaluated with a series of patient retinal images from routine diabetic eye screenings and achieved state-of-the-art results. It correctly predicted 98% of retinopathy events (95% confidence interval [CI], 97.1-98.8) and 68.9% of maculopathy events (95% CI, 58.1-79.7). Non-disease events prediction rate was 68.6% for retinopathy and 81.3% for maculopathy.
Conclusion: This novel deep learning segmentation model trained on a colour fundus photograph data set and tested on patient data from annual diabetic retinopathy screenings can detect and classify with high accuracy the DR and DME status of a person with diabetes. The system can be easily reconfigured according to any grading protocol, without starting a long AI training procedure. The incorporation of the AI grading system can increase the graders’ productivity and improve the final outcome of the screening process.

Disclosure
O. Katz: Employee; Self; NECAM, Research Support; Self; Northgate Public Services. D. Presil: Employee; Self; NECAM, Research Support; Self; Northgate Public Services. L. Cohen: Employee; Self; NECAM, Research Support; Self; Northgate Public Services. R. Nachmani: Employee; Self; NECAM, Research Support; Self; Northgate Public Services. N. Kirshner: Employee; Self; NEC, Research Support; Self; Northgate Public Service. D. R. Owens: Advisory Panel; Self; 360 Consulting. T. H. Lev: Employee; Self; NECAM (NEC Corporation of America), Research Support; Self; Northgate Public Services. A. Hadad: Consultant; Self; Necam.
882-P: QBSAFE: Pilot Study of an Intervention to Shift the Paradigm of Diabetes Care
Authors: CLARK JENNIFER , BOEHMER KASEY , BRESLIN MAGGIE , HAIDER SHANZAY , PASCIAK WERONIKA , GRAVHOLT DEREK , SANCHEZ BRIANNA B.M. , HARTASANCHEZ SANDRA A. , EL KAWKGI OMAR M. , MONTORI VICTOR M. , LIPSKA KASIA J. 
Published: June 2021

Background: Diabetes care has traditionally focused on targeting certain levels of glycemic control. This narrow emphasis may impose burdens on patients, including high treatment costs, illness-related work, or medication side effects, while leaving other needs and goals under-addressed.
Methods: In order to shift the focus of care for people with diabetes to Quality of life, Burden of treatment, Safety, and Avoidance of Future Events (QBSAFE), we developed a set of 14 conversation cards that addressed these QBSAFE domains and could be used during routine clinical encounters. We then conducted a single-arm pilot study assessing the feasibility and acceptability of the QBSAFE cards during clinical visits. Visits were video recorded to identify patterns of clinician-patient conversations. Post-visit surveys were sent to patients and clinicians to measure acceptability of the intervention. Qualitative semi-structured interviews for additional feedback and analysis were also performed in a subgroup of patients.
Results: Seven clinicians and 83 patients (54% male, mean age 63 years [SD 15], 80% white) participated in the study. Among patient participants, 63% reported QBSAFE cards were helpful and 76% felt that other patients like them would benefit from their use. In qualitative interviews, patients who responded with ‘neutral’ or ‘disagree’ categories reported feeling they could bring up QBSAFE topics without the cards due to an established, positive relationship with their clinician. Among clinician participants, 90% reported feeling confident addressing issues raised by the cards, 78% would use them again, and 82% would recommend them to their colleagues.
Discussion: With high acceptability among clinicians and patients, the QBSAFE cards have the potential to shift conversations during clinical encounters and address patient needs, symptoms, and capacity. These data suggest that a clinician-level cluster randomized trial to compare the impact of this intervention versus usual care is needed.

Disclosure
J. Clark: None. V. M. Montori: None. K. J. Lipska: None. K. Boehmer: None. M. Breslin: None. S. Haider: None. W. Pasciak: None. D. Gravholt: None. B. B. M. Sanchez: None. S. A. Hartasanchez: None. O. M. El kawkgi: None.

Funding
National Institute on Aging (5R21AG061427-02)
887-P: Moderator Role of Family Protective Factors on the Association between Family Structure Type and Obesity in Children
Authors: SONG MINKYOUNG , HAYMAN LAURA L. , DIECKMANN NATHAN , MUSIL CAROL 
Published: June 2021

Purpose: Current literature indicates that childhood obesity is associated with family structure type. For example, children living in grandparent-headed households are more likely to be obese compared to children living in two-parent headed households. However, little is known about the conditions that might interact with family structure to influence children’s obesity. Since family protective factors are known to directly influence childhood obesity, we examined whether two specific family protective factors might moderate the association between family structure type and childhood obesity.
Methods: We utilized data from the 2017-2018 National Survey of Children’s Health (n=24,800). Multivariable logistic regressions were used to assess the moderating effect of “family resilience” and families eating meals (7 vs. &lt; 7 days/week). We controlled for child’s sex, age, race/ethnicity, health insurance, number of adverse childhood experiences, and physical activity level. We tested the moderating effect of family resilience and family meals as dichotomous variables, on the association between family structure type and obesity.
Results: In the fully adjusted models, we observed no significant moderating effect of family resilience on the association between family structure type and childhood obesity. There was a moderating effect of the family meal variable: In grandparent-headed households (compared to two-parent headed households), children were significantly less likely to be obese when families ate meals together 7 days/week (adjusted odds ratio [aOR] =0.95) vs. &lt; 7 days/week (aOR = 2.55). In single-parent headed households, the association did not differ significantly by that variable (aOR =1.02 vs. 1.46).
Conclusion: Our results provide evidence that eating meals together is one family protective factor that could be important considerations when developing family-based obesity interventions for children living with their grandparents.

Disclosure
M. Song: None. L. L. Hayman: None. N. Dieckmann: None. C. Musil: None.
907-P: Diabetes-Inspired Culinary Education (DICE): An Innovative Approach to Type 1 Diabetes Management through Culinary Medicine
Authors: MCMANUS CATHERINE R. , BARKOUKIS HOPE , KIM ROY , NGUYEN JULIA 
Published: June 2021

Despite the critical role nutrition plays in T1DM management and growth/development, youth with TIDM consistently have poorer diet qualities compared with their healthy counterparts. While culinary medicine is an area of research that is still in its infancy, initial studies have demonstrated success in improving youth diet quality and dietary and disease management outcomes in individuals with T2DM. Yet despite its great potential to elicit positive behavior change among youth with T1DM, this area of research is under-explored. Therefore, Diabetes Inspired Culinary Education (DICE), a community-based culinary medicine program aiming to improve diet quality and disease management among 6-14 year old youth with T1DM, was developed and assessed for feasibility and potential efficacy in a pilot study. The DICE program included ten, 90-minute lessons delivered weekly at a community teaching kitchen and included: hands-on, age-appropriate culinary education; nutrition and diabetes education delivered through experiential learning; a group family meal prepared by participating youth; and culinary/mealtime goal-setting. Baseline and post-test outcomes were assessed on participating families at the child- (food preparation self-efficacy (SE), involvement, attitude; dietary intake; diabetes management; diabetes quality of life; hgbA1c; BMI), primary caregiver- (dietary intake; diabetes management SE; mealtime SE; BMI) and family-level (family food preparation; mealtime environment). Feasibility was evaluated using participant attendance, retention and a program-specific fidelity tool. Eleven families were recruited and 8 completed (73% retention) the program. On average, 78% of participating families attended weekly lessons. Improvements in primary caregiver SE for healthy mealtime behaviors (p=0.02) and family food preparation (p=0.05) were observed at post-test, inferring potential program efficacy.

Disclosure
C. R. Mcmanus: None. H. Barkoukis: None. R. Kim: None. J. Nguyen: None.
909-P: Telemedicine Visits Attendance and Perception among Pediatric Patients with Type 1 Diabetes
Authors: DEMETERCO-BERGGREN CARLA , GOTTSCHALK MICHAEL 
Published: June 2021

COVID-19 pandemic has triggered the widespread adoption of Telemedicine (TM). As physical distancing measures were established, we rapidly shifted our outpatient appointments to TM. Here we show findings regarding patient TM perception and attendance. Patient demographics and attendance to in person and TM outpatient encounters from January to July 2020 were reviewed. A survey evaluating TM perceptions was distributed to patients and their families following an encounter between March and July 2020. Our diabetes clinic currently cares for 1504 unique patients with type 1 diabetes (T1D) with 46% being publicly insured. A total of 1,653 encounters including in person and TM were included in the analysis. TM visits became available in March 2020, with a total of 571 encounters by July 2020. There was a significantly lower number of completed TM encounters by publicly insured patients when compared with privately insured (p value=0.03523) and a threefold increase in no-shows and same day cancelations by the publicly insured group. Perception of TM was addressed with a survey completed by 40 patients. TM perception was positive with 86% of patients being very satisfied with the visit. TM encounter was thought to be the same as in person encounter by 60% and better than in person visit by 37% of patients. Reported benefits associated with TM included: overall time saved, no missed school day for the patient or workday for the parent, decreased childcare and transportation costs.
In conclusion, although TM is perceived as positive by patients with T1D, low-income families showed lower TM visit attendance rate when compared to privately insured families. The COVID-19 pandemic has highlighted disparities related to access to and use of technology to improve diabetes care. More research is needed to identify the specific causes for the disparities. Patient centered approach to increase education and help navigate the processes required for utilizing TM technology may help decrease the health equity gaps.

Disclosure
C. Demeterco-berggren: None. M. Gottschalk: None.
93-OR: Muller Glial-Derived Zfp36 Expression Protects the Retina from Diabetes-Induced Damages in the Early Stage of Diabetic Retinopathy
Authors: WANG SUI 
Published: June 2021

Diabetic retinopathy (DR), one of the most common complications of diabetes, is the leading cause of blindness among working-age populations in the US. The molecular mechanisms responsible for the initiation and early progression of DR have not been fully elucidated. This represents a significant barrier to the development of effective therapies to prevent or slow down the initiation of DR. Retinal Müller glial cells have been shown to play important roles in the initiation and early progression of DR. However, the underlying molecular mechanisms remain unclear. To address this question, we profiled the transcriptomic alterations induced by diabetes specifically in Müller glial cells by RNA-seq in the early stage of DR using diabetic rat models. Zinc finger protein 36 homolog (Zfp36), which is a RNA binding protein and functions via destabilizing the mRNAs of pro-inflammatory genes, was found to be upregulated in Müller glia by diabetes at one and two months after the induction of diabetes. As the disease progresses, the level of Zfp36 decreased to below its normal level starting from three months after diabetes. In addition, depleting Zfp36 enhanced gliosis, retinal ganglion cell degeneration, and vascular lesions in diabetic rats. Over-expression of Zfp36 slowed down the occurrence of DR-related retinopathy phenotypes. More importantly, Zfp36 can modulate inflammatory responses induced by diabetes in Müller glial cells. Based on these results, we concluded that Müller glial cells can exert protective roles via Zfp36, and failure of maintaining Zfp36 levels contributes the development of DR.

Disclosure
S. Wang: None.

Funding
American Diabetes Association/Pathway to Stop Diabetes (1-16-INI-16)
942-P: The Choline Metabolite TMAO Inhibits NETosis and Promotes Placental Development in GDM of Humans and Mice
Authors: LIN XIAOJING , ZHANG YUNQI , HE XIAOLING , CHEN NAN , WANG MIAORAN , CHEN YAN , XIAO XIAOQIU 
Published: June 2021

Objective: Trimethylamine N-oxide (TMAO) is a choline metabolite and has been reported as a risk factor of gestational diabetes mellitus (GDM). Diabetes primes neutrophils to produce neutrophil extracellular traps (NETosis). We investigated the effect of TMAO and NETs on the placenta and revealed the role of TMAO and NETs in GDM.
Methods: Peripheral plasma, cord plasma and placenta from normal pregnant and GDM women were collected. Plasma concentrations of TMAO, ds-DNA and myeloperoxidase (MPO) were compared and association analysis was performed. HTR-8/Svneo cells and GDM models of wild-type and PAD4-/- mice were used to observe the effect of TMAO and NETs on the placenta.
Results: The peripheral and cord plasma TMAO levels of GDM women were significantly higher than those of control. BMI and glucose levels were positively correlated with the concentration of blood TMAO, especially the newborn weight and placental thickness were positively correlated with TMAO levels in cord blood. TMAO could promote proliferation, migration, invasion and angiogenesis of HTR-8/Svneo cells, and TMAO-treated neutrophils could resist NETosis stimulated by PMA or LPS. Plasma concentrations of ds-DNA and MPO in peripheral and cord blood were significantly higher in GDM women, and BMI and blood glucose levels were positively correlated with ds-DNA and MPO levels. MPO levels from GDM placenta were also higher than those in the control group. NETs inhibit the proliferation, migration, invasion and angiogenesis of HTR-8/Svneo cells. The placenta weight of PAD4-/- mice was significantly higher than that of wild-type mice. TMAO feeding also significantly increased the weight of the placenta and fetuses, and this increase did not affect the normal structure of the placenta.
Conclusion: Higher TMAO levels and abnormal NETosis were associated with GDM. TMAO could not only promote the development of the placenta and fetus, but also inhibit NETosis to protect the placenta.

Disclosure
X. Lin: None. Y. Zhang: None. X. He: None. N. Chen: None. M. Wang: None. Y. Chen: None. X. Xiao: None.

Funding
National Natural Science Foundation of China (82071734, 81871222)