bluuebunny/crossref_metadata_2025_split huggingface dataset:
503-P: Intensive Lifestyle Interventions for Treatment towards Remission of Type 2 Diabetes: A Case Series
Authors: KARLSEN MICAELA , PANIGRAHI GUNADHAR , KELLY JOHN 
Published: June 2021

Background: Lifestyle interventions, including very low-calorie diets and liquid meal replacements, have been shown to achieve blood glucose improvements or remission. However, intensive lifestyle intervention using solid foods without calorie restriction has not been studied.
Objective: The objective of this study is to describe changes in blood glucose, medication use and diabetes status among 50 patients who were prescribed intensive lifestyle changes to treat type 2 diabetes (T2D).
Methods: Physicians were recruited by the American College of Lifestyle Medicine to submit case histories of patients who achieved blood glucose improvements and/or remission in QuestionPro, an online survey platform.
Results: A total of 12 physicians reported on 50 patients, including 1 physician who reported on 37 patients. Mean (SD) age of patients was 66.4 (12.8) years (range 20-84), and 64% of patients were male. Primary lifestyle interventions included a whole food, plant-based diet (n=43), coaching program (n=3), ADA diet (n=2), whole food diet (n=1) and calorie restricted diet &lt;1800kcal (n=1). No liquid meal replacements or other calorie restrictions were reported. Mean biometrics (SD) for time periods pre-intervention; 3-6 months post-; and most recent follow-up were: HbA1c 7.6 (1.5); 5.7 (0.3); 5.8 (0.4), fasting glucose 150.1 (53.4); 101.0 (30.8) ;105.2 (25.0), BMI 34.9 (14.4); 30.0 (6.0); 28.6 (5.2). A majority of patients were taking diabetes medications prior to interventions. At 3-6 months post intervention, a total of n=20 patients were not taking diabetes medications and of these, n=10 achieved either HbA1c&lt;5.7 % or FSG&lt;100 mg/dL. At most recent follow-up, n=21 were not taking diabetes medications and of these, n=9 achieved both HbA1c&lt;5.7% and FSG&lt;100 mg/dL, with n=1 for at least 12 months.
Conclusion: Patients can improve blood glucose and may achieve remission of T2D using a whole food, plant-based dietary pattern, without liquid meal replacements.

Disclosure
M. Karlsen: None. G. Panigrahi: None. J. Kelly: None.
509-P: Type 1 Diabetes Management and the Impact on Caregiver Quality of Life
Authors: JEWELL VANESSA D. 
Published: June 2021

After a child’s type 1 diabetes diagnosis, significant demands may be placed on the family. Families are thrust into a new routine focused on daily diabetes management that include continuous monitoring of their child’s blood glucose levels, nutritional needs, activity and sleep patterns, stress and emotional responses, and medication administration, among others. Additionally, the caregivers become inundated with time and financial strain for travel for new medical appointments, management of healthcare insurance policies, and medical bills, causing some caregivers to cease employment or secure a job that allows for increased time flexibility. The purpose of this mixed methods study was to examine how caring for a child living with type 1 diabetes impacts caregiver quality of life, burden, and roles. Through convenience sampling, caregivers (n=43) completed an electronic demographic survey, Burden Scale for Family Caregivers, WHOQoL, followed by an individual phenomenological interview (n=6). The majority of caregivers reported moderate burden (48%) or severe to very severe burden (20%). A significant large negative correlation was found between caregiver burden and quality of life (r = -0.73, p&lt;0.01), indicating that as burden increased, quality of life decreased. Interview findings revealed three themes: relationship maintenance difficulties lead to decreased social support; declining productive occupations; and a strong desire for education and advocacy. Due to caregivers reporting difficulty with maintaining their own health and well-being while caring for a child living with type 1 diabetes, it is imperative for interprofessional diabetes health care teams to develop novel interventions aimed to improve family quality of life.

Disclosure
V. D. Jewell: Research Support; Self; Dexcom, Inc.
51-LB: Emotional Impact of Hypoglycemia and Use of Glucagon: Perspectives of People with T1D
Authors: HUGHES ALLYSON , CHAPMAN KATHERINE S.M. , BISPHAM JEOFFREY , HEYDARIAN NAZANIN M. , DIMSITS JEANNETT , WEINZIMER STUART A. , WOLF WENDY 
Published: June 2021

Introduction: Severe hypoglycemia is an ongoing barrier to achieving glycemic targets. Glucagon is an effective, yet underutilized treatment for severe hypoglycemia. This study characterized the emotional impact of severe hypoglycemia, glucagon perceptions, and barriers to glucagon use for people with T1D.
Methods: Participants included individuals recruited from the T1D Exchange online community. The current study conducted 7 focus groups consisting of adults with T1D (n = 38, average age 49.4, SD = 16.11 years). Average duration of diabetes was 34.4 years (SD = 17.3) and average self-reported A1c was 6.8% (SD = 0.7). Focus groups were recorded, transcribed, and thematically analyzed.
Results: A range of emotions was expressed about severe hypoglycemia including fear, anxiety, stress, frustration, shame, and embarrassment. Due to hypoglycemia unawareness, participants discussed relying on CGM to make hypoglycemia treatment decisions. Multiple participants self-administered glucagon to prevent or treat a severe hypoglycemic event. Although overnight hypoglycemia and CGM alarms were described as important, some participants also viewed them as sleep disruptors for themselves and their partners. Participants frequently identified prescription cost and insurance deductibles as barriers to glucagon use. Participants were also concerned about ease of administration—how difficult it is to prepare the glucagon in an emergency situation. Many participants expressed a preference for auto-injectables over nasal administration. Timing of glucagon action and time to recovery were high priorities. Some participants, while they had not self-administered glucagon, were interested in a mini-dose glucagon they could self-administer.
Conclusions: These results provide insight into the real-world impact of diabetes management in persons with T1D and highlight the attitudes about severe hypoglycemia and emergency glucagon treatment.

Disclosure
A. Hughes: None. K. S. M. Chapman: None. J. Bispham: None. N. M. Heydarian: None. J. Dimsits: Employee; Self; Zealand Pharma A/S. S. A. Weinzimer: Advisory Panel; Self; Dompe, Zealand Pharma A/S, Speaker’s Bureau; Self; Medtronic. W. Wolf: None.
513-P: Associations of Common Mental Health Disorders with Impaired Awareness of Hypoglycaemia in Type 1 Diabetes
Authors: PIERI BEATRICE , BERGIN-CARTWRIGHT GABRIELLA , HOTOPF MATTHEW , HUSSAIN SUFYAN 
Published: June 2021

Objective: This cross-sectional study aimed to assess the prevalence of mental health disorders and impaired awareness of hypoglycemia (IAH) in type 1 diabetes, as well as examine associations between these and sociodemographic and clinical characteristics. It also assessed the hypothesis that symptoms of common mental health disorders are independently associated with IAH.
Methods: Data was collected from patients attending a diabetes outpatient clinic between January 2016 and April 2018 who completed questionnaires as part of routine clinical care. Probable depression (pMDD), probable anxiety (pGAD) and IAH were measured using validated self-report tools. Associations were examined with multiple regression models, adjusting for sociodemographic and clinical characteristics.
Results: Data from 950 patients was included in the sample. 93 patients (9.8%) met criteria for pMDD; 89 patients (9.4%) met criteria for pGAD; and 215 (22.6%) patients met criteria for IAH. Only depression was independently associated with IAH after adjustment for covariates when depression and anxiety were included in the same model (OR 3.27 (CI 1.74-6.15)). However, both depression and anxiety were associated with increased odds of IAH and robust to adjustment, when included separately (OR 3.64 (CI 2.19-6.04), and OR 2.46 (CI 1.46-4.14), respectively).
Conclusions: The robust independent relationship between symptoms of common mental health disorders, and in particular depression, with IAH demonstrates the need for routine psychological assessment and management in people with type 1 diabetes patients and IAH. This data also provides further support for the inclusion of mental health support strategies alongside the use of technology in hypoglycemia awareness restoration programmes.

Disclosure
B. Pieri: None. G. Bergin-cartwright: None. M. Hotopf: Research Support; Self; Biogen, Janssen Pharmaceuticals, Inc., Lundbeck, Merck Sharp & Dohme Corp., UCB Japan Co. Ltd. S. Hussain: Speaker’s Bureau; Self; Novo Nordisk.
515-P: The Impact of COVID-19 Worries on Diabetes Distress and Depressive Symptoms in Older Adults with Type 2 Diabetes
Authors: KIM MIN JUNG , PARK CHANG G. , FRITSCHI CYNTHIA 
Published: June 2021

Objectives: The 2019 coronavirus (COVID-19) pandemic has created serious physical and mental problems in older adults with diabetes. Aging, obese adults with type 2 diabetes (T2D) are especially vulnerable to COVID-19 morbidity and mortality. COVID-19 related worries may exacerbate their diabetes-related psychological symptoms of diabetes distress or depression. Our team investigated the impact of COVID-19 worries on levels of diabetes distress and depressive symptoms in older adults with T2D.
Methods: Data were collected using an online survey from June to December 2020 across the United States. COVID-19 worries were measured using eight questions (scale range 0-4) developed by Barbara and Kim (2020). Psychological symptoms were assessed using the Diabetes Distress Scale (DDS) and Patient-Reported Outcomes Measurement Information System (PROMIS) depression version 1.0. Data were analyzed using bivariate correlation and tobit regression analyses.
Results: A total of 84 adults aged ≥ 60 years with T2D were included (age 68.46 ± 5.41, female 54.76%, White 77.38%). Participants reported moderate COVID-19 worries (1.70 ± .93), little or no diabetes distress (1.55 ± .63), and fewer depressive symptoms than the U.S. normative sample (48.92 ± 8.10). COVID-19 worries were associated with DDS total and emotional and regimen-related subscores (r = .25-.34) and PROMIS depression scores (r = .41). One point increase in COVID-19 worries increased DDS-total by .25, DDS-emotional by .34, DDS-physician by .58, DDS-regimen by .42, and PROMIS depression by 3.95.
Conclusions: The COVID-19 pandemic created worries that worsened common diabetes-related psychological symptoms. Our results indicated that diabetes distress, especially emotional and physician- and regimen-related distress, should be closely monitored in addition to depressive symptoms in this population during and after the pandemic, as these symptoms have been associated with poor self-care.

Disclosure
M. Kim: None. C. G. Park: None. C. Fritschi: None.

Funding
National Institute on Aging (P30AG022849); University of Illinois Seth and Denise Rosen Memorial Research Award; Sigma Theta Tau International (Alpha Lambda Chapter)
531-P: “I Feel Human, I Feel Normal”: A Qualitative Study of Experiences with Control-IQ Technology in Early Adopters
Authors: SINGH HARSIMRAN , MCELWEE-MALLOY MOLLY , SANCHEZ HAIDEE , HABIF STEPHANIE 
Published: June 2021

The Tandem Diabetes Care® t:slim X2TM insulin pump with Control-IQTM technology is an advanced hybrid closed-loop system, cleared by the FDA in December 2019. To date various studies have demonstrated glycemic and patient-reported improvements using this system. However, there are no published qualitative studies evaluating real-world experiences of using Control-IQ technology. As part of a larger, real-world study involving people with type 1 diabetes (T1D) using Control-IQ technology, we randomly selected and invited participants (Ps) to phone interviews to discuss their experiences using this system. Semi-structured, in-depth interviews were conducted in May-June 2020. They were audio-recorded and transcribed verbatim. Interviews were conducted by two experienced health professionals and lasted an average of 23 minutes (range 9-50 minutes). Interview transcripts were imported into NVivo V.12 for data coding and analysis. Interviews were analyzed using inductive thematic analysis. In all, 27 T1D adults (14 women, 13 men) were interviewed. Four major themes (T) emerged: the initiation phase (T1), successes (T2), and challenges (T3) with Control-IQ technology, and its impact on quality of life (QoL) (T4). Ps reported taking some time to trust the new automated system and “feeling comfortable in letting it do its thing” (T1). Improved sleep quality, glycemic control (HbA1c), and sensor time in range were commonly reported by Ps (T2) along with reduced burden of diabetes management (T2). A few Ps discussed their need for the system to be more aggressive while managing hyperglycemia (T3). Overall, Ps described valuable improvements in their QoL, including reduced stress and decision-making around diabetes management, and increased freedom and spontaneity in daily life (T4). These qualitative findings highlight the significant impact of Control-IQ technology on Ps glycemic control, psychological health, and their ability to engage in daily life activities.

Disclosure
H. Singh: Employee; Self; Tandem Diabetes Care. M. Mcelwee-malloy: Employee; Self; Tandem Diabetes Care. H. Sanchez: Employee; Self; Tandem Diabetes Care. S. Habif: Employee; Self; Tandem Diabetes Care.
537-P: Predictors of Engagement in Clinical Care: CoYoT1 to California
Authors: GARCIA JAQUELIN J. FLORES , REID MARK W. , PYATAK ELIZABETH , FOX D. STEVEN , FOGEL JENNIFER L. , SALCEDO-RODRIGUEZ ELIZABETH , BISNO DANIEL I. , MILLER DEBRA , MITTAL ANUVA , RAYMOND JENNIFER 
Published: June 2021

Background: Current type 1 diabetes (T1D) care models do not effectively engage racially and ethnically diverse Adolescents and Young Adults (AYA) indicating a need for new approaches. Objective: To assess clinical and demographic predictors of care engagement among diverse AYA with T1D.
Methods: In an ongoing 15-month randomized controlled 2x2 trial with pragmatic care assignment, 53 AYA ages 16-25 received either quarterly usual T1D care (in-person or via telehealth (TH)), or CoYoT1 Care, which includes bimonthly T1D group sessions via TH and quarterly patient-centered care provider visits (in-person or via TH). Participant engagement was measured by the proportion of clinic visits attended out of all offered to date, per participant, including all currently enrolled. Predictors of engagement included: pre-trial clinic attendance, care group assignment (CoYoT1 or usual care), demographic, and clinical variables. All were entered into a multiple linear regression model, then reduced via stepwise regression.
Results: Participation in CoYoT1 Care was associated with a 12% greater attendance rate (p=0.006) relative to usual care. Participants who retained their pre-trial care providers during the study attended clinic visits 7% more frequently than those randomized to a new provider (p=0.06). Participants’ who identified as African American (p=0.001) or Multi-racial (p=0.002) attended clinic visits at least 16% more frequently than participants from other groups; Latinx ethnicity was not associated with more or less frequent attendance. Females attended clinic visits 10% less frequently than non-females (p=0.006). Baseline A1c was also negatively associated with attendance rate, with each percentage increase in A1c associated with a 2% reduction in attendance rate (p=0.01).
Conclusion: CoYoT1 Care successfully engaged patients from diverse backgrounds. The model warrants further investigation to identify which intervention components most promote engagement.

Disclosure
J. J. Flores garcia: None. J. Raymond: None. M. W. Reid: None. E. Pyatak: None. D. Fox: None. J. L. Fogel: None. E. Salcedo-rodriguez: None. D. I. Bisno: None. D. Miller: None. A. Mittal: None.

Funding
The Donaghue Foundation
543-P: Challenges in Glucose Management in Young Adults during the COVID-19 Pandemic
Authors: SAYLOR JENNIFER , LEE SARA , COMMISSARIAT PERSIS V. , SABINO ANNA , PIERRE DANIELLE ST. 
Published: June 2021

Aim: Young adults (YA) with type 1 diabetes (T1D) are particularly vulnerable to direct and indirect effects of COVID-19 on their diabetes care, due to the intensive nature of managing their disease while simultaneously transitioning into adulthood during this ongoing global health crises. This study examined glucose management and diabetes-related hospitalizations in YA with T1D during the COVID-19 pandemic.
Method: Surveys were distributed electronically to YA between 17-30 years old and associated with the College Diabetes Network at two timepoints (spring and fall 2020). The survey included questions about hospitalization for diabetic ketoacidosis and/or severe hypoglycemia and challenges filling prescriptions. Chi-Square statistics were used for analyses.
Results: No demographic differences were found between the spring (n=473) and fall (n=375) participants. There was a significant increase in hospitalizations for severe hypoglycemia from 3.4% in the spring to 10.4% in the fall (p&lt;.001). In the spring, 21% of participants reported difficulty filling prescriptions due to COVID-19, compared to 7.3% in the fall. Among those who reported difficulty filling prescriptions, insulin (Spring [n=58], Fall [n=43]) and CGM supplies (Spring [n=41], Fall [n=22]) were most commonly cited. Reported hospitalizations for DKA increased from 6.7% in the spring to 10.1% in the fall and trending towards statistical significance (p=.077).
Conclusions: YA with T1D reported increased incidence of severe hypoglycemia hospitalization during COVID-19, with many YA reporting difficulty filling and obtaining insulin and CGM supplies. Increased support may be necessary to protect health outcomes during this difficult time. Future work should utilize longitudinal methods to further assess the impacts of the COVID-19 pandemic on diabetes management.

Disclosure
J. Saylor: None. S. Lee: None. P. V. Commissariat: None. A. Sabino: None. D. St. pierre: None.
550-P: Unique Associations of Depressive Symptoms and Diabetes Distress with Quality of Life (QoL) in Youth with Type 1 Diabetes (T1D)
Authors: SHAPIRA AMIT , VOLKENING LISA K. , LAFFEL LORI M. 
Published: June 2021

Youth with T1D often experience emotional distress, which can negatively impact QoL. We sought to understand associations of depressive symptoms and diabetes distress with QoL in youth with T1D. Participants (N=420; 50% male; ages 8-17 years; T1D duration 6.4±3.7 (M±SD) years; A1c 8.3±1.0%; 69% pump treated; 70% having parent with college degree) completed the Pediatric Quality of Life Inventory Generic Core Scales (PedsQL)and measures of depressive symptoms (Center for Epidemiologic Studies Depression Scale [CESD]) and diabetes distress (Problem Areas in Diabetes-Pediatric version [PAID-Peds]). Multivariable linear modeling determined independent associations of depressive symptoms and diabetes distress with total, physical, and psychosocial QoL, adjusting for sex, age, T1D duration, A1c, pump therapy, insulin dose, and parent education. Total PedsQL score was 85±13, (physical subscale 89±12, psychosocial subscale 82±15); CESD score was 9±9; PAID-Peds score was 37±24. CESD and PAID-Peds were both correlated with A1c (CESD: p=.01, PAID-Peds: p&lt;.0001); QoL scales were not correlated with A1c. CESD and PAID-Peds were correlated with total, physical and psychosocial QoL (all p&lt;.0001). In multivariable analyses, more depressive symptoms were associated with poorer total (∆R2=.52, p&lt;.0001), physical (∆R2=.35, p&lt;.0001), and psychosocial (∆R2=.51, p&lt;.0001) QoL, adjusting for diabetes distress and sociodemographic/diabetes factors. More diabetes distress was associated with poorer total (∆R2=.05, p&lt;.0001) and psychosocial (∆R2=.06, p&lt; .0001) QoL, adjusting for depressive symptoms and sociodemographic/diabetes factors; more diabetes distress marginally contributed to poorer physical QoL (∆R2=.01, p=.002). Findings suggest unique, negative associations of both depressive symptoms and diabetes distress with QoL. Targeting both depressive symptoms and diabetes distress may help improve QoL in youth with T1D.

Disclosure
A. Shapira: None. L. K. Volkening: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc.

Funding
National Institutes of Health (R01DK089349, R01DK095273, T32DK007260, P30DK036836); JDRF (2-SRA-2014-253-M-B)
566-P: Is a Zoom, Family-Based Intervention Feasible during a Pandemic?
Authors: WONG JESSIE J. , LANNING MONICA S. , NGO JESSICA , WU CHRISTINE A. , HANES SARAH , LINZMEYER HALEY M. , NARANJO DIANA , HOOD KOREY K. 
Published: June 2021

Background: Access to psychosocial services is limited, especially during a pandemic. A Zoom-delivered family-based intervention for adolescents with type 1 diabetes has the potential to enhance access to psychosocial services.
Methods: Nine families enrolled in a pilot of a 6-session online (Zoom) intervention for adolescents with type 1 diabetes and their parents during the COVID-19 pandemic. Qualitative and quantitative data were collected via online focus groups and surveys.
Results: Teens’ ages ranged from 12-17 years (M=14.9, SD=1.76) and most self-identified as male (78%). All parents self-identified as female and most families self-identified as non-Hispanic white (78%). Qualitative results revealed that participants found the program to be generally helpful and would recommend the program to others. Perceived benefits included increased parental empathy toward teens, enhanced parental involvement in teens’ diabetes management, and decreased parent-teen conflict. Participants conveyed that these benefits were particularly impactful given increased family contact and tensions related to the COVID-19 pandemic. Identified areas for improvement included adding follow-up group sessions with parents to maintain program impact on parenting over time and to target teens in early adolescence, when family dynamics are more malleable. Quantitative results from paired t-tests of pre-post comparisons revealed no significant differences in teen or parental diabetes distress or depression (all p&gt;0.05), but should be interpreted with caution due to small sample size.
Conclusions: Adolescents with type 1 diabetes and their parents responded positively to this program and found it particularly relevant during the current pandemic. Zoom delivery of these programs may be instrumental in their feasibility, acceptability, and ultimately dissemination in the future.

Disclosure
J. J. Wong: None. M. S. Lanning: None. J. Ngo: None. C. A. Wu: None. S. Hanes: None. H. M. Linzmeyer: None. D. Naranjo: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK121771-01A1)