bluuebunny/crossref_metadata_2025_split huggingface dataset:
526-P: Prevalence and Predictors of Spiritual/Existential Distress among Adults with Uncontrolled Diabetes
Authors: RAJAEE GEILA , HEISLER MICHELE , PIETTE JOHN , RESNICOW KENNETH , SHI XU , SMITH ALYSSA N. , SONG PETER X. , PATEL MINAL R. 
Published: June 2021

Purpose: Spiritual and/or existential (S/E) distress is the experience of strain or conflict within a person’s religious, spiritual, or existential framework and is associated with worse psychological and health outcomes among individuals with acute illness. Little is known about S/E distress among individuals with a chronic condition, such as diabetes mellitus (DM). We explored the prevalence of S/E distress among adults with DM and examined patient factors associated with S/E distress.
Methods: Data came from the 2019-2020 baseline assessment of participants in an ongoing trial of an intervention addressing social determinants of health among people with DM (n=286). Participants had HbA1cs ≥ 7.5 (18-70 years) or ≥ 8.0 for (71-75 years). We measured S/E distress in two ways: 1) with an abbreviated version of the Religious and Spiritual Struggle Scale (RSSS-14); and 2) with three screening questions adapted from the Rush Religious Struggle Screening Protocol (3Q). Bivariate analyses examined the association between patient factors, including health behaviors, DM distress, social support, and S/E distress.
Results: Mean age of the sample was 53 years (SD:13.3). Prevalence of S/E distress was 20% (3Q) and 22% (RSSS-14). Both screeners found that compared to those without S/E distress, those with S/E distress reported a poorer general diet, lower social support, higher levels of DM distress, and higher psychological distress (all p &lt;0.05). The RSSS-14 also identified elevated levels of HbA1c, more chronic conditions, and greater unmet social needs among those with potential S/E distress (all p &lt;0.05). The 3Q identified poorer medication adherence (p=0.03) in those with S/E distress.
Conclusions: One-fifth of adults with poor glycemic control have potential S/E distress, and such distress is associated with worse mental health and functional status. Future interventions should seek to address S/E distress as part of efforts to improve DM patient-centered and clinical outcomes.

Disclosure
G. Rajaee: Consultant; Self; UnitedHealth Group. M. Heisler: None. J. Piette: None. K. Resnicow: None. X. Shi: None. A. N. Smith: None. P. X. Song: None. M. R. Patel: None.

Funding
National Institutes of Health (R01DK116715)
532-P: Artificial Intelligence Identifies a Modest Influence of Character and Emotions on Blood Glucose in Type 1 Diabetes
Authors: SHOHAM GON , HOCHBERG IRIT , ELDOR ROY , GILAD-BACHRACH RAN 
Published: June 2021

Introduction: People with T1DM and their healthcare providers perceive that mood and sleep quality influence blood glucose (BG). Artificial pancreas algorithms use only BG estimates to predict future BG and determine insulin requirements. We aimed to improve the understanding of the effect of emotional states and personality on temporal BG changes using machine learning.
Methods: Patients with T1DM using continuous glucose monitoring (CGM) completed questionnaires on demographic, socioeconomic and medical information and personality characteristics. For several days, using a mobile app, patients recorded their present valence, arousal state and sleep quality. The data was synced with patient CGM readings and evaluated using gradient boosting decision tree (GBDT) over 5-fold cross-validation. Area under the receiver operating characteristic curve (AUROC) and marginal contribution were used to determine model feature importance. BG was divided into three classes: normal (70-180), high (&gt;180), low (&lt;70). For normal BG values, models were trained to predict BG class in the next 15, 30, and 45 minutes.
Results: A total of 64 participants (age 48±15 years SEM, years of T1D 18±13, 59% women) from two medical centers participated for 17.3±15.2 SEM days, each reporting valence and arousal 56±53 times. Models using personality and emotional features to predict future BG outperformed models using only BG, albeit by a small margin. Following BG and time-of-day features, both neuroticism and arousal were found to be predictive. Neuroticism levels and sleep were significantly different between participants with HbA1c values under 7.6% and over 9.5%. (p=0.001, p=0.02, respectively).
Discussion: Our results show that personality and present arousal are associated with BG fluctuations, while the effect of valence, while detectible, is minute. Integrating personality trait information using standard questionnaires may improve artificial pancreas algorithms.

Disclosure
G. Shoham: None. I. Hochberg: None. R. Eldor: Consultant; Self; Oramed , Speaker’s Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim International GmbH, MSD Corporation, Novo Nordisk, Sanofi. R. Gilad-bachrach: None.
54-OR: Nucleolin Autoantibody Accelerates Atherosclerosis in Type 1 Diabetes
Authors: PARK KYOUNGMIN , LI QIAN , PARK HYUNSEOK , FU JIALIN , KISSLER STEPHAN , MADDALONI ERNESTO , WU I-HSIEN , LICHTMAN ANDREW H. , KING GEORGE L. 
Published: June 2021

Hyperglycemia has been evaluated extensively as risk factors for cardiovascular disease (CVD) in people with type 1 diabetes (T1DM). However, the effects of the autoantibody on atherosclerosis and immunogenic trigger are not well understood in T1D. Using the generated several mice models of atherosclerosis including NOD, congenic ApoE-/-/NOD (NDM and no- autoimmune), ApoE-/-/NOD (autoimmunity with insulitis, NDM) and ApoE-/-/NOD autoimmune DM mice, we analyzed immune cells composition of aorta and have observed the increasing numbers of CD3+(CD3+/CD25-), Th1 and Th17 subset of T cells and B cells and decreased Treg (CD3+/CD25+/Foxp3+) in the ApoE-/-/NOD and ApoE-/-/NOD-DM mice vs. control. In addition, we postulate that the identification of specific autoantibody(s) which induce dysregulaton of T-cells, resulting in enhancing its infiltration and accumulation at the plaques could aid new immunotherapies for atherosclerosis. Here we performed autoantigen microarrays to profile and identify specific autoantibodies, enhancing the severe atherosclerosis in subgroups of Medalist patients with chronic duration of T1D due to autoimmunity with positive HLA DR3/4 risk alleles and autoantibodies and compared to the people with monogenic diabetes lacking HLA DR3/4 risk alleles for T1D and autoantibodies. Autoantigen microarrays from the plasma of T1D patients with positive DR3/4 risk and CVD identified 8 autoantibodies changed in the context of atherosclerosis, compared to the people with monogenic diabetes. To confirm the autoantibody profiling data from the patients, we analyzed the autoantibody profiles in the T1D mice models of atherosclerosis described above. Autoantigen microarrays analysis of the plasma of T1D patients and mice showed several common findings that reached significance anti-Nucleolin Ab, p=0.005. These findings indicate autoimmunity may contribute to the progression of atherosclerosis in T1D. Further studies are in progress to replicate these findings in other cohorts of T1D.

Disclosure
K. Park: None. Q. Li: None. H. Park: None. J. Fu: None. S. Kissler: None. E. Maddaloni: Research Support; Self; European Foundation for the Study of Diabetes, Speaker's Bureau; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Merck KGaA. I. Wu: None. A. H. Lichtman: None. G. L. King: Consultant; Self; Agios, Inc., Medtronic, Other Relationship; Self; Janssen Pharmaceuticals, Inc.

Funding
DK036836, DK036836, EY026080
55-OR: Targeted Deletion of Insulin Receptor in Vascular Smooth Muscle Cells Promoted Atherosclerosis and Unstable Plaque
Authors: LI QIAN , FU JIALIN , PARK KYOUNGMIN , WU I-HSIEN , KING GEORGE L. 
Published: June 2021

Risks of unstable arterial plaques are increased in diabetes or insulin resistance. We hypothesized that insulin resistance in VSMCs contributes to reduced plaque stability since we have reported that insulin receptors (IR) on VSMCs are potent regulators of its proliferation and apoptosis. Further, insulin induced Akt phosphorylation was decreased in the aorta of diabetic mice. Lipid deposition were increased in the aortas of ApoE-/- and VSMCs IR double knockout (SMIRKO/ApoE-/-) mice vs. control mice. Pathological analysis of the atherosclerotic plaques of SMIRKO/ApoE-/- mice demonstrated features of unstable plaques, including reduced VSMCs proliferation and reduced cap thickness and collagen, but increased VSMCs apoptosis and more macrophages and necrosis area. VSMCs from SMIRKO/ApoE-/- mice exhibited less insulin induced proliferation and more apoptosis which were not inhibited by insulin compared to VSMCs from ApoE-/- mice. Artery relaxation induced by sodium nitroprusside (SNP) (NO donor) was impaired in artery from SMIRKO/ApoE-/- mice vs. control mice. Insulin and SNP induced VASP phosphorylation, a downstream signaling protein of NO in VSMCs, were reduced in SMIRKO/ApoE-/- mice vs. control mice. Expressions of MMP2, THBS1, sFRP3, and COMP were increased in the aorta of SMIRKO/ApoE-/- mice vs. ApoE-/- mice, which were also observed in the aorta of diabetic mice fed with high fat diet or diabetes induced by STZ. Insulin induced Akt and Foxo1 phosphorylation were impaired in cultured VSMCs from SMIRKO/ApoE-/- mice vs. control mice. Overexpression of constitutively activated Akt increased VASP phosphorylation and downregulated THBS1 expression in cultured VSMCs, whereas overexpression of FoxO1 increased THBS1 expression. This is the first report that selective inhibition of IR activation of pAkt in VSMCs is partially causing the elevated risk of unstable atherosclerotic plaques found in insulin resistance or diabetes.

Disclosure
Q. Li: None. J. Fu: None. K. Park: None. I. Wu: None. G. L. King: Consultant; Self; Agios, Inc., Medtronic, Other Relationship; Self; Janssen Pharmaceuticals, Inc.

Funding
National Institutes of Health (R01DK053105)
551-P: Results from a National Multicenter Study: Health Professionals Report High Feasibility, Acceptability, and Utility of a New Pro Dialogue Tool in Routine Multisectorial Diabetes Care
Authors: SKOVLUND SOREN E. , GLÜMER CHARLOTTE , NIELSEN SIGNE H. , BERTHELSEN DORTHE B. , PERRILD HANS , BALK-MØLLER NINA C. , NØRGAARD LISE MELLERGAARD , TROELSEN LISE , PIETRASZEK ANNA , HESSLER DANIELLE M. , KAPLAN SHERRIE H. , EJSKJAER NIELS 
Published: June 2021

Aim: To assess health care professionals’ (HCP) perceptions of feasibility, acceptability, and impacts of a new digital patient-reported outcome (PRO) dialogue tool in routine diabetes care.
Methods: A single-arm implementation study (MPRODIA) evaluating use of a PRO tool by 33 HCP in routine multi-sector diabetes care. Intervention: Persons with diabetes (PWD) filled out a digital questionnaire about health, well-being and self-care 1-8 days prior to the visit and their HCP used a PRO dialogue dashboard in the visit to facilitate a collaborative, person-centered dialogue. Primary outcome in this sub study was HCP responses to a clinical end-of-study Likert-Scale and Free-Text evaluation survey. Quantitative and explanatory qualitative data analyses were done with SPSS 25.0/Nvivo 12.
Results: 33 HCP at 7 unique sites used PRO in 474 diabetes visits and completed the end-of-study survey. 80% were diabetes specialized, 67% saw&gt;10 PWD/week, 33% had &lt;10 years of care experience. HCP confidence in use of PRO improved in pre-post analysis (3,8 (SD=.9) to 4,4 (SD=.7), range 1-5, p&lt;0.05). 97% were confident in their ability to use PRO well (interpret and use PRO insights). 52% became more positive (3% more negative) towards the PRO tool overall over time. 85% reported improved work satisfaction (due to better preparation and dialogue), 0% worse satisfaction. 33% felt visits were less stressful, 21% felt it was somewhat more stressful with PRO (due to time constraints). All HCP indicated the desire to continue PRO use (9,0(SD=1,2), range 1-10) and recommend it to others (9,0(SD=1,4), range 1-10). 64% found it essential that HCP are trained in use of PRO prior to implementation.
Conclusions: HCP in both municipality and hospital settings found a new digital PRO diabetes tool to be highly acceptable and value-adding by improving the active participation of PWD and the delivery of quality person-centered care.

Disclosure
S. E. Skovlund: None. D. M. Hessler: Consultant; Self; Eli Lilly and Company. S. H. Kaplan: None. N. Ejskjaer: None. C. Glümer: None. S. H. Nielsen: None. D. B. Berthelsen: None. H. Perrild: n/a. N. C. Balk-møller: None. L. Nørgaard: None. L. Troelsen: None. A. Pietraszek: None.

Funding
Danish Health Data Authority
564-P: Long-Term Follow-up of Glycemic Excursion Minimization (GEM) Compared with Weight Loss in Management of Type 2 Diabetes (T2D)
Authors: COX DANIEL , MONCRIEF MATTHEW A. , MCCALL ANTHONY L. 
Published: June 2021

In a recent randomized clinical trial, we compared 6 hours of conventional weight loss (WL) training to an equivalent amount of Glycemic Excursion Minimization (GEM) that is a paradigm-shift in lifestyle management for adults with T2D. GEM focuses on diminishing post-nutrient BG excursions by: 1) minimizing BG upsurge by reducing net carbohydrate ingestion, and 2) hastening BG recovery by increasing routine and post-meal physical activity.1 We now present the 13-month follow-up data, with no further training or contact, to evaluate the relative durability of these interventions. All of the WL and 97% of GEM participants who completed 3-month post-assessment also completed 13-month follow-up. At 13 months, WL participants sustained the improvement in BMI they showed at 3 months, while GEM participants continued to significantly benefit from lower HbA1c (p&lt;.001), diabetes medication usage, cardiovascular risk, BMI, HDL, and improved psychological function regarding empowerment and diabetes distress (p’s &lt;.01). Fifty-two percent of GEM participants were classified as Responders (mean HbA1c reduction of -1.5%). Being a GEM Responder at 13 months was unrelated to demographic or disease severity variables. Regression analyses indicated being a GEM long-term Responder was preceded by short-term post-treatment reduction of HbA1c, BMI and diabetes medication, correctly classifying 76% of eventual Responders and Non-responders. WL Responders could not be identified. Our data suggest GEM is a sustainable treatment option in the management of T2D.
1BMJ Open Diabetes Research & Care, 8:e001795. doi: 10.1136/bmjdrc-2020-001795.

Disclosure
D. Cox: Research Support; Self; Abbott Diabetes, Dexcom, Inc. M. A. Moncrief: Research Support; Self; Abbott Diabetes, Dexcom, Inc. A. L. Mccall: None.

Funding
National Institutes of Health (DK108957)
565-P: Loop Automated Insulin Delivery System: Reasons for Discontinued Use
Authors: WONG JESSIE J. , SUTTIRATANA SAKINAH , LANNING MONICA S. , DUNLAP ADRIENNE , HANES SARAH , HOOD KOREY K. , LAL RAYHAN , NARANJO DIANA 
Published: June 2021

Background: Loop is an open-source do-it-yourself (DIY) automated insulin delivery system that allows users unrivaled control over physiologic settings that effect future glucose prediction. Over 9,000 individuals have adopted Loop, but little is known about those who discontinue.
Methods: Twenty Loop users (14 adults and 6 caregivers; 60% female, 85% white, 75% household income &gt;$100k/year, and HbA1c 6.7±1.0%) participated in semi-structured interviews about their experiences with Loop following discontinuation. Qualitative data were transcribed, coded, and analyzed.
Results: Prominent themes reflected the perception that the stress, effort and/or time required to set up Loop and achieve management goals exceeded potential benefits. Two quotes: “I couldn’t spend any more time trying to work on my settings and trying to make it better,” and “I know I could get an improvement with it, but the problem was the cost of it⋯I couldn’t concentrate anymore at work⋯it felt like fog in my brain.” Technical issues with component devices, connectivity issues, lack of technical support, cost (time, energy, supplies), fear of provider disapproval, concerns related to pregnancy, exercise, hypoglycemia and managing low insulin doses, and desire to try other new technologies were among other reasons for ending use. Participants indicated that improved technical assistance and expert guidance might lead to them to use Loop again in the future.
Conclusions: For those who manage to set up Loop there are additional challenges, even among individuals with adequate glycemic control and access to various financial, social, and personal resources. Technical support and education specific to setting calculations could expand Loop benefits, alleviate burden, and support sustained use among new Loop users.

Disclosure
J. J. Wong: None. S. Suttiratana: Employee; Spouse/Partner; CVS Health. M. S. Lanning: None. A. Dunlap: None. S. Hanes: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool. D. Naranjo: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
590-P: Disparities in the Utilization of Bariatric Surgery among Obese Patients with or without Type 2 Diabetes: Evidence from the OneFlorida Clinical Research Consortium
Authors: CHEN GUANMING , DONAHOO WILLIAM T. , CARDEL MICHELLE , HOLGERSON ALLISON , AYZENGART ALEXANDER L. , GURKA MATTHEW J. 
Published: June 2021

Background: Contemporary data characterizing the utilization of metabolic and bariatric surgery (MBS) by type 2 diabetes mellitus (T2DM) status are limited.
Methods: In this study, we analyzed data from patients 18-88 years of age eligible for MBS seen in the OneFlorida (https://onefloridaconsortium.org/) between 1/1/ 2012 to 12/31/2018. MBS eligibility was defined by any of the following criteria: (1) an encounter with a body mass index (BMI) ≥ 40 kg/m2; or (2) BMI ≥ 35 kg/m2 with at least one obesity-related comorbidity, including T2DM, hypertension, or hyperlipidemia. We compared patients’ characteristics stratified by T2DM status and whether they underwent common bariatric procedures including Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding (AGB). We performed multivariable logistic regression to identify factors independently associated with receipt of MBS among diabetic patients.
Results: Among 190,606 patients with T2DM, 4103 (2.2%) of them underwent BS. Patients with diabetes were more likely to receive RYGB than those without T2DM (47.6% vs. 37.7%). We also observed that patients without diabetes aged between 18-44 years had a higher rate of MBS utilization than patients in that age range with diabetes (58.7% vs. 37.4%). The logistic regression results showed that female, higher pre-surgical BMI, had pre-surgical hypertension were strong indicators associated with bariatric treatment among patients with diabetes.
Conclusion: In this study, we observed that patients with obesity and T2DM still had relatively low rates of MBS. The observed differences in rates of MBS among different demographic subgroups could inform interventions that target reductions in these disparities.

Disclosure
G. Chen: None. W. T. Donahoo: None. M. Cardel: Consultant; Spouse/Partner; Weight Watchers International, Inc. A. Holgerson: None. A. L. Ayzengart: None. M. J. Gurka: None.
60-LB: Dendritic Cells Engineered with Tailored Multiepitopes-Encoding mRNA as Precision Medicine for Immunotherapy of Type 1 Diabetes
Authors: FITE REBUMA FIRDESSA , CREUSOT REMI J. 
Published: June 2021

Type 1 diabetes (T1D) is a complex autoimmune disease characterized by heterogeneity in genetic risk factors and immune profiles of patients and for which a cure or approved treatment is not yet available. Antigen-specific immunotherapy (ASIT) offers a targeted treatment of T1D that selectively inhibits autoreactive T cells. So far, ASIT trials showed limited efficacy, as only a subset of patients is responsive. Thus, approaches that consider the genetic and immunological heterogeneity of T1D patients to provide more tailored treatments are needed. Using mRNA encoding multiple epitopes tailored to the NOD mouse (model of T1D), we engineered bone marrow-derived dendritic cells (DCs) by mRNA electroporation (mRNA-DCs). The mRNA is designed to enable optimal presentation of epitopes to both CD4 and CD8 T cells. Antigen presentation persisted at least three days in vivo. Markers of anergy as well as IL-10 expression were found to be upregulated in antigen-specific CD4 and CD8 T cells after treating NOD mice with mRNA-DCs. T1D development was significantly suppressed with 3 biweekly treatments with 106 DCs containing 2 µg of antigen mRNA. Moreover, efficacy of the mRNA-DCs was enhanced when mRNAs encoding antigens and IL-27 were co-delivered into DCs by electroporation or when DCs were treated with rapamycin during differentiation. Endogenous expression of antigens may enable post-translational modifications and more prolonged presentation. Thus, we developed a promising and customizable ASIT platform to deliver multiple epitopes to exogenous tolerogenic DCs (or to endogenous APCs using a nanoparticle-based platform not covered here) that will consider the patient’s immune profile for a precision medicine treatment of T1D.

Disclosure
R. Fite: None. R. J. Creusot: None.

Funding
American Diabetes Association (1-19-PMF-022 to R.F.F.)
60-OR: Patient Engagement in Diabetes Self-Management Education and Support (DSME/S) Using Immersive Virtual World Technology
Authors: MITCHELL SUZANNE , BRAGG ALEXA , WINTER MICHAEL , GARDINER PAULA , HOWARD JESSICA M. , LAIRD LANCE D. 
Published: June 2021

Introduction: Immersive online technologies, such as virtual world (VW) platforms, can increase patient engagement in DSME/S. The Women in Control 2.0 (WIC2) trial compared DSME/S delivered in a VW vs. in-person for minority women with uncontrolled type 2 diabetes (HbA1c ≥8.0). We hypothesize the sense of presence afforded by a VW platform fosters patient engagement. Presence in a virtual reality setting is defined as a feeling of being immersed in an environment despite its artificiality.
Methods: We used a triangulation mixed-methods design embedded within the WIC2 clinical trial. For the 145 participants randomized to the VW study arm, we measured participant experience of physical, self and social “presence” in the VW using the validated Multimodal Presence Scale (MPS) and 63 participated in qualitative interviews. We analyzed participant experiences in the VW with qualitative data collected via direct observation, focus group, and key informant interviews. We calculated the MPS scores and conducted a qualitative thematic analysis of transcripts. Qualitative and quantitative data were collected independently and integrated using a conceptual mapping process to correlate participants’ experience of DSME/S in the VW.
Results: Half of participants were over 56yo and had a mean baseline HbA1c of 9.9% (SD=1.75). Two-thirds of the VW participants reported a sense of social (63.7%) and physical (63.1%) presence, while half-experienced self (49.0%) presence in the VW. Data integration led to three themes related to “presence” in a VW: (1) Self-presence fosters user identification with the personalized avatar (2) Physical presence fosters a growth mindset through imaginative play and visualization, and (3) social presence fosters peer social support.
Conclusion: Patient engagement in DSME/S is enhanced by the sense of physical, social and self- presence experienced by learners when using immersive technology software in a peer group context.

Disclosure
S. Mitchell: Other Relationship; Self; See Yourself Health LLC, Speaker's Bureau; Self; Merck Sharp & Dohme Corp. A. Bragg: None. M. Winter: None. P. Gardiner: None. J. M. Howard: None. L. D. Laird: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK10653)