bluuebunny/crossref_metadata_2025_split huggingface dataset:
555-P: Leveling the Playing Field of Technology Access for Youth with T1D: NICH Helps, but Challenges Persist
Authors: LELY JUSTINE , HARRIS MICHAEL A. , NARANJO DIANA , JENISCH CELESTE , CADIZ WINNIEBHELLE C. , BENSEN RACHEL , VIANA JULIA , WAGNER DAVID V. 
Published: June 2021

Objective: Advancements in technology (insulin pumps, CGMs) for youth with type 1 diabetes (T1D) hold promise for better outcomes, but multiple barriers to access exist, especially for underserved and underrepresented populations. Novel Interventions in Children’s Healthcare (NICH), was designed to improve health for youth with T1D and social vulnerabilities. NICH is associated with improvements in glycemic control and reductions in complications (DKA), but less is known regarding technology access for participating youth. This study aims to 1) identify prevalence of technology use prior to and after NICH initiation and 2) examine the relationship between technology access and NICH outcomes.
Methods: Youth with T1D served by NICH (n=65) across three distinct geographical sites were included. EHR review included T1D complications (DKA), HbA1c values, and presence of T1D technology one year prior and two years following initiation of NICH services. Mean age was 15.0 years (SD=3.5); 52% female; 73% non-Hispanic White.
Results: Ten percent of youth had access to technology prior to NICH (pump=8%; CGM=2%), and 22% had access to technology 2 years post NICH initiation (pump=17%; CGM=14%). Youth were significantly more likely to gain access to CGMs (p&lt;.01) and any T1D technology (p=.02) while in NICH. Youth with technology prior to NICH had fewer days admitted (p=.001) and ED visits (p&lt;.01) pre-referral than those without technology. Youth who gained access to a CGM within the first year of NICH services were significantly more likely to show improvements in glycemic control (p=.01) compared to those without.
Conclusion: With rates of access hovering around 40% for CGMs and 50% for pumps, this study demonstrates that 1) youth referred to NICH experience substantial barriers to accessing T1D technology, 2) NICH participation is associated with increased access to T1D technology for socially vulnerable youth, and 3) despite program involvement, technology access inequities persist.

Disclosure
J. Lely: None. M. A. Harris: None. D. Naranjo: None. C. Jenisch: None. W. C. Cadiz: None. R. Bensen: None. J. Viana: None. D. V. Wagner: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust; BUILD EXITO Foundation; Central Oregon Health Council
56-LB: The Mediating Role of Shared Responsibility in the Relationship of Trait Mindfulness and Diabetes-Related Outcomes
Authors: ABUJARADEH HIBA , VISWANATHAN PUSHPA , SEREIKA SUSAN M. , DINARDO MONICA M. , FEELEY CHRISTINE A. , CHARRON-PROCHOWNIK DENISE 
Published: June 2021

In youth with T1D, mindfulness and parental involvement (i.e., shared responsibility) of diabetes self-management (DSM) behaviors are associated with positive diabetes-related outcomes. This study explored the mediating role of shared responsibility in the relationship of mindfulness with DSM and A1c. A cross-sectional study was conducted among 129 adolescents aged 12-18 years with T1D at a tertiary medical center. Adolescents completed a survey on mindfulness (Child Acceptance & Mindfulness Measure), shared responsibility (Diabetes Family Responsibility Questionnaire-Short) and DSM (Self-care Inventory). A1c was obtained from medical records. The PROCESS SPSS macro by Hayes (v3.5) was used to assess mediation. Unstandardized and standardized path coefficients (β), SE, p-value, and 10,000 bias-corrected bootstraps 95% CI reported.
Results: Mindfulness had positive significant association with shared responsibility (a-path=0.974, SE=.045, β=.189, R2=.036, p=.032). Shared responsibility had significant association with DSM (b-path=0.055, SE=.017, β=.275, p=.0015). The direct (c’) and total (c) relationships between mindfulness and DSM were significant (c’=0.198, SE=.087, β=.193, p=.024; c=.251, SE=.088, β=.245, R2=.06, p=.005). The relationship between mindfulness and DSM was partially mediated by shared responsibility (ab=0.053, SE=0.031 bias-corrected bootstrapped 95% CI = [0.0059, 0.0119]). For the second mediational model, neither mindfulness nor shared responsibility was associated with A1c (p&gt;.05). Mindfulness and shared responsibility had positive association with DSM but not A1c. Shared responsibility partially mediated the relationship between mindfulness and DSM, whereby youth with higher levels of trait mindfulness had greater shared responsibility and better DSM. Temporal inferences should be interpreted with caution. Interventions targeting both mindfulness and shared responsibility should be explored.

Disclosure
H. Abujaradeh: None. P. Viswanathan: None. S. M. Sereika: None. M. M. DiNardo: None. C. A. Feeley: None. D. Charron-Prochownik: None.

Funding
National Association of Pediatric Nurse Practitioners; Eta Chapter-Sigma Research Award; Swigart/Gold Doctoral Student Award; J. Wiggins Scholarship
560-P: Reimagining the Assessment of Diabetes Distress in Type 2 Diabetes
Authors: POLONSKY WILLIAM H. , FISHER LAWRENCE , HESSLER DANIELLE M. , KING SARAH B. , DESAI URVI , KIRSON NOAM , PEREZ-NIEVES MAGALY 
Published: June 2021

Recent advances in type 2 diabetes (T2D) care have led to changes in the lived experience of diabetes. Thus, an updated understanding of concomitant changes in diabetes distress (DD) and its measurement is now warranted. Toward this end, we developed a new measurement strategy and instrument to assess DD among adults with T2D: the T2-Diabetes Distress Assessment Tool.
Cognitive interviews with a diverse group of 11 T2D adults and 6 diabetes clinicians resulted in the development of 51 items that were administered through an online survey to a validation sample of 599 T2D adults from the TCOYD Research Registry. Included for construct validity were measures of affect (WHO-5, PHQ-8, PSS), hypoglycemic concerns (HABS), self-management (SDSCA), and clinical outcomes (A1C).
Item content suggested two broad categories: (1) the core affective experience of DD (T2-DD Core), e.g., feeling overwhelmed with diabetes, and (2) 7 contributors to DD (T2-DD Sources): concerns about hypoglycemia, complications, healthcare provider, management demands, interpersonal issues, shame and stigma, and diabetes care access.
The T2-DD Core items and each of the 7 T2-DD Sources items were submitted separately to an EFA with PROMAX rotation. Each analysis yielded a single, dominant factor. Poorly loaded and conceptually overlapping items were removed for parsimony. The final T2-DD Core measure (8 items) and each of the 7 T2-DD Sources measures (22 items in total) yielded acceptable alpha coefficients. T2-DD Core was significantly associated with all construct validity measures; while each of the 7 T2-DD Sources was associated with validity measures in expected areas (e.g., hypoglycemia with HABS). Results were similar for insulin users and non-insulin users.
In total, these scales comprise the T2-Diabetes Distress Assessment Tool, which provides a unique method of assessing two complementary and clinically relevant aspects of DD, based on T2D adults’ lived experience: the core level of DD and the specific sources of DD.

Disclosure
W. H. Polonsky: Advisory Panel; Self; Intarcia Therapeutics, Inc., Consultant; Self; Abbott Diabetes, ADOCIA, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Insulet Corporation, Lilly Diabetes, Novo Nordisk, Onduo LLC., Sanofi US. L. Fisher: Consultant; Self; Ascensia Diabetes Care, Lilly Diabetes, Speaker’s Bureau; Self; Dexcom, Inc. D. M. Hessler: Consultant; Self; Eli Lilly and Company. S. B. King: Consultant; Self; Eli Lilly and Company. U. Desai: Consultant; Self; Eli Lilly and Company. N. Kirson: Consultant; Self; Eli Lilly and Company. M. Perez-nieves: Employee; Self; Eli Lilly and Company.

Funding
Eli Lilly and Company
562-P: Transition of Care in Type 1 Diabetes and Association with Student and Employment Status
Authors: MAJIDI SHIDEH , ROBERTS ALISSA J. , SUERKEN CYNTHIA , REBOUSSIN BETH A. , MALIK FAISAL , MARCOVINA SANTICA M. , CORATHERS SARAH , REYNOLDS KRISTI , IMPERATORE GIUSEPPINA , WADWA R. PAUL , PIHOKER CATHERINE 
Published: June 2021

Transition between pediatric and adult diabetes care is often associated with new responsibilities in diabetes care and increased risk of acute complications. This study examines post-transition rates of acute complications and independence in diabetes self-care as a function of student and employment status based on time since transfer.
The study included young adults with type 1 diabetes (T1D) between 18-26 years of age who completed a SEARCH for Diabetes in Youth Study visit between 2016-2019. Subgroup analysis compared those that transitioned care to an adult provider in the past 2 years to those who had transitioned ≥2 years prior. Chi-squared tests and linear and logistic regression models were applied. The models for diabetes complications and care included an interaction term between student and employment status and adjusted for gender, race/ethnicity, age, education level, insurance type, diabetes duration, and site.
1,043 participants were included in the analysis (56.6% female, mean age 22.2±2.5 years, mean T1D duration 11.7±3.0 years). Overall, 65.9% of participants had transferred to an adult diabetes care provider prior to their study visit. Among those who transitioned within the past two years (N=254), unemployed non-students were significantly more likely to experience diabetic ketoacidosis or severe hypoglycemia than unemployed students (p=0.01). Non-students who transferred within the past two years were less likely to be performing all diabetes self-care independently (p=0.03).
In conclusion, recent transition from pediatric to adult diabetes care represents a high-risk period for acute complications, specifically for non-students who are unemployed. For those who had transitioned in the past 2 years, students were more likely to be independent in their diabetes self-care. Additional support may be needed in this group to improve independent diabetes care and reduce the risk for acute complications.

Disclosure
S. Majidi: Advisory Panel; Self; Companion Medical. R. Wadwa: Consultant; Self; Tandem Diabetes Care, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care. C. Pihoker: None. A. J. Roberts: None. C. Suerken: None. B. A. Reboussin: None. F. Malik: None. S. M. Marcovina: None. S. Corathers: None. K. Reynolds: Research Support; Self; Merck & Co., Inc. G. Imperatore: None.

Funding
National Institutes of Health (1UC4DK108173, 1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); Centers for Disease Control and Prevention
563-P: The Relationship between Educational Attainment and Attrition Rates among Participants in the National Diabetes Prevention Program
Authors: ZHANG XUANPING , CANNON MICHAEL , NG BOON PENG , ELY ELIZABETH 
Published: June 2021

Research shows that education plays a critical role in participants’ commitment to public health programs. While participants’ age and race/ethnicity have been shown to be associated with attrition in the National Diabetes Prevention Program (National DPP), the effect of education remains uncertain. Using data from the CDC Diabetes Prevention Recognition Program, we examined the relationship between educational attainment and attrition rates. We included the study population who enrolled from March 2018 through February 2019 and had the opportunity to attend for at least one year. Cumulative attrition rates were calculated by delivery mode: in-person, online, distance-learning, and combination. Education was categorized as follows: &lt;high school (HS), HS graduate, 1-3 years college, and college graduate. We used cross-tabulation method with chi-square tests in our analyses. The study population (N=313,150) was 74.8% female and 65.5% white, with a mean age of 49.1 years (SD: 12.5) and mean BMI of 35.0 kg/m2 (SD: 7.1). Participants with lower educational attainment had significantly higher cumulative attrition rates compared to those with higher educational attainment among programs delivered in-person (through Session 5: 20.4% in &lt;high school (HS) group vs. 12.5% in HS graduate group vs. 9.3% in 1-3 years college group vs. 8.4% in college graduate group, p&lt;0.05) and distance-learning programs; by contrast, differences were not significant in online and combination programs. This pattern continued through Session 16, when similar attrition rates emerged from all education groups. These findings highlight the need for new strategies to better engage participants in the National DPP, especially those with lower educational attainment.

Disclosure
X. Zhang: None. M. Cannon: None. B. Ng: None. E. Ely: None.

Funding
Centers for Disease Control and Prevention
573-P: Insulin and Supply Rationing in Emerging Adults with Type 1 Diabetes
Authors: BLANCHETTE JULIA E. , TOLY VALERIE B. , WOOD JAMIE R. , LITCHMAN MICHELLE L. 
Published: June 2021

Over 25% of adults with diabetes have reported rationing insulin in the United States. Emerging adults, ages 18-25, may be even more vulnerable to rationing as they grapple with financial instability during this developmental period of increasing independence coupled with the rising cost of healthcare. The purpose of this study was to explore factors related to insulin and diabetes supply rationing in a sample of emerging adults with type 1 diabetes (T1D). Content analysis was used to examine a single open-ended response to the question, “Please tell me about your experiences rationing insulin or diabetes supplies,” in a parent cross-sectional study. The parent study explored financial stress factors, psychological factors, and self-management outcomes in 413 emerging adults from the T1D Exchange Clinic Registry. Chi-square tests were utilized to understand if rationing (yes or no) differed based on gender, race/ethnicity, employment status, type of health insurance, insulin pump usage, CGM usage, and A1c level (&lt;8.9% or &gt;9.0%). Alpha was set at .05. A total of 268 participants responded to the open-ended question about rationing. Over one-third of respondents (N=99, 36.9%) reported rationing insulin or diabetes supplies. Lack of private health insurance X2(3, N=224)=8.38, p&lt;.05, racial/ethnic diversity (non-white, Hispanic) race/ethnicity X2(6, N=224)=13.54, p&lt;.05 and no CGM usage X2(1, N=224)=9.75, p&lt;.01 had significant relationships with rationing. Gender, employment status, A1C level, and insulin pump usage were not associated with rationing. A considerable number of emerging adults with T1D have experience rationing. Diabetes providers should routinely assess for insulin and diabetes supply rationing in this population. Attention should be paid to emerging adults who are racially/ethnically diverse, lack private insurance, and do not use CGM. Policy changes are necessary in order to improve access to affordable diabetes management tools in this vulnerable population.

Disclosure
J. E. Blanchette: Board Member; Self; JDRF, Consultant; Self; Insulet Corporation, Other Relationship; Self; Insulet Corporation, Tandem Diabetes Care, Research Support; Self; Association of Diabetes Care and Education Specialists. V. B. Toly: None. J. R. Wood: Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Insulet Corporation, Speaker’s Bureau; Self; Xeris Pharmaceuticals, Inc. M. L. Litchman: Research Support; Self; Abbott Diabetes.

Funding
Sigma Theta Tau Alpha Mu; Frances Payne Bolton School of Nursing
578-P: Impact of COVID-19 on Diabetes Self-Management and Care
Authors: ZUPA MARGARET , PEREZ STEPHANIE , PALMISANO GLORIA , KIEFFER EDITH C. , PIATT GRETCHEN , VALBUENA FELIX , DEVERTS DENISE J. , YABES JONATHAN , HEISLER MICHELE , ROSLAND ANN-MARIE 
Published: June 2021

Stay at home orders, changes in business and clinic operations, and financial concerns related to the COVID-19 pandemic may have affected how adults with diabetes obtained food, medications, medical care, and performed diabetes self-management. These impacts may be most pronounced among people in low-resource urban communities. We assessed the experiences of adults with type 2 diabetes participating in a federally-qualified health center diabetes management program. Of 72 patients called, 61 completed telephone surveys from July to October 2020 in Spanish and English. 74% of respondents were Latino with Spanish as their preferred language. Respondents’ mean age was 54 years, 62% were female, and 57% had less than a high school degree. Five patients reported testing positive for COVID-19, and 7 lived with someone who tested positive. Of 33 respondents who worked outside the home before COVID-19, 61% had lost their jobs or now worked fewer hours. When asked how diabetes management behaviors changed during the pandemic, 53% of respondents reported less physical activity, while 25% reported more. 18% reported eating less healthfully, while 38% reported eating more healthfully. 43% found it more difficult to obtain healthy food. 15% reported taking their medications more regularly, while 5% reported less. 61% reported increased difficulty accessing medical care. 41% felt more worried about being able to manage their diabetes during the pandemic and 49% felt more socially isolated. Changes in diabetes self-management behaviors related to COVID-19 were both positive and negative for patients in this low-resource urban setting. Programs supporting patients with diabetes could help patients adapt to pandemic changes by facilitating access to medications and health care, providing virtual support for self-management and other health habits, connecting patients with financial and food security concerns to community resources, and addressing stress and social isolation through virtual diabetes support groups.

Disclosure
M. Zupa: None. A. Rosland: None. S. Perez: None. G. Palmisano: None. E. C. Kieffer: None. G. Piatt: None. F. Valbuena: None. D. J. Deverts: None. J. Yabes: None. M. Heisler: None.

Funding
National Institutes of Health (R01DK116733)
585-P: Buffering Effects of Subjective SES on Parental Depressive Symptoms following Child T1D Diagnosis
Authors: WANG CHRISTINE H. , TULLY CARRIE , MONAGHAN MAUREEN , HILLIARD MARISA E. , STREISAND RANDI 
Published: June 2021

Introduction: Parent depression is linked to negative child T1D outcomes. Some studies find that subjective (SSES) and objective socioeconomic status (OSES) are uniquely related to depressive symptoms, but few studies have examined them together in a T1D population. The current study explores the associations among SSES, OSES, and parent mood following child T1D diagnosis.
Method: Participants included 157 parents (62% non-Hispanic white, 77% married, 92% female, 28% public insurance) of young children (Mage=4.46±1.64 years) newly diagnosed (M=29 days post-diagnosis) with T1D. At baseline of a behavioral RCT, parents self-reported on their depressive symptoms (Center for Epidemiological Studies-Depression Scale; CES-D; ≥16=elevated scores), SSES (The MacArthur Scale of Subjective Social Status), and OSES (lower OSES=public insurance; higher OSES=private insurance). χ2 test of independence was used to compare rates of elevated CES-D scores across four OSES/SSES categories (n, % elevated): both lower (n=14; 79%), lower OSES/higher SSES(n=29; 31%), higher OSES/lower SSES(n=49; 48%), and both higher (n=63; 44%).
Results: There was a significant association between OSES/SSES category and parent depressive symptoms, χ2(3, N=153)=8.81, p=.03. Post hoc analyses using Bonferroni corrections indicated one significant group difference: the lower OSES/higher SSES group had significantly lower rates of elevated CES-D scores than the both lower group.
Discussion: During the stressful period following a young child’s T1D diagnosis, higher perceived SES, relative to one’s peers, may be a protective factor against depressive symptoms, specifically for parents with public insurance. Despite having fewer financial resources, these parents reported depressive symptoms similar to parents with private insurance. Future studies using a positive psychology framework may examine methods to improve subjective well-being in parents of children with T1D.

Disclosure
C. H. Wang: None. C. Tully: None. M. Monaghan: None. M. E. Hilliard: None. R. Streisand: None.

Funding
National Institute of Diabetes and Digestive and Kidney Disease (R01DK102561)
587-P: Adherence, Acceptability, and Feasibility of Mobile Ecological Momentary Assessments (mEMA) in Young Adults (YA) with Type 1 Diabetes (T1D) of Racial-Ethnic Minority Status
Authors: LEUNG STEPHANIE , CRESPO-RAMOS GLADYS , FINNAN MOLLY , GONZALEZ JEFFREY S. , AGARWAL SHIVANI 
Published: June 2021

Background: YA with T1D of racial-ethnic minority disproportionately experience stress related to social determinants of health (SDOH), which may be associated with hyperglycemia, glycemic variability, and poorer emotional well-being. Mobile EMA methodology uses mobile technology to assess contextually relevant, real-time behavioral and self-report data.
Methods: Coupled with real-time CGM for two weeks, we employed mEMA methodology with three times daily cell phone-delivered surveys to study the association of momentary variations in SDOH-related stress with glycemia in YA with T1D from the Bronx, NY. We report our preliminary findings on acceptability, feasibility, and adherence of mEMA methodology in this ongoing study. We evaluated adherence by real-time app tracking of mEMA survey completion, and evaluated acceptability and feasibility by post-study questionnaires and qualitative interviews.
Results: Thus far, 18 participants have completed the study: (mean age 23 yrs, 11 Hispanic, 7 non-Hispanic Black, mean HbA1c 8.0%). Adherence to assigned daily surveys was high at 85% (753/887 surveys). There were no differences in survey adherence across timepoints. Acceptability was high: participants reported good understanding of mEMA procedures (mean score 4/5 on Likert scale), high satisfaction (mean score 5/5), high willingness to participate again (mean score 5/5), and were very likely to recommend participation to others (mean score 5/5). For feasibility, the most common barrier cited was mEMA app issues (40%, n=7), specifically dropped survey notifications, which interfered with adherence.
Conclusions: YA with T1D of racial-ethnic minority demonstrated high adherence, feasibility, and acceptability of mEMA methods, however there were app-related issues that need closer monitoring. mEMA is a viable tool to study real-time contextual and behavioral factors in minority YA with T1D.

Disclosure
S. Leung: None. G. Crespo-ramos: None. M. Finnan: None. J. S. Gonzalez: None. S. Agarwal: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (5P30DK111022, K23DK115896)