bluuebunny/crossref_metadata_2025_split huggingface dataset:
476-P: Multidisciplinary Predialysis Team Education for Patients with Diabetic Nephropathy, Postponed Hemodialysis Induction, and Prolonged Survival after Hemodialysis Induction
Authors: HITOMI MAMIKO , SATO TERUKO , MORIYA TATSUMI 
Published: June 2021

To determine whether a multidisciplinary team approach (MTA) improves the course of hemodialysis (HD), including clinical status, hospital admission costs, and prognosis after HD induction, in patients with diabetic nephropathy (DN), we compared the HD course of 36 patients who received MTA and 33 patients managed with a dietitian approach (DA) (n=69; 47 men: mean age, 59±12 years; 66 type 2 diabetic patients). HD started between January 2010 and June 2016. The observation period ended with death or in September 2018. MTA staff consisted of physicians, dietitians, nurses, laboratory technologists, and pharmacists. They provided broad education, including advice on nutrition, medication, medical examinations, and foot care. There were no significant differences in HbA1c, age, BMI, or eGFR between the groups when the baseline serum creatinine (S-Cr) was 2.0 mg/dL. There were no differences in the incidence of severe hypoglycemia or use of erythropoiesis-stimulating agents or RAS inhibitors. The MTA group was more likely to undergo 24-h urine collection than the DA group (likelihood ratio, 6.11; p=0.014). The MTA group had smaller CTR than the DA group (52.0% vs. 55.8%; p=0.024). Sodium intake based on 24-h urine collection was correlated with CTR (p=0.033). The MTA group had lower cost per admission for HD induction than the DA group ($20,580±14,170 vs. $14,804±8,397; p=0.023). Kaplan-Meier survival analysis showed that the MTA group had a longer duration from Cr 2.0 mg/dL to HD initiation (Wilcoxon 5.679; p=0.017) and from HD initiation to death than the DA group (Wilcoxon 3.860; p=0.050). MTA provided multiple broad effects with a longer duration before HD initiation, better clinical course, lower costs, and prolonged survival after HD induction compared with DA when observation started at the same S-Cr level. Future studies are needed to examine whether MTA has legacy effects after HD initiation.

Disclosure
M. Hitomi: None. T. Sato: None. T. Moriya: None.
481-P: Risk Assessment among Organizations Participating in the National Diabetes Prevention Program (National DPP) Lifestyle Change Program
Authors: JABRAH RAJAI , ELY ELIZABETH 
Published: June 2021

The National DPP is a partnership of public and private organizations working to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay onset of type 2 diabetes in adults with prediabetes. The CDC’s Diabetes Prevention Recognition Program (DPRP) recognizes organizations that deliver the 12-month LCP. Organizations can achieve three levels of recognition—pending, preliminary, or full—which reflect their ability to meet national quality standards. Identifying factors that impact organizations’ ability to meet these standards provides opportunities to strengthen their program delivery. This study aims to compare program enrollment and retention among in-person LCP participants in organizations that have achieved preliminary or full recognition to that of organizations that withdrew from the DPRP. Analysis was limited to the 109,201 eligible participants who had the opportunity to complete the 12-month program by March 2020. Among the 862 organizations that had achieved preliminary or full recognition, the average enrollment per 6-month period was 31 participants. However, the average enrollment per 6-month period among the 335 withdrawn organizations was 19 participants. Among organizations that achieved preliminary or full recognition, 60% of participants were retained for ≥9 months. Among withdrawn organizations, however, only 44% of participants were retained for ≥9 months. Among organizations that achieved preliminary or full recognition, the average number of sessions attended in the first and second 6-month phases was 14 and 6, respectively. For withdrawn organizations, however, the average number of sessions attended in the first and second phases was 13 and 3 sessions, respectively. Knowing that withdrawn organizations struggled with enrollment and retention provides a starting point for identifying strategies to assist these organizations.

Disclosure
R. Jabrah: None. E. Ely: None.
485-P: Insights from Type 2 Diabetes Patients Reveal Education- and Income-Based Disparities in Awareness Surrounding Kidney Disease Risk and Renoprotective Therapies
Authors: STEVENSON JULIA , YE EMILY , SUHL SARA , GOWEN REBECCA , TAIT JACQUELINE , FLORISSI CATERINA , WOOD RICHARD 
Published: June 2021

Objective: Diabetes is a leading cause of chronic kidney disease (CKD), and new drug classes including SGLT-2 inhibitors and GLP-1 receptor agonists have shown renal benefits for those with type 2 diabetes (T2D). This study evaluated T2D patients’ awareness regarding CKD and renoprotective drugs across household income and educational attainment.
Method: In an online survey in September 2020, 2,008 adults with T2D not currently being treated for kidney disease rated their level of agreement with statements about CKD risk and renoprotective drugs. Demographic information was collected.
Result: The majority (58%) of patients strongly agreed that diabetes increases risk of CKD. Those with an income of &lt;$50k and a high school diploma were less aware of the link between diabetes and CKD than those with the same income and a bachelor’s degree or higher (51%, vs. 62%) and those with an income of &gt;$100k and a bachelor’s degree or higher (65%). Only 30% of patients indicated strong concern about CKD risk, and 25% were aware that some T2D drugs have renal benefits. Among those earning $50k-$100k, patients with a high school diploma were more concerned about their risk (44%) than those with some college (24%) or a bachelor’s degree or higher (29%). Those earning &gt;$100k with a bachelor’s degree or higher were more likely to indicate strong awareness that some T2D drugs are renoprotective (34%) than those earning &lt;$50k (high school diploma: 23%; some college: 24%), those earning $50k-$100k (some college: 24%; bachelor’s degree or higher: 25%), and those earning &gt;$100k with some college (20%).
Conclusion: While few T2D patients are aware that some T2D drugs have renoprotective effects, those with higher education and income are more likely to be aware. These findings emphasize the importance of informing patients about renal health and therapeutic options, in efforts to increase accessibility of SGLT-2 and GLP-1 therapies to all who would benefit.

Disclosure
J. Stevenson: Other Relationship; Self; Abbott, Ascensia Diabetes Care, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, LifeScan, Medtronic, Roche Diabetes Care, Senseonics, Tandem Diabetes Care. E. Ye: Other Relationship; Self; dQ&A. S. Suhl: Other Relationship; Self; dQ&A has several clients (&gt;10) in the diabetes field. R. Gowen: Other Relationship; Self; dQ&A. J. Tait: Other Relationship; Self; dQ&A Market Research Inc. C. Florissi: Other Relationship; Self; Abbott Diabetes, Ascensia Diabetes Care, Dexcom, Inc., Insulet Corporation, LifeScan, Lilly Diabetes, Medtronic, Roche Diabetes Care, Senseonics, Tandem Diabetes Care. R. Wood: Research Support; Self; Abbott Diabetes, American Diabetes Association, Ascensia Diabetes Care, Boehringer Ingelheim International GmbH, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk Inc., Sanofi.
487-P: Exploring the Research Experiences of American Indian Mother/Daughter Dyads and Site Coordinators after a GDM Risk Reduction and Preconception Counseling Randomized Controlled Trial
Authors: STOTZ SARAH A. , FISCHL ANDREA F. , TERRY MARTHA A. , GARROW HEATHER , O’BANION NANCY , CHALMERS LAURA , MOORE KELLY R. , CHARRON-PROCHOWNIK DENISE 
Published: June 2021

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and contributes to increased risk for T2D in both the mother and offspring. American Indians are at higher risk of GDM and subsequent diagnosis of T2D than non-Hispanic white women. This project examined the experiences of American Indian mother-daughter (M-D) dyads as participants and the site coordinators who facilitated a GDM risk reduction and preconception counseling randomized controlled trial (RCT) to evaluate Stopping GDM (SGDM). The SGDM RCT included 4 visits over 9 months which dyads attended together but completed SGDM intervention (video and eBook) and questionnaires separately. SGDM content included GDM risk reduction (e.g., healthy nutrition), GDM risk awareness/health beliefs, preconception counseling, reproductive health communication, and family planning. For this study, dyads (n=22 dyads) were recruited from three of the five study sites and site coordinators from all sites participated (n=6). Mothers, daughters, and site coordinators were in separate focus groups. Focus groups were facilitated by trained qualitative researchers, conducted/recorded remotely using Zoom, transcribed verbatim, and analyzed using qualitative content analysis and Atlas.ti. Themes include: 1) SGDM provided valuable quality time and conversation about GDM and reproductive health among dyads; 2) GDM risk factors and risk reduction was largely new information for most dyads; 3) all sites experienced challenges to study engagement and recruitment; 4) recommendations for study improvement: personalized recruitment that is clinic-based and mother-focused; remote/asynchronous study visits; and significantly shorter content. These findings will be used to inform revisions of SGDM to improve the program and for a broader, more inclusive version of the program for other at-risk females.

Disclosure
S. A. Stotz: None. A. F. Fischl: None. M. A. Terry: None. H. Garrow: None. N. O’banion: None. L. Chalmers: None. K. R. Moore: None. D. Charron-prochownik: None.

Funding
National Institutes of Health (UL1TR001857 to D.C-P.); National Institute of Nursing Research (1R01NR014831-01A1 to D.C-P., K.R.M.)
505-P: Implementation of Nutrition Assessments to Evaluate and Improve Nutrition Knowledge at Initial Follow-up of New-Onset Type 1 Diabetes
Authors: THIVIERGE MEREDITH R. , SNOW SHANI , SEEL MAUREEN , BROWN ELIZABETH A. , AKHTAR YASMIN , WOLF RISA 
Published: June 2021

Background: Carbohydrate counting is a key component of type 1 diabetes (T1D) management that is taught at the time of diagnosis, but it is hard to determine how much knowledge is retained during that stressful period. We hypothesize that implementation of a nutrition quiz at one of the first comprehensive diabetes follow-up visits will evaluate knowledge retained and increase carbohydrate counting knowledge in newly diagnosed T1D patients.
Methods: A quality improvement project was prospectively conducted to assess nutrition knowledge retained following new onset diagnosis of T1D. We implemented a 16-item nutrition assessment (at the 1st or 2nd outpatient visit), evaluating topics including nutrition label reading, hypoglycemia/hyperglycemia management, and insulin dose calculations. Data was collected from the medical record, and descriptive and summary statistics were performed.
Results: Quizzes were administered to 17 patients/caregivers, mean age of patient 8.9y (SD=3.5), 83% NH White, mean HbA1c 9% at time of assessment, and mean time of 2.5 months from diagnosis. Quizzes were completed by parents 53%, parents and child 35%, and child 12% of the time. Mean overall quiz score was 13.5/16, with scores related to questions about insulin of 4.18/5, general nutrition of 3.24/4, nutrition labels of 1.65/2, and symptoms and complications of 4.41/5. The dietitian spent on average 20 min (range 13-30 min) with patient/caregiver. Patient age was not associated with quiz score. Patients with private insurance scored higher on the quiz compared to those with Medicaid (p = 0.05). Ongoing recruitment may further elucidate this association.
Conclusions: Implementation of nutrition assessments is feasible and facilitates nutrition education with the patient and/or caregiver in an engaging manner. There is a vast amount of nutrition knowledge to be acquired at diagnosis of T1D, and reinforcement is important for long-term diabetes management and outcomes.

Disclosure
M. R. Thivierge: None. S. Snow: None. M. Seel: None. E. A. Brown: None. Y. Akhtar: None. R. Wolf: Consultant; Self; NEMA Research.
518-P: User Experiences with Loop, an Open-Source Automated Insulin Delivery (AID) System
Authors: SUTTIRATANA SAKINAH , WONG JESSIE J. , LANNING MONICA S. , DUNLAP ADRIENNE , HANES SARAH , HOOD KOREY K. , LAL RAYHAN , NARANJO DIANA 
Published: June 2021

Background: Loop is an open-source AID system used by more than 9,000 people with type 1 diabetes. Understanding the pros and cons of Loop use may help improve disease management and support population level innovation.
Methods: Focus groups illuminated 72 new and experienced users’ perspectives on Loop uptake, use and persistence. Participants were predominately white (95%), male (50%), privately insured (94%), reported annual household income ≥ $100K (73%) and education exceeding a bachelor’s degree (87%) with a mean HbA1c of 6.6±0.8%. Twenty discontinuers who stopped using Loop during the study (60% female, 85% white, 85% privately insured) completed interviews. Qualitative data, collected as part of the larger observational study, were analyzed and synthesized by a multidisciplinary team.
Results: High frequency thematic content described experiences with: a) technical support and troubleshooting, b) decreased mental/behavioral burden, c) technical issues with parts of the system, d) glycemic control, e) personalizing settings, and f) providers while using Loop. Users also emphatically highlighted the effects of Loop on overnight experiences and the role that “Loop communities” played during use. Decreased burden was the most endorsed benefit characterized by less worry, stress, and cognitive effort; less time spent on diabetes management tasks, and more space to think about nondiabetes aspects of life. The most discussed drawback was having technical issues with any part of the system including challenges with insulin pumps, CGMs, infusion sites, signal loss, the app, and/or the algorithm. A range of provider attitudes and knowledge about Loop complicated users’ disclosure and experiences.
Conclusions: This sample of Loop users reported benefits to quality of life and glycemic control that outweighed challenges of setting up system components and adjusting settings. Users reported being empowered by the customizability and educational effects of the open-source AID system.

Disclosure
S. Suttiratana: Employee; Spouse/Partner; CVS Health. J. J. Wong: None. 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
519-P: Unmet Communication Needs and Barriers of Black and African Americans with Type 2 Diabetes
Authors: ZISMAN-ILANI YAARA , SIMINOFF LAURA A. , SAVOY MARGOT L. , PARANJAPE ANURADHA , LIU JIN , JACOB REGINA A. , GARDINER HEATHER M. , BASS SARAH B. , MONTORI VICTOR M. , RUBIN DANIEL J. 
Published: June 2021

T2D is disproportionately prevalent among Black and African Americans (BAAs) and is one of the leading causes of mortality and morbidity among BAAs. T2D care is improved by patient-centered communication and Shared Decision Making (SDM). However, culturally sensitive T2D communication and SDM tools that focus on patient’s communication preferences, needs, and racial and cultural background that shape the interaction with a provider and influence treatment follow-up, are missing. The purpose of this formative study was to identify communication preferences, barriers, and needs of BAAs with T2D. Interviews were conducted with 32 BAAs with T2D served at a safety-net hospital located in a poor urban area. The sample included 17 women (53.1%), ages 31 to 81 years (58.9, SD=11.9), with a range of glycemic control (HbA1c: M=9, SD=2.7, range 6 to 14). A third (N=11) were prescribed oral medication and insulin, another third (N=11) were on oral medication only. A majority of participants (n=18, 56.3%) identified paternalistic communication, mistrust in the provider, and communication mismatch as barriers to T2D care. Receiving information about managing T2D in real-life situations (n=18, 56.3%) and patient-clinician collaboration in T2D decision-making (n=23, 72%) were the preferred communication strategies. A majority of participants stated expression of empathy, concern, and compassion by providers (n=22, 68.8%) and informal, open and direct communication (n=31, 96.9%) are needed to improve the quality of T2D care among BAAs. We identified several communication barriers and needs of BAAs with T2D with their providers, which interrupt their T2D management and treatment follow-up. There is an urgent need to improve patient-provider communication by developing culturally-sensitive communication support tools to address the communication needs and preferences of BAAs to improve SDM and the quality of diabetes care.

Disclosure
Y. Zisman-ilani: None. D. J. Rubin: Research Support; Self; AstraZeneca. L. A. Siminoff: None. M. L. Savoy: None. A. Paranjape: None. J. Liu: None. R. A. Jacob: None. H. M. Gardiner: None. S. B. Bass: None. V. M. Montori: None.
52-LB: Weight Management Practices among U.S. Safety-Net Health Center Patients with Diabetes or Other Metabolic Disorders
Authors: WANG JASON J. , SHI ZUMIN , YAN ALICE 
Published: June 2021

Introduction: First-line intervention for the metabolic disorders or type 2 Diabetes is lifestyle change, including weight management, diet, and increased physical activity. This study evaluated the associations between health professional (HP) weight discussions and weight management practices among high risk safety-net patients.
Methods: Cross-sectional data on adults (aged≥18 years) with self-reported diabetes, hypertension or hyperlipidemia from the 2014 National Health Center Patient Survey (HCPS) was analyzed. The HCPS is a nationally representative survey of patients receiving care at safety-net health centers. Outcome (binary) was whether patients tried to lose weight in prior 12 months. Independent variables were HP discussing the weight problem, talking about weight loss options (i.e., exercise), suggesting a nutritionist visit, or offering weight loss medication. Logistic regression models with complex sampling design was used to test the association between HP weight discussions and the outcome, adjusted for psycho-sociodemographic covariates.
Results: Of 3671 patients, 55.5% (n=2039) tried to lose weight in prior 12 months. Women (62.4%) and Hispanic race/ethnicity (62.8%) were associated with a higher prevalence of attempting to lose weight in prior 12 months. In the fully adjusted model, having received HP’s weight discussion (AOR=5.54, 95%CI: 3.59-8.56), suggest exercise (AOR=3.61, 95% CI: 2.37-5.49), and recommend a nutritionist visit (AOR=2.59, 95% CI: 1.67-4.01) were associated for increased likelihood of attempting weight loss.
Conclusions: HP advice to lose weight may increase patients’ motivation to lose weight and weight loss behavior. Better training for HPs in delivering high-value care such as brief weight counselling could lead to improved chronic disease health outcomes for safety-net patient populations.

Disclosure
J. J. Wang: None. Z. Shi: None. A. Yan: None.
54-LB: Multidimensional Lifestyle Measures as Tools for Self-Reflection in Type 2 Diabetes
Authors: FANCHIANG SHANPIN , MORRIS KEIYANA , BOUCHONVILLE MATTHEW F. 
Published: June 2021

Background: For people with diabetes, self-management is important to reduce the risks of complications. Lifestyle interventions are multidimensional because of the influence of resources, societal changes, scientific and technological advancement, and the environment. The COVID-19 pandemic has strained lifestyle on a global scale. Lifestyle surveys provide opportunities to reflect on the living experience and identify alternatives to enrich lifestyle.
Method: A qualitative approach was used to explore existing generic, none-disease specific, and multidimensional lifestyle measures to identify if these have included smartphone use for self-management to determine the potential for use as a tool for self-reflection and lifelong learning.
Results: A total of 15 multidimensional lifestyle measures were identified. All included diet/nutrition, physical activity/exercise. Stress or mental health was described in all 9 generic lifestyle measures; social support and relationship were included in 6 (67%), sleep and health responsibility were in 5 (56%), and spiritual or religious pursue was in 3 (33%). One lifestyle measure classified spirituality in the stress management dimension. None included smartphone use and technology-related chronic illness management.
Conclusion: New dimensions need to be created to use a lifestyle measure as a self-reflection learning process, including those that incorporate the use of technology. The advancement in environmental neuroscience can also shed light on a healthy lifestyle in the area of connection to nature/environment. Lifelong learning to adopt these new activities as lifestyles should also be reflected in lifestyle measures for it to be a self-administered learning tool.

Disclosure
S. Fanchiang: None. K. Morris: None. M. F. Bouchonville: None.
548-P: Understanding T2D Self-Management in Racial/Ethnic Minorities: Application of the Extended Parallel Processing Model and Sensemaking Theory
Authors: RUBIN DANIEL J. , SWAVELY DEBORAH A. , BRAJUHA JESSE , KELLY PATRICK J. , ALLEN SHANEISHA , HOADLEY ARIEL , IWAMAYE AMY , ZISMAN-ILANI YAARA , BASS SARAH B. 
Published: June 2021

Behavioral health interventions are needed to address disparities among low-income racial/ethnic minorities with type 2 diabetes (T2D). We aimed to gain a better understanding of the role of disease threat perception and self-efficacy using the Extended Parallel Processing Model (EPPM) as a guide in T2D self-management among Black and Hispanic patients.
Semi-structured interviews were conducted with minority T2D patients who receive care in endocrinology, internal or family medicine practices in an urban safety-net hospital. Participants were placed in one of 4 EPPM groups based on validated questionnaires: High or low disease threat and high or low self-efficacy. The interviews were transcribed then analyzed using both inductive and deductive coding based on Sensemaking Theory.
From this ongoing study, the current analysis includes 11 interviews. The cohort had a median age of 52 years, was 55% female, 82% were black and 18% were Hispanic. Participants in the high threat groups indicated disease threat fluctuated throughout their diabetes history and that certain triggers (e.g., diabetic complications) drove changes in disease view. Participants with high threat/high efficacy (n=4) expressed acceptance of T2D and reported adequate social support, whereas those with high threat/low efficacy (n=2) expressed anger or denial about T2D. Participants with low threat/high efficacy (n=2) reported poor social support, while those with low threat/low efficacy (n=3) had heightened positive and negative emotional responses. Both low efficacy groups reported less problem-solving skills than the high efficacy groups.
Perceived health threat and low self-efficacy may impede T2D self-care, presenting barriers to achieving good diabetes control. A greater focus on the role of diabetes threat perception and self-efficacy is needed to improve T2D care among low-income minority patients.

Disclosure
D. J. Rubin: Research Support; Self; AstraZeneca. D. A. Swavely: None. J. Brajuha: None. P. J. Kelly: None. S. Allen: None. A. Hoadley: None. A. Iwamaye: None. Y. Zisman-ilani: None. S. B. Bass: None.