bluuebunny/crossref_metadata_2025_split huggingface dataset:
492-P: Glucose Level Recommendations for Vo2 Max Exercise Testing in Adolescents with Type 1 Diabetes
Authors: KING KRISTI , THRASHER BRAD J. , MCKAY TIM E. , WINTERGERST KUPPER A. 
Published: June 2021

Glucose level recommendations have yet to be established for adolescents diagnosed with type 1 diabetes (T1D) who participate in VO2 max exercise testing for clinical or strength and conditioning purposes. Although a decrease in glucose may be expected throughout, and immediately after exercise testing, a minimal pre-test glucose setpoint has not been established to reduce the risk of hypoglycemia. Retrospective medical and sports medicine chart reviews were conducted of clinical pediatric sports medicine and physical activity program patients with a diagnosis of T1D (N = 24; mean age = 15.5 ± 1.7 years; male = 14, 58.3%) who participated in a modified Bruce protocol for maximal oxygen uptake (VO2 max). The majority of the participants identified as non-Hispanic (n = 22, 91.7%) and white (n = 19, 79.2%). Their average body mass index (BMI) based on age and sex was in the 66th percentile ± 19.5 and their average hemoglobin A1c (HbA1c) was 8.8% ± 1.8. Almost 2/3 of the participants (n = 15, 62.5%) wore a continuous glucose monitor. Their average VO2 max peak was 43.7 ml/kg/min ± 7.1. A paired-samples t-test was employed to detect a statistically significant reduction in glucose levels between pretest (&lt; 30 minutes, mean = 191.1 mg/dl ± 61.2) and post-test VO2 max (&lt; 5 minutes, mean = 166.7 mg/dl ± 57.9); t(21) = 2.3, p &lt;. 05). The American Diabetes Association recommends that glucose levels do not fall below 70 mg/dl in order to prevent symptoms of hypoglycemia. These results demonstrated a mean decrease in glucose of 24.4 mg/dl and provide further data which can be used to set safety parameters and expectations for adolescents with T1D participating in VO2 max testing.

Disclosure
K. King: None. B. J. Thrasher: None. T. E. Mckay: None. K. A. Wintergerst: None.
496-P: Large-Scale Association of Basal Metabolic Rate and Blood Glucose Outcomes in People with Type 2 Diabetes
Authors: WEXLER YDO , GOLDNER DAN 
Published: June 2021

Background: Basal metabolic rate (BMR) measures the energy utilized by the body at rest. A growing body of literature reports increased BMR in people with type 2 diabetes (T2D), after controlling for sex, age and weight. We used blood glucose (BG) measurements and BMR values from the Apple Watch collected in the One Drop app, to measure the correlation of BMR and BG for the population as a whole, and for individuals over time.
Method: Data included over 48,000 person-months of blood-glucose and BMR measurements from 5,585 people with T2D. BG was self-monitored except for 186 people who provided continuous glucose monitoring (CGM) data through Dexcom’s API. BMR values were summed daily and correlated with 30-day average BG for the study population by linear regression. For each person using CGM, we computed the Pearson correlation coefficient of BMR with Time-in-Range (TIR), and used a random effects model to compute the overall correlation and associated p-value.
Results: The correlation coefficient of 30-day average BMR with 30-day average BG was 0.07 (p &lt; 10-6), and of BMR with 30-day TIR was -0.26 (p &lt; 10-6). The average correlation coefficient for individuals of BMR with TIR was -0.23±0.38. After applying the random effects model, the overall adjusted coefficient for individuals was -0.18 (p &lt; 10-6).
Conclusion: BMR and BG measurements collected in the One Drop app for 5,585 people with T2D show significant correlation of BMR with monthly BG levels at the population level and for individuals over time. This is among the largest scale analyses of such correlation, and the first one to use highly available BMR measurements from the Apple Watch.

Disclosure
Y. Wexler: None. D. Goldner: Employee; Self; One Drop.
498-P: Resistance Exercise Rapidly Alters Citric Acid Cycle and Amino Acid Metabolism in Skeletal Muscle
Authors: PATAKY MARK W. , KUMAR ARATHI PRABHA , KLAUS KATHERINE , NAIR K. SREEKUMARAN 
Published: June 2021

Muscle glucose metabolism is improved by either aerobic or resistance exercise (RE) training, but the mechanisms leading to improved metabolism for each of these exercise modes are not identical. Much work has been done onimproved oxidative metabolism by aerobic exercise, but far less is known about how RE impacts fuel metabolism. Here, TCA and amino acid metabolites are measured in skeletal muscle after a single bout of RE. Twenty one healthy subjects performed a session of one-legged knee extension RE that consisted of 3 sets of 10 reps at 70% of their 1 rep max. Two muscle biopsies were obtained from the vastus lateralis of each leg. From the RE leg, biopsies were obtained ≤10min post-RE (0hr PEX) and approximately 1hr post-RE (1hr PEX), respectively. From the non-RE leg, biopsies were obtained before and 1hr PEX, respectively. Muscle samples were frozen and stored until mass spectrometry analysis of metabolites was performed. A 2-fold increase in plasma lactate (P&lt;0.05) and a 30-40% increase in muscle glycolytic enzyme activity (P&lt;0.05) at 0hr PEX suggest increased activation of the glycolytic pathway. Also at 0hr PEX, TCA metabolites citrate and isocitrate were increased (P&lt;0.05) compared to the pre-RE biopsy (0.35 and 0.01 mmol/μg, respectively). Further, multiple amino acid metabolites Arg, Asn, Lys, Thr, and Val were increased (P&lt;0.05) in the REmuscle at 0hr PEX. These amino acids can enter the TCA cycle at various steps, indicating increased flux through the TCA cycle immediately after RE. By 1hr PEX, TCA intermediates malate and fumarate were reduced (P&lt;0.05)compared to the non-RE leg (-0.65 and -0.35 mmol/μg, respectively), and multiple amino acid metabolites were also reduced (P&lt;0.05). The decrease in these metabolites at 1hr PEX suggests increased use of metabolites for mitochondrial respiration. These results suggest activation of glycolytic and amino metabolism pathways, contributing to citric acid flux immediately following RE in order to meet energy needs in skeletal muscle.

Disclosure
M. W. Pataky: None. A. Prabha kumar: None. K. Klaus: None. K. Nair: None.

Funding
National Institutes of Health (R01AG062859)
506-P: Weight Loss Is Associated with Changes in Gut Microbiome: A Randomized, Crossover Trial Comparing a Mediterranean and a Low-Fat Vegan Diet in Overweight Adults
Authors: KAHLEOVA HANA , HOLUBKOV RICHARD , BARNARD NEAL 
Published: June 2021

Background: Mediterranean and vegan diets improve body weight and gut microbiome composition. The aim of this study was to compare both diets head-to-head.
Methods: Randomized cross-over trial, conducted February-October 2019. Sixty-two overweight adults were assigned to each diet for 16-week periods in random order, separated by a 4-week washout. Body weight was the primary outcome. Secondary measures included changes in gut microbiome which was measured using 16S rRNA sequencing.
Results: Body weight decreased on the vegan compared with the Mediterranean diet (treatment effect -6.0 kg [95% CI -7.5 to -4.5]; p&lt;0.001). The relative abundance of Bacteriodetes decreased (p&lt;0.001 for both diets) and Eubacteria increased on both diets (p&lt;0.001 for the Mediterranean and p=0.009 for the vegan diet). The relative abundance of Lachnospiraceae increased (p=0.03), the Firmicutes to Bacteroidetes ratio increased (p=0.04) and the butyrate-producing bacteria decreased (p=0.02) on the Mediterranean diet. The relative abundance of Proteobacteria decreased (p&lt;0.001), and Enterobacteria and Ruminococcus increased on the vegan diet (p=0.04 and p&lt;0.001, respectively). Changes in body weight correlated positively with changes in relative abundance of Firmicutes both on the Mediterranean (r=+0.36; p=0.01) and the vegan diet (r=+0.41; p&lt;0.001) and with changes in relative abundance of Lachnospiraceae both on the Mediterranean (r=+0.40; p&lt;0.001) and the vegan diet (r=+0.44; p&lt;0.001). In addition, the changes in body weight correlated negatively with changes in relative abundance of Enterobacteria on the Mediterranean diet (r=-0.32; p=0.02) and Eubacteria on the vegan diet (r=-0.49; p&lt;0.001).
Conclusions: A low-fat vegan diet lead to a greater weight loss compared with a Mediterranean diet. This may be partly explained by the difference in gut microbiome composition.

Disclosure
H. Kahleova: None. R. Holubkov: Advisory Panel; Self; National Institutes of Health, U. S. Food and Drug Administration, Board Member; Self; Pfizer Inc., Revance Therapeutics. N. Barnard: None.

Funding
Physicians Committee for Responsible Medicine
507-P: Effectiveness of a Ketogenic Diet and Virtual Coaching Intervention for Patients with Diabetes: A Difference-in-Differences Analysis
Authors: STROMBOTNE KIERSTEN , LUM JESSICA , NDUGGA NAMBI , UTECH ANNE , PIZER STEVEN , FRAKT AUSTIN , CONLIN PAUL 
Published: June 2021

Objective: Nutrition interventions are key components of diabetes care. In light of increased disease prevalence among Veterans, the Veterans Health Administration (VA) partnered with Virta Health to test the effectiveness of a ketogenic-diet and virtual coaching intervention in controlling markers of diabetes care and healthcare utilization.
Research Design and Methods: Using a difference-in-differences analysis with a waitlist-control group—a quasi-experimental methodology—we estimated the five-month change in hemoglobin A1c (HbA1c), body mass index, blood pressure, prescription medication use, and healthcare utilization. The analysis included 590 patients with diabetes who were also overweight or obese, and who regularly utilize VA for healthcare. We used data from VA electronic health records from 2018-2020.
Results: The ketogenic diet and virtual coaching intervention was associated with significant reductions in HbA1c levels (-0.68, [95% CI -1.01, -0.35]), diabetes medication fills (-0.38, [-0.49, -0.26]), body mass index (-1.08, [-1.96, -0.20]), diastolic blood pressure levels (-1.4, [-2.73, -0.14]) and outpatient visits (-0.36, [-0.70, -0.02]). We found no significant change in emergency department visits.
Conclusions: This real-world assessment of a virtual coaching and diet program shows that such an intervention offers short-term benefits on markers of diabetes care and healthcare utilization in patients with diabetes. It remains unclear whether the effect of the program operates primarily through the personalized coaching component, the ketogenic diet recommendations, or some combination of the two.

Disclosure
K. Strombotne: None. J. Lum: None. N. Ndugga: None. A. Utech: None. S. Pizer: None. A. Frakt: None. P. Conlin: None.

Funding
U.S. Department of Veterans Affairs (HSR&D SDR 20-386); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK114098)
527-P: Pediatric Parenting Stress, Child Behavior, and COVID-19-Specific Parent Functioning among Parents of Youth with Type 1 Diabetes (T1D)
Authors: ROONEY KELLYANN , WANG CHRISTINE H. , HILLIARD MARISA E. , STREISAND RANDI , DANKO CHRISTINA 
Published: June 2021

Introduction: Parents of children with T1D experience substantial caregiving distress, and child behavior problems are common among children with T1D. Stressors associated with the COVID-19 pandemic may disrupt T1D management and/or parent psychological functioning. This study examined the associations among pediatric parenting stress, child behavior, and diabetes- and COVID-19-specific psychosocial experiences among parents of children with T1D during the initial months of the COVID-19 pandemic.
Methods: Participants were 100 parents of young children with T1D (M age=6.7±1.6; M T1D duration=2.9±.5 years), who had completed participation in a multi-site behavioral intervention trial. In June/July 2020 (≥6 months after trial completion), parents self-reported on demographics, pediatric parenting stress (Pediatric Inventory for Parents; PIP), child behavior (Eyberg Child Behavior Inventory; ECBI), and a newly developed questionnaire measuring negative/positive impact of COVID-19 on T1D management and parent mood related to COVID-19.
Results: During the COVID-19 pandemic, there were significantly lower ECBI scores for married versus non-married participants (t=2.53, p&lt;.05). PIP was positively correlated with ECBI (r=.35, p&lt;.01) and negative COVID-related T1D management (r=.42, p&lt;.01), but negative COVID-related T1D management was not associated with ECBI. Worse COVID-19-specific parent mood was associated with PIP (r=.63, p&lt;.01) and ECBI (r=.28, p&lt;.01). Positive COVID-related T1D management was unrelated to PIP or ECBI.
Conclusion: Given the increased demands of managing home, school, work and adhering to social distancing measures while managing a chronic illness, parents of children with T1D are particularly vulnerable during the COVID-19 pandemic. Clinically, findings highlight the importance of assessing parent psychosocial functioning, child behavior, and challenges to children’s T1D management.

Disclosure
K. Rooney: None. C. H. Wang: None. M. E. Hilliard: None. R. Streisand: None. C. Danko: None.
53-LB: Prevalence and Correlates of Diabetes Distress in Low-Income Immigrants with Type 2 Diabetes
Authors: HU LU , XU XINYI , YANG SHUWEN , LEI LEI , BAO HAN , FAN BAOLUN , SEVICK MARY ANN 
Published: June 2021

Objective: The American Diabetes Association has called for more research on distress in adults with type 2 diabetes (T2D). There is a dearth of data on diabetes distress in underserved immigrants. This study aimed to examine prevalence and correlates of diabetes distress among Chinese immigrants with T2D.
Methods: A cross sectional study was conducted among Chinese immigrants with T2D in New York City in 2018. Sociodemographic survey and diabetes distress scale (DDS) were administered face-to-face by bilingual study staff. DDS is a validated 17-item survey to assess diabetes distress and includes 4 subscales: physician, regimen, interpersonal, and emotional-related distress. Responses for each item ranged from 1 (not a problem) to 6 (a very significant problem) with a score greater than 2 indicating a clinically significant and at least a moderate level of distress. Descriptive statistics and multivariable logistic regression modeling were used.
Results: The sample (N=94) was mostly female (60.6%), married (75.5%), retired (57.4%), limited English proficient (86.2%) with a mean age of 70.6 (SD=11.6). The majority of participants had a high school education or less (61.7%) and a household income of ≤$25,000/yr (69.1%). Overall, 23.4% of the participants reported at least a moderate level of distress. The most common sources of distress were emotional burden (33.0%), followed by regimen (30.9%), interpersonal (29.8%), and physician (18.1%). Compared to those who were currently employed, those who were retired had a lower odds of diabetes distress (OR=0.12, 95% CI 0.02-0.83). Age, gender, years living in the US, education, and income were not significant correlates.
Conclusions: We found high rates of diabetes distress and emotional burden among Chinese immigrants with T2D. Given the known link between diabetes distress and poor health outcomes, it may be important to consider screening for diabetes distress and incorporating psychological counseling in diabetes care.

Disclosure
L. Hu: None. X. Xu: None. S. Yang: None. L. Lei: None. H. Bao: None. B. Fan: None. M. Sevick: None.

Funding
National Institutes of Health (U54MD000538-15, K99MD012811, R00MD012811, P30DK111022)
53-OR: Structural Grey Matter Alterations and Cognitive Function in Diabetes: A UK Biobank Study
Authors: BURGESS JAMIE , KELLER SIMON S. , PETROPOULOS IOANNIS N. , SELVARAJAH DINESH , TESFAYE SOLOMON , ALAM UAZMAN 
Published: June 2021

Structural alterations of the central nervous system are demonstrated in people with diabetes. We aimed to characterise areas of global and anatomical grey matter volumes using T1-weighted magnetic resonance (MR) brain imaging (3-T MR imaging machine) in participants from the UK Biobank dataset. Participants with diabetes (DM) (n=569) and people without diabetes (CON) (n=20,801) were analysed. The mean age of DM diagnosis was 49.5±15 years. Baseline demographic and anthropometric data are as follows: DM group included more men (DM: 65% vs. CON: 47%) but were of a similar age (DM: 57.6±7.1 vs. CON: 55±7.5 years). BMI (DM: 29.6±5.2 vs. CON: 26.5±4.2 kgm2; p&lt;0.0001) and systolic blood pressure (DM: 141±17 vs. CON: 137±19mmHg; p&lt;0.0001) were higher in DM compared to CON with no difference in diastolic blood pressure (DM: 82±10 vs. CON: 81±10mmHg; p=NS). The majority of participants in both groups were right-handed (DM: 88.9%, CON: 89.1%) with a minority reporting ambidexterity (DM: 2.1%, CON: 1.5%). When comparing grey matter volume of DM vs. CON: peripheral cortical grey matter (corrected for head size) (599002±41503mm3 vs. 621942±40421mm3; p&lt;0.0001), superior frontal gyrus (left: 10715±1695mm3 vs. 11056±1766mm3; p=0.001; right: 9279±1513mm3 vs. 9608±1612mm3; p&lt;0.0001), left middle frontal gyrus (9894±1721mm3 vs. 10082±1786mm3; p=0.035), right anterior division of the supramarginal gyrus (3061±598mm3 vs. 3143±614mm3; p=0.001), right posterior supramarginal gyrus (5337±1052mm3 vs. 5476±1035mm3; p=0.002), paracingulate gyrus (left: 5558±866mm3 vs. 5749±856mm3; p=0.0006; right: 5456±845mm3 vs. 5700±852mm3; p&lt;0.0001), precentral gyrus (left: 13712±1717mm3 vs. 14065±1748mm3; p=0.04; right: 13294±1652 vs. 13711±1731 p&lt;0.0001) and left postcentral gyrus (10905±1481mm3 vs. 11313±1492mm3; p=0.0008) were all lower in DM compared to CON. People with diabetes have a significant reduction in global grey matter volume in distinct brain regions as previously described in the literature.

Disclosure
J. Burgess: None. S. S. Keller: None. I. N. Petropoulos: None. D. Selvarajah: None. S. Tesfaye: Advisory Panel; Self; Angellini, Bayer AG, Eva Pharma, Wörwag Pharma, Speaker's Bureau; Self; Abbott, AstraZeneca, Grunenthal Group, MSD Corporation, Novo Nordisk, Pfizer Inc. U. Alam: None.
545-P: Experiences of Emerging Adults with T1D during the COVID-19 Pandemic
Authors: MONAGHAN MAUREEN , BRYANT BREANA , WANG CHRISTINE H. 
Published: June 2021

Introduction: Emerging adults (EAs) with T1D may be disproportionately affected by COVID-19 related disruptions given the many transitions that occur during this developmental period. The current study examined self-reported challenges in daily routines and T1D care in a sample of EAs during the COVID-19 pandemic.
Method: Participants included 22 EAs with T1D (M age=21.6±1.1 yrs; 45.4% male; 40.9% non-Hispanic white; 86.4% enrolled in higher education; 77.3% employed; M A1c=7.8%±1.2%). EAs completed surveys about exposure/personal impact of COVID-19 (n=13), a structured interview (n=2), or both (n=7) during the first 9 months of the COVID-19 pandemic (3/2020 - 11/2020).
Results: Most EAs (86.4%) denied COVID-19 symptoms, diagnoses, or hospitalizations in themselves or close contacts; 3 EAs (13.6%) reported COVID-19 diagnoses in family members, with one reported death of a family member. Fifty-five percent of EAs reported strictly social distancing. On the survey, 85% of EAs reported significant disruptions due to COVID-19, including job loss/reduction in hours (45%), education changes (45%), and moving (40%). T1D impact varied, with 50% reporting easier management of T1D; 30% reporting less exercise/worse diet; 30% reporting sleep problems; and 40% reporting more health anxiety. For EAs with more than one instance of survey completion (n=9), diabetes-specific impact worsened over time (t(8)=-2.20, p=.06; Cohen’s d = -.72). Interview data (n=9) supported quantitative results, with themes related to the impact of COVID-19 on daily routines for T1D management and delayed transition to adult T1D care.
Discussion: EAs with T1D experienced many COVID-related changes and increasing negative impact on T1D self-care over time. EAs may be particularly vulnerable to the widespread impacts of COVID-19 on employment, education, and receipt of medical care. Future research should examine longitudinal responses to the COVID-19 pandemic to identify EAs who may need additional support or resources for T1D care.

Disclosure
M. Monaghan: None. B. Bryant: None. C. H. Wang: None.

Funding
American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.)
547-P: Worry and Mental Health in Young Adults with Type 1 Diabetes during the COVID-19 Pandemic
Authors: COMMISSARIAT PERSIS V. , PIERRE DANIELLE ST. , SABINO ANNA , LEE SARA , SAYLOR JENNIFER 
Published: June 2021

Aim: There are many challenges to navigating young adulthood with type 1 diabetes (T1D). The COVID-19 pandemic has negatively impacted mental health, particularly in young adults (YA) who may already struggle to find structure and support.
Methods: Surveys were distributed electronically to YA with T1D (ages 17-30) associated with the College Diabetes Network, a nonprofit organization serving YA with diabetes, in Spring and Fall 2020. Participants in each cohort were asked to rate their worry about contracting COVID-19 (scale of 1-5, 5=”very worried”), and report current diagnoses of depression or anxiety by a healthcare professional (yes/no). T-tests and chi-square tests examined the differences in reported COVID-19 worry, anxiety, and depression from Spring to Fall, as well as the association between worry and diagnosed depression/anxiety at both time points.
Results: Participants were demographically similar at both time points ((M±SD) Spring: n=468, age 22.1±2.7 years, 82% female, 84% white; Fall: n=375, 22.4±3.2 years, 79% female, 82% white; p&gt;.10). Overall, participants endorsed significantly more COVID-19 worry in Fall than in Spring (3.57±1.1 vs. 3.29±1.4; p&lt;.001). Self-reported anxiety diagnoses showed an increasing trend from Spring to Fall (p=.065), while self-reported depression diagnoses showed no change between time points (p&gt;.10). Participants with a pre-existing diagnosis of anxiety or depression endorsed significantly more COVID-19 worry than those without a mental health diagnosis at both time points during the pandemic (Spring: anxiety p=.012, depression p=.031; Fall: anxiety: p=.001, depression: p=.004).
Conclusions: YA with T1D endorse more worry about contracting COVID-19 as the pandemic progresses, with an upward trend in anxiety diagnoses. Worry was exacerbated in those with a pre-existing mental health condition. These results underscore the need for greater support for YA with T1D, to reduce COVID-19 related worry and protect mental health outcomes.

Disclosure
P. V. Commissariat: None. D. St. pierre: None. A. Sabino: None. S. Lee: None. J. Saylor: None.