bluuebunny/crossref_metadata_2025_split huggingface dataset:
556-P: Codesigning a Diabetes Online Community Intervention for Adults with Type 1 and Type 2 Diabetes
Authors: LITCHMAN MICHELLE L. , SHOCKLEY CHERISE , GRIGORIAN ERNEST , WALKER HEATHER R. , WILSON ELLERY , THOMPSON ASHLEY , BLANCHETTE JULIA E. , RICE CHELCIE , HILLIARD MARISA E. , OSER TAMARA 
Published: June 2021

Engagement in Diabetes Online Communities (DOCs) and diabetes online resources have proven benefits, including improved psychosocial, behavioral and clinical outcomes. However, patients report that finding credible and relevant information can be daunting. The aim of this study was to co-design an intervention with people with diabetes (PWD) to train “Peer Connectors” to help adults with type 1 and type 2 diabetes navigate DOCs and diabetes online resources to improve social support.
A community advisory board (CAB) of 11 diverse (race, ethnicity, age, diabetes type, diabetes duration) PWD who were active in a variety of DOCs convened over four 2-hour meetings to discuss and prioritize intervention components and outcome measures. Field notes and audio recordings were analyzed to guide development of the D-COPES (Diabetes - Connecting Online Peers to Enhance Support) intervention.
The CAB recommended three intervention components: 1) pairing participants to trained Peer Connectors based on matching characteristics/interests, (2) Peer Connectors delivering a small group intervention to orient participants to DOCs and online resources, and (3) Intervention content that includes tailoring to participants’ individual needs and how to identify misinformation. Recommended outcome measures focused on psychosocial (diabetes distress, empowerment), behavioral (self-efficacy, self-care), and clinical outcomes (A1C as secondary outcome), as well as usage of DOCs and online resources.
The co-design process centered the D-COPES intervention on avoidance of misinformation and provided strategies to expand the benefits of DOCs to PWD who might not otherwise have the knowledge and skills to engage most effectively. Co-design also served as a form of social validation, ensuring the intervention itself would be of interest and socially relevant to PWD. The D-COPES intervention will be iteratively piloted with 12 participants over 12 weeks.

Disclosure
M. L. Litchman: Research Support; Self; Abbott Diabetes. T. Oser: Advisory Panel; Self; Cecelia Health, Dexcom, Inc., Advisory Panel; Spouse/Partner; Cecelia Health, Dexcom, Inc. C. Shockley: None. E. Grigorian: None. H. R. Walker: None. E. Wilson: None. A. Thompson: None. 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. C. Rice: None. M. E. Hilliard: None.

Funding
Dick and Timmy Burton Foundation
567-P: The Role of Family History In Self-Management of T2D: A Qualitative Examination
Authors: BLATCHINS MARUTA A. , XU KAREN , ALTSCHULER ANDREA , GRANT RICHARD W. , GOPALAN ANJALI 
Published: June 2021

Adults diagnosed with type 2 diabetes (T2D) at a younger age are at increased risk for poor outcomes. We examined how family history of diabetes shaped the experiences and self-management perspectives of younger-onset individuals newly diagnosed with T2D.
We conducted six focus groups between Nov 2017 and May 2018. Participants (n=41) were members of an integrated healthcare delivery system, had been diagnosed with T2D during the prior two years, and were 21-44 years old at the time of diagnosis. Each group met twice for 60-90 minutes, two weeks apart. Groups were led by an experienced facilitator, audio-recorded, transcribed verbatim, and coded by two reviewers using thematic analysis.
The average age of participants was 38.4 years (±5.8 years); 20 were women, 10 self-identified as Latinx, 12 as Black, 12 as White and 7 as multiple or other races. Over 65% had a family history of T2D. Having a family member with T2D facilitated self-management in several ways. First, personal familiarity with T2D and related lifestyle changes, as well as advice from older relatives, led individuals to feel that they were capable of modifying behaviors and made adjusting to the diagnosis easier. In addition, family members with T2D served as both positive and negative role models that motivated individuals to adapt relatives’ health-promoting behaviors and take steps to avoid adverse outcomes. Conversely, for some, the perception that T2D diagnosis was inevitable was a barrier to initial self-care. Perceived lack of control over developing T2D due to family history of the disease led to feelings of self-blame and futility regarding self-management efforts.
Our results highlight the importance of recognizing how familial experiences impact patients’ ability to navigate a new T2D diagnosis. Proactively addressing perceived barriers to and facilitators of self-management in the context of family T2D history may aid in efforts to educate and support high-risk, younger patients establish a trajectory towards improved health.

Disclosure
M. A. Blatchins: None. K. Xu: None. A. Altschuler: None. R. W. Grant: None. A. Gopalan: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK116968); Kaiser Permanente Northern California
57-LB: Daily Communal Coping and Blood Glucose in Young Adult Couples with Type 1 Diabetes
Authors: YORGASON JEREMY B. , SAYLOR JENNIFER , BERG CYNTHIA , RELLAFORD SUSANNAH , STEEGER DANIELLE (ELLIE) L. , DAVEY ADAM 
Published: June 2021

Young adulthood is a time when persons with type 1 diabetes (PWD) become more fully responsible for diabetes management. Establishing healthy diabetes routines during this period is foundational for successful management across adulthood, yet this age group experiences higher HbA1c levels and more frequent diabetes-related hospital visits than any other age group. New partnered relationships during young adulthood may play a crucial role in mitigating these risks. Long-term married couples with type 1 diabetes report poorer outcomes (lower self-care, lower physical health and higher HbA1c) when they report greater critical and overprotective behaviors from their spouse (Helgeson et al., 2019). Daily collaboration and support may be associated with poorer self-care (Berg et al., 2020). The objective of this study was to examine associations between daily communal coping and PWD blood glucose. Twenty-four young married couples (ages 20-37, M=25.7 years) wherein one spouse had T1D completed daily measures of communal coping (i.e., emotional support, instrumental support, over-protective behavior, illness avoidance, and controlling behavior) for 9 consecutive days. Daily average blood glucose and time-in-range were computed from PWD glucose meter or continuous blood glucose monitor. Results from multilevel models suggested that higher within-person (person mean centered) instrumental support (b = -1.38, p=.002) and overprotective (b = -1.36, p=.025) or controlling (b = -1.86, p=.027) spousal behaviors predicted lower PWD time-in-range. Higher between-person (grand-mean centered) overprotective spousal behaviors predicted higher PWD daily average blood glucose (b = 32.20, p=.002). Findings suggest that some young romantic partners may engage in behaviors that are associated with higher average PWD blood glucose and lower time-in-range.

Disclosure
J. B. Yorgason: None. J. Saylor: None. C. Berg: None. S. Rellaford: None. D. L. Steeger: None. A. Davey: None.
572-P: Impact of Isolation during the COVID-19 Pandemic on the Care of Older Adults with Type 1 Diabetes: A Qualitative Study
Authors: MUNSHI MEDHA , SLYNE CHRISTINE , SIFRE KAYLA , DAVIS DAI’QUANN J. , DEWAR RACHEL , SY SARAH M. , ATAKOV-CASTILLO ASTRID , MICHALS AMY , HAQUE SAIRA N. , NEUWAHL SIMON , CUMMINGS STIRLING , BROWN STEPHEN L. , WEINGER KATIE , TOSCHI ELENA 
Published: June 2021

Background: Older adults with type 1 diabetes (T1D) face unique challenges, especially when their support structure is disrupted, as happened during the Covid-19 lockdown. We evaluated the clinical and psychological impact of this imposed isolation on the older population with T1D.
Methods: We conducted semi-structured interviews with older adults with T1D who were part of an ongoing study, which was paused from March - August 2020. The interviews were performed between May - August 2020, and were transcribed, coded, and analyzed using content analysis to derive theme. A multidisciplinary team of 12 individuals coded the interviews to identify the themes and included geriatricians, endocrinologists, a nurse educator, infomaticists, an economist, a methodologist, and research assistants.
Results: We have analyzed 12/35 interviews at this time; mean age 74±4 years, 50% female, 92% non-Hispanic white, mean duration of diabetes 37±18 years, and A1C 7.3±0.7%. Three main themes have emerged. The challenges related to diabetes care included fear of hypoglycemia, interruption in supply chain related to diabetes technology (insulin pump and continuous glucose monitoring (CGM) supplies), use of telehealth, diabetes-related distress, and adapting to new routines in self-care (diet and exercise). Challenges related to the Covid-19 pandemic included fear of getting Covid-19 infection, and a lack of reliable information on pandemic. The challenges related to psychological well-being included a feeling of isolation, loneliness, inability to spend time with family and friends, lack of in-person communication, and lack of recreational activity.
Conclusion: The results of this qualitative study help to understand critical areas of need when social support structures are unavailable to older adults with T1D. Our results will help develop intervention strategies to overcome barriers in maintaining support for this vulnerable population.

Disclosure
M. Munshi: Consultant; Self; Sanofi. S. Neuwahl: None. S. Cummings: None. S. L. Brown: Stock/Shareholder; Self; Pfizer Inc., Siemens Corporation. K. Weinger: None. E. Toschi: Consultant; Self; Medtronic. C. Slyne: None. K. Sifre: None. D. J. Davis: None. R. Dewar: None. S. M. Sy: None. A. Atakov-castillo: None. A. Michals: None. S. N. Haque: None.

Funding
National Institutes of Health (1DP3DK112214-01)
574-P: GoFundMe Isn’t a Medical Plan
Authors: BLANCHETTE JULIA E. , TRAN M.J. , IACOB ELI , OSER TAMARA , GRIGORIAN ERNEST , EDELMAN LINDA S. , LITCHMAN MICHELLE L. 
Published: June 2021

The rising cost of insulin, costly insurance premiums and the popularity of high deductible insurance plans have resulted in decreased access to insulin. People with diabetes who need financial support for insulin turn to crowdfunding websites, such as GoFundMe, to raise funds. It is unknown if crowdfunding is successful in funding insulin campaigns. This study aims to explore the success and contributing factors for crowdfunding insulin requests in the United States (US). In this retrospective, descriptive study, data were extracted from GoFundMe insulin campaigns for human use in the US from February to April 2019. Data were coded for the following characteristics: campaign requestor, the reason for the request, facial recognition age, gender and race, education level of the post (Flesch-Kincaid), diabetes type, insurance status, disability status, and previous request for pharma support. Descriptive statistics and chi-square tests were utilized to describe and analyze the campaign requestor, purpose and success rate, and contributing factors to campaign success. Of 205 GoFundMe campaigns, 114 (55.0%) were started by the person with diabetes (as opposed to family/friends). Campaigns were created due to insurance issues (i.e., loss of insurance, inadequate insurance coverage; N=125, 61.0%) and requested a median of $1,100 ($50-$200,000), and raised a median of $65 ($0-$6,920). A mean of 29.5% (± 0.6%) of the requested campaign amounts were met. There were no differences in funded status by the characteristics tested. Those who requested lower amounts of money &lt;$500 were more likely to achieve funding X2(1, N=205) = 9.6, p&lt;.01. Despite crowdfunding websites being used to augment insulin purchases, campaigns raise only a fraction of the money requested. Generally, crowdsourcing for insulin is not successful. Diabetes providers should routinely assess their patients’ ability to access insulin and provide resources as needed. People with diabetes must understand the limited success of crowdfunding insulin online.

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. M. Tran: None. E. Iacob: None. T. Oser: Advisory Panel; Self; Cecelia Health, Dexcom, Inc., Advisory Panel; Spouse/Partner; Cecelia Health, Dexcom, Inc. E. Grigorian: None. L. S. Edelman: None. M. L. Litchman: Research Support; Self; Abbott Diabetes.
576-P: Maintenance of Time-Restricted Eating in Daily Life to Lose Weight and Lower Risk of Type 2
Authors: BJERRE NATASJA , HOLM LOTTE , QUIST JONAS S. , FÆRCH KRISTINE , HEMPLER NANA F. 
Published: June 2021

Background: Effective weight loss maintenance interventions are a key factor to lower the risk of type 2 diabetes (T2D), and time-restricted eating (TRE) is a novel strategy which has proven successful in obtaining a weight loss in a few studies. This study examined if people with overweight or obesity at high risk of T2D were able to maintain TRE in real-life settings.
Methods: Participants were recruited from the randomized controlled RESET study, an RCT investigating effects of TRE on body weight and other cardiometabolic risk factors. Semi-structured interviews were conducted with a subgroup of 20 participants allocated to 12 weeks of TRE (i.e., consuming all foods and beverages within a 10-h window). The intervention was followed by a 12-week follow-up period with no intervention. All participants were interviewed at the end of intervention and again at 12-week follow-up. Data were analyzed using a thematic analysis approach.
Result: Participants had a positive attitude towards TRE, and seven wished to maintain it stringently during the follow-up period. Half of the participants wished to maintain an individually adjusted TRE concept by e.g., drinking coffee outside the interval or exceeding it at social events. Some participants found it easy to maintain TRE stringently, while two struggled to do so. A few participants were able to maintain their individually adjusted TRE concept, while seven found it too intrusive. Particularly the degree of daily life structure, meal pattern organization and social support determined maintenance success. The three remaining participants chose not to maintain TRE in the follow-up period and experienced a relief when going back to usual rhythms.
Conclusion: Elements from the TRE concept were highly valued by most participants, but it often required individual adjustments in order to undertake TRE on a longer-term basis. A tailored fit to daily life activities is therefore crucial to maintain TRE which underlines the complexity of long-term maintenance.

Disclosure
N. Bjerre: None. L. Holm: None. J. S. Quist: None. K. Færch: Board Member; Self; ChemoMetec, Research Support; Self; Novo Nordisk Foundation, Stock/Shareholder; Self; Novo Nordisk A/S. N. F. Hempler: None.

Funding
Novo Nordisk Foundation; Helsefonden (20-B-0109)
579-P: Behavioral Outcomes of a Digital Health Coaching Program Stratified by Baseline A1C: A Real-World Retrospective Analysis
Authors: MARTIN MEGAN , PATTERSON JONATHAN , TRAN VANESSIA T. , OCONNOR BLAKELY B. , ALLISON MATTHEW , PATEL DHIREN 
Published: June 2021

Background: The 2021 ADA Standards of Medical Care suggest digital health coaching (DHC) programs can be beneficial in treating diabetes. As programs expand, it is increasingly important to understand expected benefits for diverse populations. Studies have shown greater clinical impact for patients with suboptimal baseline health, yet little is known about the influence of health on behavioral outcomes. In this real-world study, we analyzed trends in lifestyle change by baseline A1c following exposure to a T2DM DHC program.
Methods: The 12-week DHC program, including patient-centered phone, email and/or text interactions, was delivered to T2DM patients. Retrospective analysis of patient reported data at baseline and program completion was conducted to evaluate impact on engagement in CDC recommended physical activity and healthy meal consumption (defined by USDA MyPlate guidelines). Outcomes were analyzed for 3 cohorts stratified by baseline A1c (&lt;7% 7-9%, &gt;9%) using Wilcoxon matched-pairs signed rank tests and paired proportion tests.
Results: Individuals who completed all measures (n=130) were included in the study. A majority (82.30%) reported a baseline A1c ≥ 7%, and 27.69% were high-risk (A1c &gt; 9%). Across all cohorts, there were significant improvements in the percent of participants adherent to CDC guidelines, median weekly activity minutes and number of healthy meals (p&lt;0.01). For subgroup analyses, weekly activity minutes improved the most for the A1c &lt; 7% cohort (50 minutes; p&lt;0.01). Change to weekly healthy meals was greatest for those with an A1c ≥ 7%.
Conclusions: Outcomes suggest that DHC can improve lifestyle behaviors among all individuals with T2DM, irrespective of baseline A1c, with those at an elevated glycemic risk reporting the greatest dietary benefit and those with the lowest risk reporting the greatest shift in physical activity. If confirmed, findings may inform DHC referral strategies and individualized behavioral goals.

Disclosure
M. Martin: Consultant; Self; PACK HEALTH. J. Patterson: None. V. T. Tran: None. B. B. Oconnor: Employee; Self; Pack Health. M. Allison: None. D. Patel: None.
58-LB: ß-Cell Targeted Immune Suppressive PD-1 Bispecific Agonists: A Novel Approach to Treat Type 1 Diabetes
Authors: BOSSI GIOVANNA , CURNOCK ADAM P. , WEBER PETER , KUMARAN JYOTHI , BAWDEN LINDSAY J. , FIGUEIREDO RITA , WISEMAN KATHERINE E. , O’DWYER RONAN , OVERTON DAVID , GONZALEZ VERONICA , LUCATO CHRISTINA M.A. , PAGE KEITH , SMITH NICOLA , WHALEY LORRAINE , GHADBANE HEMZA , KNIGHT DAVID , HENDERSON EMMA , HEARTY STEPHEN , MAHON TARA , WEBER PETER 
Published: June 2021

The success of immunosuppressive therapies to preserve pancreatic islets and treat Type 1 Diabetes (T1D) has, so far, been limited either due to safety concerns or lack of persistent efficacy. Restricting T cell suppression to the pancreas, thereby avoiding systemic immunosuppression, may overcome these issues and is thus an attractive option for T1D. One possible approach to inhibit the destruction of pancreatic β-cells in T1D is to activate the PD-1 receptor on autoreactive T cells only when they enter in the pancreas. The PD-1 pathway is a key immune checkpoint that limits T cell responses and helps to maintain peripheral tolerance. Blocking this pathway in cancer patients has been shown to cause diabetes-like symptoms. Therefore, stimulating PD-1 to inhibit autoreactive T cells and treat this disease is an appealing concept. To create β-cell-restricted inhibitors of autoreactive T cells, we designed targeted PD-1 agonist bispecific molecules that contain a high affinity TCR specific for a pHLA complex expressed on the surface of pancreatic β-cells. We show that these bispecific molecules bind specifically to immortalized β-cell lines and primary β-cells from disaggregated pancreatic islets. Once bound to target pHLA, these bispecifics engage PD-1 on attacking T cells and inhibit TCR signaling resulting in potent inhibition of T cell effector functions. At picomolar concentrations, these bispecifics suppress secretion of inflammatory cytokines from cytotoxic T cells and inhibit β-cell killing by autoreactive CD8+ T cells. Importantly, these PD-1 agonists are unable to inhibit T cells when free in solution and not bound to target cells. Hence, these immune modulating bispecifics have the potential to limit autoimmunity in pancreatic islets while avoiding systemic immunosuppression. These features make them an attractive and novel platform to treat T1D.

Disclosure
G. Bossi: Employee; Self; Immunocore Limited. V. Gonzalez: None. C. M. Lucato: None. K. Page: None. N. Smith: Employee; Self; Immunocore Limited. L. Whaley: Employee; Self; Immunocore Limited. H. Ghadbane: Employee; Self; Immunocore Ltd. D. Knight: Employee; Self; Immunocore Limited. E. Henderson: Employee; Self; Immunocore Ltd. S. Hearty: Employee; Self; Immunocore Limited. T. Mahon: None. A. P. Curnock: Employee; Self; Immunocore Ltd. P. Weber: Employee; Self; Immunocore Ltd., Stock/Shareholder; Self; Vertex Pharmaceuticals Incorporated. P. Weber: Employee; Self; Immunocore Ltd., Stock/Shareholder; Self; Vertex Pharmaceuticals Incorporated. J. Kumaran: None. L. J. Bawden: Employee; Self; Immunocore Ltd. R. Figueiredo: None. K. E. Wiseman: None. R. O’dwyer: Employee; Self; Immunocore ltd. D. Overton: None.
581-P: It Is What It Is...You Don’t Have to be Perfect: Life after T1D Diagnosis
Authors: GARZA KIMBERLY P. , HOWARD KELSEY R. , SMITH NICHOLAS DAVID W. , WEISSBERG-BENCHELL JILL , FELDMAN MARISSA 
Published: June 2021

Purpose: A T1D diagnosis can have a profound psychosocial impact on families, and adaptation post diagnosis is critical for long term well-being. This study sought to assess the psychosocial experiences of families during the first year following T1D diagnosis.
Method: Focus groups and interviews with children diagnosed with T1D between 8-12 years of age within the past two years (n=10) and parents (n=16) were conducted to explore the feelings, challenges, and experiences of that first year. Transcripts were analyzed using thematic analysis and deductive coding.
Results: Children reported fear of needles and concerns about their relationships with peers, family and teachers changing once people knew of their diagnosis. They expressed annoyance with the number of questions asked of them and the intrusion of diabetes tasks in activities. Children and parents experienced feelings of distress, isolation, and sadness during the first year and were overwhelmed by the amount of information they were required to master. Parents expressed distress over keeping their child safe while also managing the emotional burden of diagnosis. Parents reported frustration with their inability to recall the content of their diabetes education and the calculations necessary to maintain “ideal” blood sugars. After receiving formal education, families reported fear and anxiety around managing food and insulin, concern about hyper- and hypoglycemia, feeling overwhelmed by the practical demands, like supply management, and a general lack of support. Most parents felt the need for their child maintain perfect blood sugars and a sense of hopelessness in trying to do so.
Conclusions: Prior research has shown that individuals who are overwhelmed, worried, or sleep-deprived find it more difficult to learn new content. Our results suggest the need for an alternate approach to education at diagnosis that provides families with increased psychosocial support in a way that assists families during this first year, a time of learning and change.

Disclosure
K. P. Garza: None. K. R. Howard: None. N. W. Smith: None. J. Weissberg-benchell: None. M. Feldman: None.

Funding
JDRF (2-SRA-2020-985-S-B)