bluuebunny/crossref_metadata_2025_split huggingface dataset:
603-P: The Effect of Different Frequency of Autonomous Flash Glucose Monitoring Application on Blood Glucose Control in Patients with Type 1 Diabetes under 14 Years Old
Authors: HU KEYAN , JIANG HONGWEI , ZHANG WINNIE , PENG HUIFANG , LIU JING 
Published: June 2021

Objective: To explore the influence of different self-wearing frequency of Flash Glucose Monitoring System (FGMS) on the blood glucose control of children with type 1 diabetes (T1DM), and to analyze the factors that affect the frequency of instrument wearing.
Method: A total of 89 children with T1DM under the age of 14 were recruited. Collect clinical data, baseline indicators and wear FGMS for 2 weeks continuously. The above children were followed up after 3 years, and FGMS was worn again for 2 weeks, the baseline indicators were rechecked, and filled out relevant questionnaires. The children were divided into low-frequency wearing group and high-frequency wearing group according to the frequency of autonomous application of FGMS during follow-up.
Result: The average glucose level and the percentage of time above range in the low-frequency wear group were higher than those in the baseline period (9.05±2.02% vs. 8.63±1.71%, p=0.042;36.52±17.38% vs. 31.16±15.16%, p=0.047) while the time in range is significantly lower (53.23±14.34% vs. 59.94±14.54%, p=0.001). The average blood glucose fluctuation amplitude of the high frequency wearing group improved compared with the previous [8.80 (7.21, 12.09) mmol/L vs. 9.68 (7.65, 12.00) mmol/L, p=0.027]. The results of multivariate logistic regression analysis showed that the guardian's educational background (OR=3.162, 95%CI: 1.024-9.764) and the guardian's attention to the child's blood glucose (OR=2.537, 95%CI: 1.074-5.997) are the frequency of voluntary FGM wearing Independent influencing factors (P&lt;0.05).
Conclusion: Higher frequency application of FGM can significantly improve blood glucose fluctuations and delay the deterioration of the disease. The educational background of the guardian and degree of attention to the condition are the main influencing factors of high frequency wearing FGM.

Disclosure
K. Hu: None. H. Jiang: None. W. Zhang: None. H. Peng: None. J. Liu: None.
605-P: Generating Self-Reported Clinical and Lifestyle Data in Patients Living with T2DM in Qatar
Authors: JANDALI NOOR , ZARZOUR RACHA , FADLELBARI AYMAN M. 
Published: June 2021

Background: Lack of localized tools to monitor lifestyle patient data between doctor visits challenges healthcare providers in the Middle East to personalize care to Arabic-speaking patients living with T2DM. This study presents Droobi Health (DH), the first Arabic, digital therapeutic, as an effective tool to increase patient self-reported data and share clinical and lifestyle data between visits efficiently to enable doctors to personalize care without a time burden.
Methods: The Droobi Health app is a digital therapeutic that delivers a online behavior change programs that combines real-human coaching, digital tracking and data analytics to deliver timely and personalized interventions for behavior change. The messaging system is based on the Transtheoretical Model of Behavior Change to encourage users to self-report data on blood glucose, weight, food intake and physical activity. This study described data collected from participants with T2DM (N=44) using DH who completed the 16-week program.
Results: During the 16-weeks, users reported a total 1270 blood sugar logs, 1527 food logs, 3202 activity logs, and 213 weight logs. Users initiated a total of 2880 chat messages with their coach. On average per user, 28.8 blood sugar logs, 34.7 food logs, 72.8 activity logs, and 4.8 weight logs.
Conclusion: This study shows that DH can help healthcare providers generate patient self-reported clinical and lifestyle data between doctor visits, enabling the care team to personalize care based on patients lifestyle.

Disclosure
N. Jandali: None. R. Zarzour: Employee; Self; Droobi Health Technology. A. M. Fadlelbari: Employee; Self; Droobi Health and Technology.
608-P: Relationship between Time-in-Range and Estimated HbA1c Derived from Continuous Glucose Monitoring System in Adults with Type 1 Diabetes Mellitus
Authors: ZHOU YONGWEN , LIU HONGXIA , YANG DAIZHI , AI HEYING , LV JING , MAI XIAODONG , XU WEN , YAO BIN , YAN JINHUA , WENG JIANPING 
Published: June 2021

Aims: Time-in-range (TIR) and estimated glycated hemoglobin (eHbA1c), two key metrics derived from continuous glucose monitoring system (CGMS), are valuable for glycemic control. This study is to investigate the relationship between TIR and eHbA1c, and the impact of glycemic variability on their relationship.
Methods: The CGMS data were collected from baseline and follow-up visits in a clinical trial (NCT03522870) and yearly visits in the Guangdong Type 1 Diabetes Translational Medicine Study. Adult patients with type 1 diabetes (≥18 yrs) who had available CGM data for &gt; 3 days were included. Correlation between TIR and eHbA1c was explored according to different stratification of glycemic variability assessed by glucose coefficient of variation (CV). Predicted TIR in the fixed eHbA1c value was calculated via the linear regression equations performed in the respective interquartile group of CV.
Results: From March 2014 to July 2020, a total of 260 CGMS data were collected. The mean wearing time of available CGM data was 11.8±3.8 days, and the mean value of TIR, eHbA1c, and CV was 62.9±14.1%, 7.2±0.8%, and 39.4±8.1%, respectively. There was a strong negative correlation between TIR and eHbA1c (R=-0.83, P&lt;0.001). For patients with stable glycemic variability (CV&lt;36%), the correlation between the two metrics was stronger (R=-0.95) while in the unstable group the coefficient was decreased (R=-0.80). Based on the regression equations, the predicted %TIR value was decreased across the ascending quartiles with 73.0% in the lowest quartile of CV (&lt;25th quartile, &lt;33.8%), 67.4% in 25th - 50th quartile (33.8-39.2%), 61.4% in 50th - 75th quartile (39.2-44.9%) and 58.5% in the highest quartile (&gt;75th quartile, CV &gt;44.9%) when eHbA1c was set as 7%.
Conclusions: There is a strong correlation between TIR and eHbA1c in adult patients with type 1 diabetes. Patients with lower glycemic variability usually have higher %TIR in the same eHbA1c level.

Disclosure
Y. Zhou: None. J. Weng: None. H. Liu: None. D. Yang: None. H. Ai: None. J. Lv: None. X. Mai: None. W. Xu: None. B. Yao: None. J. Yan: None.

Funding
National Key Research and Development Program of China (2017YFC1309600)
61-OR: Glycemic Control and Depressive Symptoms among Minority Women with Type 2 Diabetes Enrolled in the Women In Control (WIC2) Diabetes Medical Group Visit (DMGV) Study
Authors: GARDINER PAULA , CRUZ BARBARA M. , BRAGG ALEXA , WINTER MICHAEL , MELO KATHERINE , HOWARD JESSICA M. , MITCHELL SUZANNE 
Published: June 2021

Background: Comorbid depression is associated with poor diabetes control. DMGVs improve glycemic control and depressive symptoms among patients with type 2 diabetes (T2DM). The WIC2 study compared the effectiveness of an eight-week DGMV conducted in a virtual world platform vs. an in-person format to improve diabetes outcomes for 288 minority women with uncontrolled T2DM (HbA1c ≥8.0%).
Objective: We conducted a secondary data analysis of the WIC2 clinical trial data to examine the association between improvements in depressive symptom burden (PHQ-8) and improvements in HbA1c among participants enrolled in the WIC2 study.
Methods: We measured mean changes in PHQ-8 and HbA1c at baseline, 9-weeks, and 6-months post-enrollment among 288 WIC2 participants. We performed logistic regression to examine the association between a reduction in depressive symptoms per PHQ-8 (-5 points) and reduction in HbA1c (-0.4%) at 9-weeks and 6-months. We used multivariable logistic regression to adjust for potential confounders, including age, education, and study arm.
Results: At baseline, nearly half of WIC enrollees reported mild (29.5%), moderate (17.4), or severe (1.7%) depressive symptoms. Their mean PHQ-8 score was 5.5 (SD 5.0) and mean A1c was 9.93% (SD 1.74). From baseline to 6-months, 17.4% (n=41) achieved a 5-point decrease in PHQ-8; among this subset, the mean PHQ-8 score was 10.49 (SD 4.69), indicative of moderate depression at baseline. Of these 41 participants, 68.3% (n=28) also achieved the threshold A1c improvement at 6-months. After controlling for study arm, education, and age, participants with 5-pt or greater reduction in PHQ-8 score from baseline to 6-months had 2.45 times the odds (CI: 1.16, 5.18) of achieving 0.4% or greater reduction in A1c.
Conclusion: Improvements in depressive symptom burden correlate with improvements in diabetes management among women with uncontrolled T2DM.

Disclosure
P. Gardiner: None. B. M. Cruz: None. A. Bragg: None. M. Winter: None. K. Melo: None. J. M. Howard: None. S. Mitchell: Other Relationship; Self; See Yourself Health LLC, Speaker’s Bureau; Self; Merck Sharp & Dohme Corp.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK10653)
62-LB: The Effect of Do-It-Yourself Real-Time Continuous Glucose Monitoring on Psychological and Glycaemic Variables in Children with Type 1 Diabetes: A Randomised Crossover Trial
Authors: ELBALSHY MONA , STYLES SARA , HASZARD JILLIAN J. , GALLAND BARBARA , CROCKET HAMISH , JEFFERIES CRAIG A. , WILTSHIRE ESKO , TOMLINSON PAUL , DE BOCK MARTIN , WHEELER BENJAMIN J. 
Published: June 2021

Background: Continuous glucose monitoring (CGM) can decrease fear of hypoglycaemia (FOH) and improve glycaemic control among those affected by type 1 diabetes (T1D). No studies to date have examined the impact of using Do-It-Yourself Real-Time Continuous Glucose Monitoring (DIY RT-CGM) on psychological and glycaemic outcomes. The primary aim of this study was to investigate the effect of DIY RT-CGM compared to intermittently scanned CGM (isCGM) on parental FOH.
Methods: Child-parent dyads were recruited for this multicentre randomised crossover trial. Children with T1D were aged 2-13 years and were current isCGM users. Families had 6 weeks of using DIY RT-CGM with parental remote monitoring (intervention) and 6 weeks of isCGM plus usual diabetes care (control) in a random order with a four-week washout period. FOH was assessed by the hypoglycaemia fear survey. Standard CGM based glycaemic variables were collected via Tidepool. Parental satisfaction was assessed by the diabetes treatment satisfaction questionnaire (DTSQ).
Results: The study included 55 child-parent dyads; child mean age 9.1±2.8 years. There was no evidence of an effect on parental FOH, -0.1 (95% CI: -0.3, 0.1, p-value 0.4). Time-in-range (%3.9-10mmol/L) favoured DIY RT-CGM over isCGM (54.3%±13.7 vs. 48.1%±13.6), adjusted mean difference, 5.7% (95% CI 1.8, 9.6, p-value 0.004). There was no evidence of a difference between DIY RT-CGM and isCGM for time spent in hypoglycaemia. Parents reported higher DTSQ scores following DIY RT-CGM compared to isCGM, adjusted mean difference 5.3 (95% CI: 2.3, 8.2, p-value &lt;0.001).
Conclusion: The use of DIY RT-CGM versus isCGM did not improve parental FOH, however time in range and parental satisfaction with diabetes treatment were significantly improved, suggesting DIY RT-CGM with remote monitoring may offer families clinically important benefits over isCGM in regards to these aspects of T1D management.

Disclosure
M. Elbalshy: None. B. J. Wheeler: Research Support; Self; Dexcom, Inc., i-SENS, Inc., Medtronic, Ypsomed Group. S. Styles: None. J. J. Haszard: None. B. Galland: None. H. Crocket: None. C. A. Jefferies: None. E. Wiltshire: None. P. Tomlinson: None. M. De bock: None.
630-P: Improved Glucose Control for People with Diabetes Who Enrolled in a Multi-Chronic Condition Remote Monitoring Platform
Authors: LIU SUSIE , PAINTER STEFANIE L. , JAMES ROBERTA , KOMPALA TEJASWI , SHAH BIMAL 
Published: June 2021

Background: Remote monitoring platforms (RMP) with personalized coaching continue to scale and have shown to be an effective tool for self-monitoring blood glucose (BG) and blood pressure (BP) for individuals with diabetes (DM) and hypertension (HTN). With HTN being a common risk factor for individuals with DM, it’s important to understand how RMPs can support individuals with both DM and HTN.
Methods: Members were enrolled in a multi-chronic condition RMP with access to both DM and HTN programs. Using Propensity Score Matching to ensure no statistical differences in age, gender, race, DM type, insulin dependence, self-reported HbA1c, median zip code income, and zip code, two sample populations were constructed of those who were enrolled in DM only and DM+HTN between 1/1/2019 and 6/30/2019 and active on the platform for at least 1 year. For robust results, Bootstrapped Propensity Score Matching was used with 2,000 iterations. Paired t-test was used to compare reduction in estimated a1c at 6- and 9-months. Due to COVID-19, outcomes at 12-months were not evaluated.
Results: No statistical differences between DM only (n=888) and DM+HTN (n=888) groups in age (56 vs. 56), gender (50% vs. 48% female), race (59% vs. 62% Caucasian), diabetes type (95% vs. 95% T2DM), insulin dependent (24% vs. 27%), started uncontrolled (49% vs. 50%), and self-reported HbA1c at time of registration (7.3% vs. 7.3%). Average estimated HbA1c reductions at 6 months were -0.46% for DM only and -0.65% for DM+HTN (p = 0.011). Reduction was similar at 9-month though no longer statistically different with values of -0.42% vs. -0.57%, respectively.
Conclusions: Members enrolled in both DM+HTN versus DM only had improved glucose control within 6-months indicating RMPs that support multiple chronic conditions may have better outcomes. Future study is required to better understand the drivers of the clinical improvement for multiple conditions.

Disclosure
S. Liu: Employee; Self; Livongo, Teladoc Health. S. L. Painter: Employee; Self; Livongo. R. James: Employee; Self; Livongo, Teladoc Health, Stock/Shareholder; Self; Livongo, Teladoc Health. T. Kompala: Consultant; Self; Eli Lilly and Company, Employee; Self; Livongo. B. Shah: Employee; Self; Teladoc Health, Stock/Shareholder; Self; Teladoc Health.
636-P: Diabetes Providers Value CGM Data Despite Challenges in Data Review Process
Authors: KOMPALA TEJASWI , WONG JENISE C. , NEINSTEIN AARON B. 
Published: June 2021

People with diabetes (PWD) benefit from continuous glucose monitoring (CGM), yet CGM uptake in the US remains low. While diabetes care providers are key facilitators of CGM provision, data on provider behavior related to CGM use and CGM generated data is limited.
In March 2020, we conducted a national survey of providers caring for PWD on CGM-related opinions, facilitators and barriers to CGM prescription, data review practices, and reimbursement. Descriptive statistics were used to report prevalence of Likert scale answers to a 55-question survey.
Of 182 survey respondents caring for PWD using CGM, 75% were at academic medical centers, 66% were endocrinologists, and 70% practiced in urban settings. Nearly 70% of providers reported CGM use in a majority of their patients with type 1 diabetes. CGM use in patients with type 2 diabetes was low, with half the providers reporting &lt;10% CGM use. All respondents believed CGM improved quality of life and could help optimize diabetes control. Nearly all providers reviewed CGM data each visit (94%) and directly involved patients in data review (90%). Only 14% of providers reviewed CGM data outside of a scheduled visit without prompting from patients or their family members. Most providers (81%) reported their CGM data review was valued by patients although only half (55%) reported having adequate time or an efficient process to do so. Most providers included CGM data in the electronic health record but only 41% had an efficient process for data capture. The majority of providers (79%) sought reimbursement for CGM interpretation during a visit, but a minority (41%) sought reimbursement for interpretation outside of visits.
Despite uniform support for CGM by providers, inadequate time and inefficient data review processes are ongoing challenges. Improvements in data access and integration, supportive clinical infrastructure, and decreased administrative burden to obtain CGM, are facilitators of effective use of CGM-data by providers and necessitate ongoing attention.

Disclosure
T. Kompala: Consultant; Self; Eli Lilly and Company, Employee; Self; Livongo. J. C. Wong: Advisory Panel; Self; Provention Bio, Inc., Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. A. B. Neinstein: Consultant; Self; Eli Lilly and Company, Intuity Medical , Medtronic, Roche Diabetes Care, Steady Health.
648-P: Glucose-Dependent Insulinotropic Polypeptide (GIP) Induces Lipolysis during Stable Basal Insulin Substitution and Hyperglycemia in Men with Type 1 Diabetes
Authors: NIELSEN CHRIS N. , HEIMBÜRGER SEBASTIAN M. NGUYEN , CALANNA SALVATORE , HOLST JENS J. , VILSBØLL TINA , KNOP FILIP K. , CHRISTENSEN MIKKEL B. 
Published: June 2021

Glucose-dependent insulinotropic polypeptide (GIP) contributes importantly to postprandial insulin secretion, and - perhaps primarily due to this insulinotropic effect - affects glucose and lipid metabolism. We investigated the effects of exogenous GIP on lipid metabolism during hyperglycemia and stable insulin levels. Ten male patients with type 1 diabetes without endogenous insulin secretion (C-peptide negative), aged [mean±SD: 26±4 years; BMI: 24±2 kg/m2; HbA1c 7.3±0.8%) were studied in a randomized, double-blind, crossover study with continuous intravenous infusions of GIP (4 pmol/kg/min) or placebo (saline), during two separate 90-minute hyperglycemic (12 mmol/L) clamps with basal insulin substitution (0.1-0.2 mU/kg/min). Plasma glycerol concentrations increased from baseline during GIP infusions and decreased during placebo infusions (baseline-subtracted area under the curve (bsAUC): 703±407 vs. -262±240 µmol/L × min, respectively, P&lt;0.001). Free fatty acids increased only during GIP infusions (bsAUC: 5,431±6,393 during GIP vs. -74±2,363 µmol/l × min during placebo infusion, P&lt;0.05). Plasma concentrations of glucose, insulin, and glucagon were similar during GIP and placebo infusions (P=NS). Compared to placebo, GIP increased plasma glycerol and free fatty acids in patients with type 1 diabetes during hyperglycemia and stable basal insulin levels. With this experimental design it was possible to clearly identify an important effect of GIP on lipolysis in humans.

Disclosure
C. N. Nielsen: None. S. M. Nguyen heimbürger: Speaker’s Bureau; Self; AstraZeneca. S. Calanna: Employee; Self; Novo Nordisk A/S. J. J. Holst: Consultant; Self; Novo Nordisk, Other Relationship; Self; Antag Therapeutics, Bainan Biotech, MSD Corporation, Novo Nordisk, Other Relationship; Spouse/Partner; Antag Therapeutics, Bainan Biotech, Synklino ApS. T. Vilsbøll: Consultant; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Gilead Sciences, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk, Sanofi, Sun Pharmaceutical Industries Ltd. F. K. Knop: Advisory Panel; Self; MSD Corporation, Novo Nordisk A/S, Sanofi, Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S, Pharmacosmos, Zealand Pharma A/S, Research Support; Self; Novo Nordisk A/S, Zealand Pharma A/S, Speaker’s Bureau; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MSD Corporation, Novo Nordisk A/S. M. B. Christensen: None.
65-OR: Autoantibody Levels at Seroconversion Improve Prediction to Type 1 Diabetes Beyond Autoantibody Type and Number
Authors: NG KENNEY , ANAND VIBHA , VEIJOLA RIITTA , MAZIARZ MARLENA , WAUGH KATHLEEN , HAGOPIAN WILLIAM , ACHENBACH PETER ,   T1DI STUDY GROUP
Published: June 2021

While associations between the type and number of islet autoantibodies and progression to type 1 diabetes (T1D) have been reported, the effect of titer values is less well understood. We aim to quantify the ability of autoantibody titers at seroconversion to improve T1D onset prediction.
Prospective cohorts in Finland, Germany, Sweden, and the US have followed 24662 children at increased genetic risk for development of islet autoantibodies and T1D. For the 1400 who seroconverted (523 developed T1D), the titers of insulin autoantibodies (IAA), glutamic acid decarboxylase autoantibodies (GADA), and insulinoma antigen-2 autoantibodies (IA2A) at time of initial and confirmed seroconversion, i.e., the respective first and consecutive second autoantibody-positive serum sample, were normalized (to log multiples of upper limit of normal) and analyzed. Prediction models using multivariate logistic regression with inverse probability censored weighting (IPCW) were trained using 10-fold cross validation. Discriminative power for disease was estimated using the IPCW concordance index (c-index) with 95% confidence intervals estimated via bootstrap. Multivariate Cox proportional hazards models were used to quantify the impact of the autoantibody titers.
A baseline model with covariates for data source, sex, HLA-DR/DQ genotype, and age at initial and confirmed seroconversion had a performance of 64 c-index; 95% CI 62-65. Significant improvement was observed after adding IAA, GADA, IA2A positivity indicators at initial and confirmed seroconversion (74; 72-75). Adding the corresponding autoantibody titers resulted in significant additional gains (76; 75-76). Adjusted hazard ratios (HR) from the Cox model showed that autoantibody titers at confirmed seroconversion were predictive of diabetes (HR 1.29; 95% CI 1.20-1.38 for IAA, 1.12; 1.07-1.18 for GADA, and 1.19; 1.15-1.25 for IA2A, all p&lt;0.001).
Islet autoantibody titers at seroconversion improve T1D prediction.

Disclosure
K. Ng: Employee; Self; IBM. V. Anand: None. R. Veijola: None. M. Maziarz: None. K. Waugh: None. W. Hagopian: None. P. Achenbach: None. T1di study group: n/a.

Funding
JDRF (1-IND-2019-717-I-X)