bluuebunny/crossref_metadata_2025_split huggingface dataset:
Youths’ and Parents’ Experiences and Perceived Effects of Internet-Based Cognitive Behavioral Therapy for Anxiety Disorders in Primary Care: Mixed Methods Study
Authors: Lilja Josefine Lotten , Rupcic Ljustina Mirna , Nissling Linnea , Larsson Anna Caroline , Weineland Sandra 
Published: June 2021

Background
Anxiety is common among youths in primary care. Face-to-face treatment has been the first choice for clinicians, but during the COVID-19 pandemic, digital psychological interventions have substantially increased. Few studies have examined young people’s interest in internet treatment or the attitudes they and their parents have toward it.

Objective
This study aims to investigate adolescents’ and parents’ attitudes toward and experiences of internet-based cognitive behavioral anxiety treatment in primary care and its presumptive effects.

Methods
The study used mixed methods, analyzing qualitative data thematically and quantitative data with nonparametric analysis. Participants were 14 adolescents and 14 parents recruited in adolescent primary health care clinics. The adolescents and their parents filled out mental health questionnaires before and after treatment, and were interviewed during ongoing treatment.

Results
The quantitative data indicated that the internet-delivered cognitive behavioral therapy program used in this study was successful in reducing symptoms (χ22=8.333; P=.02) and that adolescents’ motivation is essential to the treatment outcome (r=0.58; P=.03). The qualitative results show that youths highly value their independence and freedom to organize treatment work on their own terms. The parents expressed uncertainty about their role and how to support their child in treatment. It was important for parents to respect the youths’ need for autonomy while also engaging with them in the treatment work.

Conclusions
Internet treatment in primary care is accepted by both youths and their parents, who need clarification about the difference between their role and the therapist’s role. Patient motivation should be considered before treatment, and therapists need to continue to develop the virtual alliance. Finally, primary care should be clearer in informing adolescents and their parents about the possibility of internet treatment.
1-OR: A Social Media-Based Intervention Improves Glycemic Control in a Low-Income Older Immigrant Population
Authors: HU LU , ISLAM NADIA , KHARMATS ANNA Y. , TAMURA KOSUKE , YANG SHUWEN , XU XINYI , FAN BAOLUN , SEVICK MARY ANN 
Published: June 2021

Purpose: Access to in-person diabetes self-management education (DSME) programs is limited in underserved immigrant communities. In this report, we examined the feasibility, acceptability, and potential efficacy of a social media-based DSME intervention in low-income older Chinese immigrants with type 2 diabetes (T2D).
Methods: This was a single-group study in 30 Chinese immigrants with T2D living in NYC. The intervention included 24 culturally and linguistically tailored DSME videos. Over 12 weeks, participants received 2 brief videos each week via WeChat, a free social media app popular among Chinese immigrants. Feasibility was defined as ability to achieve: 1) the recruitment goal (n=30); 2) ­&gt;80% retention; and 3) &gt;80% watch rate. Acceptability was assessed via a satisfaction survey at 6 months. HbA1c was collected at baseline and 6 months
Results: Recruitment was completed prior to the NYC COVID-19 lockdown. Despite COVID-19, the intervention continued without interruption. Participants were mostly female (70.0%), married (63.3%), with limited English proficiency (86.7%), and a mean age of 61.2 (SD=6.7) years old. Most reported an annual household income of &lt; $25,000 (84.0%) and an education of high school or less (63.3%). Thirty participants were recruited within 2 months, 93.3% were retained at 6 months, and a video watch rate of 92.2% was achieved. The mean baseline HbA1c was 7.4% (SD=1.2) and declined by 0.6% (95% CI: 0.3%-0.9%, p=0.001) to 6.8% (SD=0.8) at 6 months. Participants expressed high satisfaction (96.4%), and all strongly agreed or agreed that they preferred this video-based DSME to face-to-face visits.
Conclusions: This pilot study demonstrated that a social media-based DSME intervention is feasible, acceptable, and potentially efficacious in an aging low-income immigrant population with T2D. These findings provide timely implications in the era of COVID-19, suggesting older low-income immigrants can be engaged in mHealth interventions.

Disclosure
L. Hu: None. N. Islam: None. A. Y. Kharmats: None. K. Tamura: None. S. Yang: None. X. Xu: None. B. Fan: None. M. Sevick: None.

Funding
National Institutes of Health (K99MD012811, R00MD012811)
102-LB: Six-Month Glycemic Control with a Hybrid Closed-Loop System in Type 1 Diabetes Patients during COVID-19 Pandemic in Argentina
Authors: PROIETTI ADRIAN E. , ANGÓS MARCIAL A. , DAIN ALEJANDRO , ECHENIQUE MARIELA I. , KABAKIAN MARÍA L. , PAZ MARIA P. , RAGGIO MARCELA , RUBIN GRACIELA B. , SALEME ANTONIO , SANTUCCI MARIA P. , CASTRO MATIAS , DAGHERO ANDREA , GROSEMBACHER LUIS A. 
Published: June 2021

Background and Aims: Despite recent technological advances, optimal glycemic control remains a challenge in people with type 1 diabetes (T1D). Hybrid closed loop (HCL) systems with automated algorithm-derived adjustment of basal insulin delivery, aims to improve glycemic control without adding additional therapy burden or educational investments.
Aim: To evaluate the effectiveness of HCL system in Latin American subjects with T1D and who received a completely virtual training.
Methods: Prospective observational data analysis that included consecutive patients with T1D that initiated treatment with MiniMed™ 670G system in Argentina. Baseline and follow up visits at days 28, 90 and 180 were carried out and data was downloaded from Carelink™ Personal at each visit. Patient training and follow-up were performed completely virtual through video conference.
Results: A total of 104 patients were included, age: 32.8 ± 17.2 (range 8-77). Subjects were previously on MDI+SMBG (26%), MDI+isCGM (12.5%), CSII+SMBG (9.6%), CSII+isCGM (2.9%), and SAP-TS (49%). Baseline GMI was 7.3 ± 0.8%. Time in range (TIR) 70-180 mg/dl significantly increased regardless of prior therapy from 62.1±14.8 % at baseline to 74.6±8.6 %, 74.2±9.8 % and 74.3±9.6 % at days 28, 90 and 180 respectively (p&lt;0,05). Mean glucose levels decreased from 166,1mg/dL at baseline to 152.9 mg/dL (p&lt;0,05) at day 180. GMI was also reduced from 7.3% to 6.9% (p&lt;0,05). Sensor wear time and Auto Mode use were 89.1% and 88.6% respectively, by the end of the study. All patients completed virtual training successfully.
Conclusions: Our findings confirm that the use of MiniMed™ 670 System allows patients to achieve glycemic control within recommended targets in a non-selected population in Argentina. Virtual education appears to be suitable for patient training on HCL therapy during current COVID-19 pandemic situation.

Disclosure
A. E. Proietti: None. M. P. Santucci: None. M. Castro: Employee; Spouse/Partner; Medtronic. A. Daghero: Employee; Spouse/Partner; Medtronic. L. A. Grosembacher: None. M. A. Angós: None. A. Dain: None. M. I. Echenique: None. M. L. Kabakian: Speaker’s Bureau; Self; Abbott, Medtronic. M. P. Paz: Speaker’s Bureau; Self; Medtronic. M. Raggio: Speaker’s Bureau; Self; Abbott, Medtronic, Roche Diabetes Care. G. B. Rubin: None. A. Saleme: Advisory Panel; Spouse/Partner; Abbott Diabetes, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk.
1054-P: Incidence of Micro- and Macrovascular Complications among Persons with Type 2 Diabetes with and without Severe Mental Illness: A Nationwide Study
Authors: SCHEUER STINE H. , KOSJERINA VANJA , LINDEKILDE NANNA , POUWER FRANS , CARSTENSEN BENDIX , JØRGENSEN MARIT E. , BENROS MICHAEL E. , ANDERSEN GREGERS S. 
Published: June 2021

Background: Severe mental illness (SMI) is linked with a higher incidence of type 2 diabetes (T2D); however, it is unclear whether persons with SMI and T2D have a higher incidence of diabetes complications compared to persons with T2D only. We calculated incidence rate ratios (IRR) and incidence rates (IR) of micro- and macrovascular diabetes complications among persons with T2D and SMI compared to those with T2D only.
Methods: We used Danish nationwide registers to follow all persons with T2D from 1996 to 2018. IRR and age-specific IR of first event of each diabetes complication was estimated using Poisson regression models with risk time as offset comparing persons with T2D with and without SMI, while adjusting for sex, age, diabetes duration, calendar year, substance abuse and Charlson’s Comorbidity Index.
Results: A total of 371,625 persons with T2D were on average followed for 6.9 - 7.6 year depending on the complication outcome. Persons with T2D and SMI (n=29,249) were younger at T2D diagnosis than persons with T2D only (mean [SD], 59 [15] vs. 63 [14] year). In total, 73,598 (27%) developed cardiovascular disease (CVD), 25,846 (7%) developed retinopathy, 20,191 (5%) developed nephropathy, and 6,796 (2%) underwent an amputation during follow-up. Persons with T2D and SMI had an increased risk of CVD (IRR: 1.14 (95% CI: 1.11-1.18)) and nephropathy (IRR: 1.11 (95% CI: 1.03-1.16)), and a decreased risk of retinopathy (IRR: 0.83 (95% CI: 0.78-0.86)) compared to persons with T2D only when adjusting for confounders. The risk for amputations were similar in persons with T2D with and without SMI (IRR: 1.00 (95% CI: 0.90-1.12)). The increased risk of CVD and nephropathy in persons with SMI were persistent in all ages except for the ages 80-95 year.
Conclusion: Persons with T2D and SMI have a slightly higher risk of CVD and nephropathy and a lower risk of retinopathy compared to persons with T2D only.

Disclosure
S. H. Scheuer: None. V. Kosjerina: None. N. Lindekilde: None. F. Pouwer: None. B. Carstensen: Stock/Shareholder; Self; Novo Nordisk. M. E. Jørgensen: Research Support; Self; Boehringer Ingelheim International GmbH, Sanofi-Aventis, Stock/Shareholder; Self; Novo Nordisk A/S. M. E. Benros: None. G. S. Andersen: Stock/Shareholder; Self; Novo Nordisk A/S.
1055-P: The Machine Learning Prediction Model NASHmap Identifies Higher Insulin Resistance in Type 2 Diabetes Mellitus (T2DM) Patients at Risk for Nonalcoholic Steatohepatitis (NASH)
Authors: TIETZ ANDREAS , BADER GIOVANNI , DOCHERTY MATT , REINHART BRENDA , BALP MARIA-MAGDALENA , PEDROSA MARCOS , ACHARYA SANDIP K. , LOEFFLER JUERGEN , SCHATTENBERG JÖRN M. 
Published: June 2021

Background: Phenotypic methods such as elevated liver tests and/or the presence of obesity or hypertension are often used to identify patients with T2DM at risk for NASH. Machine learning (ML) models allow the prediction of outcomes with many interacting features and may be superior to phenotype in the context of NASH and T2DM. Here we present an intergroup comparison between patients with T2DM predicted as positive or negative for NASH by NASHmap, a ML model showing high prediction performance in real-word datasets.
Methods: We evaluated a subgroup of patients from a large T2DM clinical trial database (2002-2012) who had data for 14 NASHmap parameters. These include clinical observations and routine laboratory parameters but not HOMA-IR. We compared the profile of patients predicted by NASHmap (NASH positive or negative) using 17 parameters (14 NASHmap and 3 additional parameters). We compared HOMA-IR values between NASHmap positive and negative patients in the subgroup where the values were available.
Results: The clinical database had 23038 metabolically compensated T2DM patients without chronic liver disease of other etiologies. Data for all 14 NASHmap parameters were available in 4336 patients. NASHmap positive patients were younger, had higher HbA1c, liver enzymes, triglycerides, WBC, body mass index, platelets, and a higher rate for hypertension. Data for HOMA-IR were available in 1208 patients. Median HOMA-IR value was 4.2 in NASHmap positive group vs. 2.6 in NASHmap negative group. Patients in both groups had a similar median duration of diabetes.
Conclusion: Overall, the patients identified as at risk for NASH by NASHmap showed a metabolically unfavorable phenotype indicated by the higher HOMA-IR values in this group that the ML algorithm is also able to detect. ML models may be an important tool in effectively identifying patients at risk for NASH in electronic health records and clinical care.

Disclosure
A. Tietz: Employee; Self; Novartis AG, Stock/Shareholder; Self; Novartis AG. G. Bader: Employee; Self; Novartis AG. M. Docherty: Employee; Self; ZS Associates. B. Reinhart: Employee; Self; ZS Associates. M. Balp: Employee; Self; Novartis AG. M. Pedrosa: Employee; Self; Novartis AG. S. K. Acharya: Employee; Self; Novartis Healthcare Pvt. Ltd., Employee; Spouse/Partner; Novartis Healthcare Pvt. Ltd. J. Loeffler: Employee; Self; Novartis AG, Stock/Shareholder; Self; Novartis AG. J. M. Schattenberg: Advisory Panel; Self; Boehringer Ingelheim International GmbH, Consultant; Self; Boehringer Ingelheim, BMS, Echosens, Genfit, Gilead Sciences, Intercept Pharmaceuticals, Madrigal, Novartis, Novo Nordisk, Nordic Bioscience, Pfizer, Roche, Sanofi, Siemens Healthcare GmbH, Zydus, Bristol-Myers Squibb Company.
1058-P: The 2018 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) Score and Diabetes Risk in the Diabetes Prevention Program Outcomes Study (DPPOS)
Authors: SHAMS-WHITE MARISSA M.M. , TJADEN ASHLEY H. , EDELSTEIN SHARON , BASSIOUNI SARAH , KIM CATHERINE , PI-SUNYER XAVIER , TEMPLE KARLA A. , VENDITTI ELIZABETH M. , REEDY JILL , HECKMAN-STODDARD BRANDY M. ,   GROUP DPP RESEARCH
Published: June 2021

Lifestyle changes may reduce the burdens of diabetes and cancer. We examined how changes in the 2018 WCRF/AICR Score, reflecting key cancer prevention recommendations, are associated with diabetes risk. The Diabetes Prevention Program (DPP) randomized adults with prediabetes to a lifestyle intervention (ILS), metformin (MET), or placebo (PLB) for a mean of 3.2 years, with follow-up in DPPOS for 11 years. The Score includes 7 components: weight, physical activity, plant-based diet, red/processed meat, sugar-sweetened drinks, fast foods, and alcohol (0-7 points, with 7 as the best total score). Scores were estimated at years 0, 1, 5, 6, 9, and 15 for participants with complete baseline data (N = 3,147). Covariates included sex, age, race/ethnicity, marital status, education, family history of diabetes, hormone therapy (females), and energy intake. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) stratified by treatment group estimated the association of Score changes with diabetes risk in DPP and DPPOS within and between groups. There were significant Score improvements within all groups over 15 years (p &lt; 0.001); the differences between groups were only significant after 1 year (p &lt; 0.001; 15 years: p = 0.137). For every 1-unit improvement in Score during DPP, there was a 29% and 16% lower diabetes risk in ILS (95% CI: 0.58 - 0.88) and PLB (95% CI: 0.72 - 0.99), respectively, and no significant association in MET. The time-dependent Score improvements in ILS and PLB were significantly associated with lower diabetes risk through year 15 (ILS HR: 0.86, 95% CI 0.77 - 0.96; PLB HR: 0.85, 95% CI 0.76 - 0.95). Changes in weight, physical activity, and plant-based diet appeared to be drivers of the Score’s effect. Findings suggest that Score improvements are associated with a long-term, lower risk for diabetes among adults with prediabetes. Future research can explore how this risk reduction impacts cancer risk.

Disclosure
M. M. M. Shams-white: None. B. M. Heckman-stoddard: None. D. Research group: None. A. H. Tjaden: None. S. Edelstein: None. S. Bassiouni: None. C. Kim: None. X. Pi-sunyer: None. K. A. Temple: None. E. M. Venditti: None. J. Reedy: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (U01DK048489)
106-LB: Real-Life Efficacy and Safety of IDegLira in Type 2 Diabetic Patients during COVID-19: A 6-Month Follow-Up by Teleconsultation in Bucaramanga, Colombia
Authors: PARRA SERRANO GUSTAVO A. , TORRESLANGHAMMER MARIA PAULA , SERRANOGOMEZ SERGIO , PINTOARIAS ANDREA J. 
Published: June 2021

Objective: Determine impact of degludec / liraglutide (ideglira) on HBA1c, fasting glucose, total daily insulin dose (TDID), hypoglycemia in adults with type II Diabetes Mellitus (T2DM), during covid-19 and follow-up by teleconsultation
Methods: Secondary analysis of an anonymized database of sixty one patients with T2DM, evaluated hba1c, fasting glucose, TDID, and hypoglycemic episodes, Before, 3 and 6 months after IDEGLIRA. Weight could not me measured due to teleconsultation limitation. Performed univariated analysis of cuantitative viariables, bivariated analysis of clinical variables pre and post ideglira treatment. patients received tele-education by a diabetes educator for insulin titration
Results: 59% women, previos IDEGLIRA: 45.9% used 1 oral antidiabetic 29.5% used 2 and 55.7% used oral antidiabetics plus insulin. 54.1% used basal insulin regimen, the mean TDID was 38 units previous ideglira use, and 26 U after use (p= 0.0001). The mean for HBA1c levels was 8.44% (SD:1.4) prior to the use of ideglira, 7.78% (SD: 0.9) at 3rd month and 7.4% (SD:0.91) at 6th month. Significant differences were found when comparing zero months to three months (p= 0.01), and zero to six months (p= 0.0001), and comparing 3 and 6 months (p=0.003). Goal of hba1c &lt;7% was 10% before ideglira, 19% at 3rd month and 43% at 6th month, There was statistical diference between 0 to 3 and 0 to 6th month (p= 0.01). Mean fasting glucose level was 149.1 mg/dL, 125.4 mg/dL and 108.9 mg/dL for 0, 3 and 6 months respectively. Differences were found between 0 and 3 months (p=0,04), and 0 and 6 months (p= 0.01). None of these patients presented any episode of severe hypoglycemia during follow up.
Conclusion: in this real life COVID-19 teleconsultation follow up for 3 and 6 months, The use of ideglira showed statistically significant changes on HBA1c, fasting glucose levels and TDID without causing severe hypoglycemia.

Disclosure
G. A. Parra serrano: None. M. Torreslanghammer: None. S. Serranogomez: None. A. J. Pintoarias: None.
1060-P: Associations of Dietary Patterns and Nutrients with Biomarkers of Inflammation in Adults with and without Type 1 Diabetes
Authors: BASU ARPITA , CHIEN LUNG-CHANG , ALMAN AMY C. , SNELL-BERGEON JANET K. 
Published: June 2021

Background: People with type 1 diabetes (T1D) have a greater risk of developing cardiovascular diseases than people without diabetes. Inflammation plays a key role in atherosclerosis and diet has been known to modify inflammation. However, little is known about this association in T1D.
Methods: We conducted a six-year longitudinal analysis of data from Coronary Artery Calcification in Type 1 Diabetes study [n=1255; T1D: n=563; non-DM: n=692] collected at baseline, year 3 and year 6. Participants completed a validated food frequency questionnaire, a physical examination, and fasting (12h overnight fast) biochemical analyses. Biomarkers of inflammation and atherosclerosis [C-reactive protein (CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1), homocysteine (hcy) and adiponectin] were determined in serum samples at three time points. Dietary patterns were identified using factor analysis. Generalized estimating equations were used to examine associations of dietary patterns with inflammation in models adjusted for traditional cardiovascular risks.
Results: In a multivariate model, increasing intake of carbohydrates and total fats were positively associated with CRP [β (95% CI): 0.013 (0.003, 0.023) and 0.025 (0.011, 0.039), respectively) and fibrinogen (0.007 (0.005, 0.010) and 0.010 (0.006, 0.014), respectively) when adjusted for age, sex, time, total calories, and diabetes status. Dietary fiber revealed an inverse association with CRP [-0.014 (-0.021, -0.007)], PAI-1 [-0.009 (-0.015, -0.003)], and hcy [-0.002 (-0.005, 0.000)], and a positive association with adiponectin [0.005 (0.000, 0.009)]. A dietary pattern characterized by ‘veggies, meats and alcohol’ was positively associated with adiponectin [0.022 (0.001, 0.043)].
Conclusions: Dietary carbohydrates and total fats were associated with biomarkers of inflammation and atherosclerosis, while fiber revealed protective associations in adults with and without T1D.

Disclosure
A. Basu: None. L. Chien: None. A. C. Alman: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc.

Funding
National Institutes of Health (R01HL61753)
1071-P: Long-Term Renin-Angiotensin System Inhibitor Use and Risk of Pneumonia and Pneumonia-Related Death in Type 2 Diabetes
Authors: SHI MAI , YANG AIMIN , LAU ERIC S.H. , WU HONGJIANG , FAN BAOQI , KONG ALICE P. , LUK ANDREA , MA RONALD C. , CHAN JULIANA C. , CHOW ELAINE 
Published: June 2021

Introduction: Angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) are renin angiotensin system inhibitors (RASi) which can reduce the proinflammatory-vasoconstricting activity of ACE/angiotensin II and enhance the anti-inflammatory-vasodilatory activity of ACE2/angiotensin 1-7. These drugs may be protective across a range of respiratory infections including bacterial and viral pneumonias. We examined long-term use of ACEi/ARBs on the risk of first pneumonia hospitalization and pneumonia-related death in Chinese patients with type 2 diabetes (T2D).
Methods: Prospective analysis of 16,285 Chinese T2D patients with new RASi use observed between 2001 and 2019. Overlap weighting was performed to balance baseline characteristics. We used time-dependent Cox model to estimate the hazard ratio (HR) of outcomes while adjusting for the time-varying covariates.
Results: There were 6,379 (39.2%) ACEi-users only, 4,065 (25.0%) ARBs-users and 5,841 (35.9%) non RASi-users. During a median observation of 7.6 years, 6.1% had first pneumonia hospitalization, 1.3% died during or within one month of pneumonia hospitalization and 17.6% died from other causes. No association was observed between RASi use and first pneumonia hospitalization. However, RASi-users had lower risk for pneumonia-related death (HR 0.51, 95% CI 0.35-0.76) than non-users [ACEi-users only: HR 0.53 (0.34-0.81); ARBs-users: HR 0.58 (0.32-1.04)]. We also noted reduced risk for all-cause death in RASi-users (HR 0.60, 95% CI 0.54-0.67) [ACEi-users only: HR 0.61 (0.54-0.69); ARBs-users: HR 0.67 (0.57-0.79)].
Conclusions: Long-term use of RASi was associated with reduced risk of pneumonia-related death and all-cause death, but not first pneumonia hospitalization, in Chinese patients with T2D. Relevance to other respiratory infections such as coronavirus-disease 2019 (COVID-19) merits further investigation.

Disclosure
M. Shi: None. E. Chow: Research Support; Self; Medtronic, Speaker’s Bureau; Self; Novartis Pharmaceuticals Corporation, Sanofi-Aventis. A. Yang: None. E. S. H. Lau: None. H. Wu: None. B. Fan: None. A. P. Kong: Advisory Panel; Self; Lilly Diabetes, Speaker’s Bureau; Self; Abbott, AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Lilly Diabetes, Sanofi, Stock/Shareholder; Self; Aptorum. A. Luk: None. R. C. Ma: Other Relationship; Self; AstraZeneca, Medtronic, Research Support; Self; AstraZeneca, Bayer Healthcare Pharmaceuticals Inc., Novo Nordisk, Pfizer Inc., Sanofi-Aventis, Tricida, Inc. J. C. Chan: Consultant; Self; Bayer AG, Boehringer Ingelheim International GmbH, MSD Corporation, Sanofi, Other Relationship; Self; Asia Diabetes Foundation, GemVCare, Research Support; Self; Applied Therapeutics, AstraZeneca, Hua Medicine, Lilly Diabetes, Merck KGaA.