bluuebunny/crossref_metadata_2025_split huggingface dataset:
582-P: Gestational Diabetes and Breastfeeding: Evidence from PRAMS
Authors: HEBERT LUCIANA E. , NIKOLAUS CASSANDRA J. , ZAMORA-KAPOOR ANNA , SINCLAIR KAIMI 
Published: June 2021

Gestational diabetes (GD) disproportionately affects American Indian and Alaska Native (AI/AN) women, who are nearly twice as likely to experience GD as non-Hispanic White women. Despite the well-established benefits associated with breastfeeding, including reduction of risk of type 2 diabetes, women who develop GD are frequently less likely to breastfeed than women who do not develop GD. AI/AN women are less likely to initiate breastfeeding and breastfeed for a shorter duration compared to other women. No previous study has evaluated the potential link between GD and breastfeeding outcomes among AI/AN women. The purpose of this study was to examine the relationship between GD and breastfeeding among women of different ethnicities in four states using the Pregnancy Risk Assessment Monitoring Surveillance (PRAMS). We used data from Phase 8 (2016-2018) of PRAMS from Alaska, Oklahoma, South Dakota, and Washington. We used logistic regression to estimate factors associated with breastfeeding initiation for each group of women, conducted survival analysis using Kaplan Meier curves, and Cox proportional hazards regression to analyze duration of breastfeeding. Twelve percent of AI/AN and Hispanic women had GD in their most recent pregnancy, compared to less than 9 percent among non-Hispanic White and non-Hispanic Black women (p&lt;0.0001). AI/AN women were the least likely to initiate breastfeeding compared to other women (85% vs. 88-93%, p&lt;0.0001) and the least likely to be breastfeeding at the time of survey (51% vs. 57-69%, p&lt;0.0001). While there was no association between GD and initiation of breastfeeding, women who had GD had a shorter duration of breastfeeding compared to women who did not have GD. GD significantly modifies the association between race/ethnicity and breastfeeding duration. Increasing support for AI/AN women with GD to initiate and continue breastfeeding may represent an effective and culturally appropriate intervention to improve maternal and child health outcomes and reduce disparities.

Disclosure
L. E. Hebert: None. C. J. Nikolaus: None. A. Zamora-kapoor: None. K. Sinclair: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (P30DK092923)
586-P: Characteristics Associated with A1C at 18-Months after Diagnosis in Young Children with Type 1 Diabetes
Authors: ENG JARED S. , ROONEY KELLYANN , HENDERSON CELIA , MARKS BRYNN E. , TULLY CARRIE , MONAGHAN MAUREEN , HILLIARD MARISA E. , STREISAND RANDI , WANG CHRISTINE H. 
Published: June 2021

Introduction: The incidence of T1D in young children is increasing, yet the majority of children do not achieve glycemic targets, and little is known about predictors of A1c in young children. This study examines demographic predictors of A1c among young children through 18 months post-diagnosis.
Methods: Participants were 37 young children (age 1-6 years, Mage=4.53(1.64), MA1c at diagnosis= 10.47(1.93)) with T1D whose parents were randomized to the usual care condition of a multi-site behavioral intervention trial within 8 weeks of diagnosis. At baseline, parents self-reported on sociodemographic information, CGM use and depression symptoms; DKA status at diagnosis and A1c values at 18 months were obtained from medical records. Child A1c at 18-months post-diagnosis (MA1c= 8.05 (0.93)) was dichotomized into “below target” (≤7.5%; n=15; 40.5%) or “above target” (&gt;7.5%; n=22; 59.5%).
Results: Family income (two-tailed Fisher’s exact test, p=.019), parent race/ethnicity (χ2(1, N=37)=8.97 p=.003), and child sex (χ2(1, N=37)=3.96, p=.047) were all significantly associated with 18-month A1c. Post hoc analyses using Bonferroni corrections indicated families with higher income, parents who identified as non-Hispanic white, and male children were more likely to be in the “below target” group compared to families with lower income, parents who identify as a racial/ethnic minority and female children, respectively. The 18-month A1c was not associated with baseline CGM use or parent depressive symptoms, nor DKA at diagnosis (p&gt;.05).
Conclusions: There are limited prospective studies of early predictors of A1c in young children. Our results are consistent with findings regarding demographic correlates of A1c found in older children and highlight the importance of social determinants of health. Future research using larger samples should explore the role of additional potential correlates of later glycemic control.

Disclosure
J. S. Eng: None. K. Rooney: None. C. Henderson: None. B. E. Marks: None. C. Tully: None. M. Monaghan: None. M. E. Hilliard: None. R. Streisand: None. C. H. Wang: None.

Funding
National Institute of Diabetes and Digestive and Kidney Disease (R01DK102561)
59-OR: The Diabetes Garage: Using Automotive Maintenance Analogies to Engage Mexican-American Men to Participate in a Diabetes Self-Management and Education Program
Authors: CONCHA JEANNIE B. , SCHOBER GREGORY , PORTILLO DENISE N. , RUIZ ROSALBA F. , RAMOS REBECA , ROMERO RAQUEL L. , LOPEZ ARMANDO , WINKLER PAULA 
Published: June 2021

Mexican-American (MA) men are three times more likely to have diabetes compared to non-Hispanic whites. Despite the availability of diabetes management programs, MA men are underrepresented. The CDC reports that woman (75%) disproportionately participate in diabetes programs compared to men (25%). MA men in particular, have less diabetes knowledge, are less likely to visit a diabetes specialist or adhere to treatments, and are more likely to have complications.
Purpose: The Diabetes Garage (DG) is designed to engage MA men in self-management behaviors, improve glycemic and physical health outcomes.
Methods: The DG was implemented 2 hours weekly/4 weeks and co-taught by CDCES and automotive technicians. Pre-posttests of self-management behaviors and physical indicators were collected at workshop 1 and at the end of workshop 4. Wilcoxon matched-pairs signed-rank tests were conducted to assess pre-post test differences in behavior (food portion/carbohydrate intake, physical activity) and paired t-tests were conducted to examine differences in health outcomes (i.e., A1c, BP, weight, waist).
Results: Data from 2018-2020 (N=74) indicate 77% retention rate. Statistically significant improvements were found in self-reported food portion (Z= -2.030, p &lt;.05) and carbohydrate intake (Z= -2.787, p &lt;.01). Statistically significant improvements were found in systolic BP (t=2.91, mean diff=9.47, p=.01) and improvements in diastolic BP (t=1.41, mean diff=8.18, p =.176). Satisfaction surveys show that men enjoyed the workshops: “The information, the presenters, the diabetes education was totally empowering ⋯ I am looking forward to better managing my diabetes and driving my human-mobile for a long-time...with good quality of life.”
Conclusion: Use of automotive maintenance analogies is a feasible approach for engaging men in diabetes management programs, self-management behaviors, and improving health indicators.

Disclosure
J. B. Concha: None. G. Schober: None. D. N. Portillo: None. R. F. Ruiz: None. R. Ramos: None. R. L. Romero: None. A. Lopez: None. P. Winkler: None.

Funding
Texas Department of State Health Services
594-P: Use of Connected Glucometer with Real-Time Feedback and Counseling for Glycemic Control in Patients with Diabetes in India: BeatO's Connected Diabetes Care Program
Authors: SABHARWAL MUDIT , MOHIT MINAL , KOLUKULA VAMSI K. , JANGID RUPALI , CHOPRA GAUTAM 
Published: June 2021

Background: BeatO® offers connected diabetes care program including smartphone connected glucometer and mobile app with real time feedback and counselling support. This study aims to evaluate the effectiveness of BeatO's connected diabetes care program with real time contextualized feedback loop and certified diabetes educator (CDE) counselling on glycemic control of patients with diabetes in India.
Method: A retrospective data-based evaluation study was conducted on BeatO® cloud database. Medical records of patients with diabetes, digitally engaged between September 2019 to July 2020 and received at least one CDE counselling were evaluated. Intervention included SMBG using smartphone connected glucometer, real-time feedback, and contextualized counselling by CDE based on SMBG findings. Pre-counselling (BG values recorded for 30 days period before first counselling) and post counselling (BG values recorded between 15th to 45th day after last counselling) impact on glycemic control and in range BG values were assessed.
Results: Out of total 7514 diabetes patients, majority of them were aged &gt;40 years (76%). Most of the patients had T2D (95%) followed by T1D (4.5%), GDM (0.3%), LADA (0.1%) and MODY (0.1%). A total of 10,667 counselling sessions were conducted out of which majority had one session (74%) followed by 2 (17%), 3 (5%), 4 (2%) and ≥5 (1%) sessions. Intervention was effective in significantly reducing mean BG values across fasting (by 9.5%), pre-prandial (9.3%), post prandial (8.9%) and random (6%) BG readings (p value &lt;.05). Proportion of patients with in-range BG values post intervention increased by 9.6% (post prandial &lt;180 mg/dL), 9.1% (random &lt;200 mg/dL), 5.8% (fasting 80-130 mg/dL) and 3.3% (pre-prandial 80-130 mg/dL).
Conclusion: BeatO's smartphone connected SMBG with real time feedback, nudges, alerts and CDE counselling is effective in glycemic control in real world patients with diabetes.

Disclosure
M. Sabharwal: Employee; Self; Health Arx Technologies Pvt. Ltd. M. Mohit: Consultant; Self; Health Arx Technologies Pvt. Ltd. V. K. Kolukula: None. R. Jangid: None. G. Chopra: Employee; Spouse/Partner; Health Arx Technologies Private Limited, Other Relationship; Self; Health Arx Technologies Private Limited.
595-P: CGM Use in Ambulatory Insulin-Treated Patients following Hospital Discharge
Authors: RIZVI ALI A. , EBERLEIN CELESTE 
Published: June 2021

Hospitalization is an opportunity for initiation and reevaluation of diabetes management. Many inpatients are either found to have new hyperglycemia or suboptimal glucose control, necessitating the initiation or titration of insulin. Blood glucose monitoring has traditionally been used with insulin therapy. Continuous glucose monitoring (CGM) of interstitial fluid has gained favor as an effective means to achieve this end. We studied the impact of early institution of CGM in the hospital and continuing post-discharge in insulin-treated patients over a 6-month time period. The initiative was shepherded by a newly-established academic endocrinology practice consisting of a diabetes specialist and a nurse clinician. Focused inpatient diabetes teaching, followed by formal outpatient education delivered by certified educators, was employed. 47 patients (31 males, 16 females; average age 63.3 years) were either begun or progressed to intensive insulin therapy (2-4 daily injections), coupled with CGM use (Freestyle Libre or Dexcom G6) within 2 weeks of discharge. Patients used blood glucose meter readings as needed. Downloaded CGM data with ambulatory glucose profile was reviewed for each patient proactively at least once a month. Patients were advised of changes in insulin/diabetes therapy by phone or electronic portal, and during telehealth and in-person office visits. The average time-in-range (TIR) increased from 59.6% to 60.9% (p= 0.5), while the average hemoglobin A1c decreased from an inpatient value of 9.8% to 7.4% (p&lt;0.05) over a mean period of 6 months. The CGM continuation rate was close to 100%. We conclude that with availability of expertise and clinical support, CGM and its interactive technology offers a unique tool to improve glucose control and empower insulin-treated outpatients in the critical post-hospitalization time. It would be expected to result in better outcomes with regard to complications, readmission rates, and cost of care.

Disclosure
A. A. Rizvi: None. C. Eberlein: None.
6-OR: Psychological Comorbidities and Racial/Ethnic Disparities in Preventable Hospitalizations among Medicaid-Enrolled Adults with Type 2 Diabetes
Authors: LEE AARON A. , ZHANG YIQIAO , RAMACHANDRAN SUJITH 
Published: June 2021

Background: Among adults with type 2 diabetes, racial and ethnic minorities have significantly higher rates of potentially preventable hospitalizations (PPH) compared to White non-Hispanic adults. Depression, anxiety, and stress-related disorders are associated with increased risk of diabetes related PPH. We examined the interaction of these risk factors among Medicaid enrollees.
Methods: This study used 2014 Medicaid claims data from 17 US states. The sample included 1,049,790 adults with type 2 diabetes. The outcome was &gt;=1 diabetes related PPH, defined by the AHRQ Prevention Quality Diabetes Composite measure. Predictors were race/ethnicity and mental health diagnoses (PTSD, adjustment disorder, generalized anxiety disorder [GAD], phobic disorders, and depressive disorders). Logistic regression models examined the adjusted main-effects and interactions of both predictors on PPH, adjusting for clinical and demographic characteristics.
Results: Depression was associated with significantly greater odds of PPH (Adjusted Odds Ratio [AOR] = 1.50, 95%CI: 1.47, 1.60). PTSD (AOR = 0.81, 95%CI: 0.69, 0.96) and GAD (AOR = 0.79, 95%CI: 0.68, 0.92) were associated with lower odds of PPH. Black adults had significantly higher odds of PPH (AOR = 1.30, 95%CI: 1.26, 1.34) and Hispanic adults had significantly lower odds of PPH (AOR = 0.95, 95%CI: 0.91, 0.99) compared to White non-Hispanic adults. Depression increased odds of PPH among Black adults (AOR = 1.09, 95%CI: 1.03, 1.16) and decreased odds of PPH among Hispanic adults (AOR = 0.87, 95%CI: 0.79, 0.96) compared to White non-Hispanic adults.
Discussion: Of the psychological comorbidities examined, only depression was associated with increased risk of diabetes related PPH. Results suggest that depressive symptoms may exacerbate racial and ethnic disparities in PPH. Adults with PTSD or GAD diagnoses may have greater engagement with preventive healthcare and thus, lower risk of PPH.

Disclosure
A. A. Lee: None. Y. Zhang: None. S. Ramachandran: None.
610-P: Research on Consistency of Mass Spectrometry and Enzymatic Methods for Saliva 1,5-anhydroglucitol Measurement
Authors: BAO YUQIAN , JIAN CHAOHUI , ZHAO AIHUA , MA XIAOJING , LU WEI , ZHU WEI , WANG YUFEI , ZHOU JIAN 
Published: June 2021

Objective: To evaluate the agreement of different measurement methods of saliva 1,5-anhydroglucitol (1,5-AG) in different glucose metabolism populations.
Methods: A total of 175 healthy volunteers (21–65 years, 58 males and 117 females) with normal glucose tolerance (NGT) and 80 diabetic patients (18–70 years, 44 males and 36 females) were enrolled from January 2018 to June 2019 and saliva was collected by saliva collection tube. Saliva 1,5-AG was measured using both enzymatic and mass spectrometry methods and serum 1,5-AG was determined by enzymatic method.
Results: In subjects with NGT, the serum and saliva 1,5-AG levels detected by enzymatic method were both significantly positively correlated with the saliva 1,5-AG levels detected by liquid chromatography-mass spectrometry (LC-MS) (r = 0.247 and 0.523, respectively, both P &lt; 0.05). However, there was no significant correlation between saliva and serum 1,5-AG levels detected by enzymatic method (r =-0.074, P = 0.333). In diabetic patients, the serum and saliva 1,5-AG levels detected by enzymatic method were both significantly positively correlated with the saliva 1,5-AG levels detected by gas chromatography-mass spectrometry (GC-MS) (r = 0.284 and 0.423, respectively, both P &lt; 0.05). There was no significant correlation between saliva and serum 1,5-AG levels detected by enzymatic method (r ='0.079, P = 0.487).
Conclusion: Both the serum and saliva 1,5-AG levels detected by enzymatic method have good agreement with saliva 1,5-AG levels detected by mass spectrometry method. The saliva and serum 1,5-AG levels detected by enzymatic method are not well correlated, so the enzymatic detection of saliva 1,5-AG needs further improvement for clinical practice.

Disclosure
Y. Bao: None. C. Jian: None. A. Zhao: None. X. Ma: None. W. Lu: None. W. Zhu: None. Y. Wang: None. J. Zhou: None.
614-P: Success of CME at Improving Knowledge of Clinical Use of Real-Time CGM
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE 
Published: June 2021

We sought to determine if an online continuing medical education (CME) activity could improve knowledge and competence of diabetologists/endocrinologists (D/Es) and primary care physicians (PCPs) related to clinical use of rtCGM. The effect of an online, 15-minute, CME-certified summary of a satellite symposium was analyzed to determine efficacy. A repeated pairs pre-/post-assessment study design was used and chi-squared test (5% significance level, P &lt;.05) assessed educational effect. Cramer's V was used to calculate the effect size (0.06-0.15 is a noticeable effect, 0.16-0.26 considerable, and &gt;0.26 extensive). The activity posted June 22, 2020, and data were collected through October 14, 2020. Matched learner data indicate that overall, 19% of D/E learners' (N=234) and 26% of PCP learners' (N=241) responses improved from pre-to-post (both P&lt;.001) with a considerable effect size of 0.164 and 0.205, respectively On a question-level: 15% of D/Es and 17% of PCPs improved at recognizing recent clinical trial data on the use of rtCGM in pregnant patients with T1D 24% of D/Es and 34% of PCPs improved at identifying appropriate TIR levels in patients with gestational diabetes Overall, 33% of D/Es and 46% of PCPs reported increased confidence in interpreting glucometric data from CGM device, for a total confidence shift of +11.4% and +23.3, respectively. Continued educational gaps: • 29% of both D/Es and PCPs did not recognize data on the use of rtCGM in pregnant T1D patients • 41% of D/Es and 49% of PCPs did not recognize appropriate TIR levels in gestational diabetes This study demonstrates the success of an online summary from a satellite symposium on improving knowledge and confidence of clinical use of rtCGM, with gaps identified for future education.

Disclosure
A. Larkin: None. J. Schrand: None. A. Le: None.

Funding
Dexcom, Inc.
627-P: Uncontrolled Hyperglycemia Predicts Ventilatory Support and Duration of Hospital Stay in People with Diabetes and COVID-19
Authors: CHAUDHURI SOUMYABRATA ROY , MAJUMDER ANIRBAN , SANYAL DEBMALYA , BISWAS AJOY , BHATTACHARJEE KINGSHUK 
Published: June 2021

Background: Despite growing evidence that diabetes is associated with worse COVID-19 outcomes, there remains little information on inpatient glycemic response among individuals with diabetes and uncontrolled hyperglycemia hospitalized with the novel coronavirus SARS-CoV-2.
Methodology: This is a multicentric retrospective study aimed to explore the role of hyperglycaemia (uncontrolled HbA1c) in predicting length of hospital stay and ventilatory support in diabetic patients hospitalised for COVID-19. We excluded all patients with newly diagnosed diabetes within last 3 months and/or those who are only on lifestyle modification.
Results: A total of 133 patient records admitted to three tertiary care hospitals between 15/05/2020 to 15/11/2020 were analysed retrospectively. The 62 patients requiring ventilatory support had a significantly higher HbA1c (9.49±2.73%) as compared to those without ventilatory support (8.09±1.32%), p=0.002. Multiple logistic regression also indicated that the HbA1c was an independent risk factor for ventilatory support in DM patients with COVID-19 (Odds Ratio [OR] = 1.310, 95% confidence interval [CI]: 1.063-1.615), p=0.011. The odds of requiring ventilatory support is 35% lower in patients with good glycemic control (HbA1c&lt;7.5%) vs. those with HbA1c≥7.5% (OR-0.65, 95%CI 0.32-0.88). The mean duration of hospital stay was 10.5±3.45 days. Multiple linear regression analysis revealed HbA1c to predict the duration of hospital stay, p=0.001. For every 1% increase in HbA1c, the length of hospital stay was found to increase by 0.461 days.
Conclusion: The present study demonstrated that a high level of HbA1c was an independent risk factor for ventilatory support and prolonged hospital stay in COVID-19 patients with DM.

Disclosure
S. Roy chaudhuri: None. A. Majumder: None. D. Sanyal: None. A. Biswas: None. K. Bhattacharjee: None.
64-OR: Metformin Improves Cardiac and Aortic Parameters in Adolescents with Type 1 Diabetes
Authors: NGUYEN ALEXANDER , TRUONG UYEN , SCHAFER MICHAL , BAUMGARTNER AMY , BARKER ALEX J. , HUNTER KENDALL S. , BURKETT DALE , REUSCH JANE E. , NADEAU KRISTEN J. 
Published: June 2021

Purpose: People with type 1 diabetes (T1D) have higher rates of cardiovascular disease (CVD) despite modern advances in glucose control. While insulin resistance (IR) is known to relate to CVD in type 2 diabetes, less is understood about IR in T1D-related CVD. We previously found vascular and cardiac dysfunction, including left ventricular (LV) dyssynchrony, in adolescents with T1D. In the Effects of MEtformin on caRdiovascular function in AdoLescents with type 1 Diabetes (EMERALD) study, we also showed that metformin improves BMI, body composition, insulin sensitivity, arterial stiffness, and carotid intimal media thickness in T1D adolescents. We hypothesized that metformin, with insulin-sparing effects, would improve echocardiographically-assessed cardiac and aortic health.
Methods: 43 T1D youth ages 12-21 years (mean age 16.8 ± 2.5 years, HbA1c 8.6 ± 1.5%, BMI 25.1 ± 4.3 kg/m2, diabetes duration 7.7 ± 4.2 years) from the EMERALD study who were randomized to 3 months of either 1000 mg BID of metformin (n=23) or placebo (n=20) had echocardiograms with speckle tracking to evaluate traditional echocardiographic measures, cardiac strain and synchrony, and aortic root diameter at baseline and 3 months. One-way ANOVA and paired t-tests were utilized to assess the impacts of metformin.
Results: LV diameter (4.45 ± 0.47 vs. 4.26 ± 0.50 cm, p = 0.019) at end-diastole and at end-systole (2.89 ± 0.39 vs. 2.69 ± 0.36 cm, p = 0.022) and LV dyssynchrony (98.0 ± 36.9 vs. 81.7 ± 27.5 milliseconds, p = 0.014) showed significant improvement within the metformin group. Aortic root diameter (2.51 ± 0.39 vs. 2.73 ± 0.28 cm, p = 0.042) was also significantly lower in the metformin vs. placebo group post-treatment.
Conclusions: Metformin may be beneficial in improving or reversing early cardiovascular changes in T1D detectable by echocardiogram. A better understanding of T1D-related CVD and the benefits of improving insulin action in T1D longer-term should be investigated further as a target for new treatment modalities.

Disclosure
A. Nguyen: None. U. Truong: None. M. Schafer: None. A. Baumgartner: None. A. J. Barker: None. K. S. Hunter: None. D. Burkett: None. J. E. Reusch: Advisory Panel; Self; Medtronic. K. J. Nadeau: None.

Funding
American Diabetes Association (7-11-CD-08 to K.J.N.)