bluuebunny/crossref_metadata_2025_split huggingface dataset:
511-P: Treatment Burden, Glycemic Control, and Social Determinants of Health in Patients with Type 2 Diabetes
Authors: ROGERS ELIZABETH A. , MANSER SARAH T. , ARRIAZA STEVEN , LINZER MARK 
Published: June 2021

Burden of treatment (BoT) is the work of self-management of chronic conditions and its impact on function and well-being. BoT may negatively affect behavioral outcomes. With 90% of patients with type 2 diabetes (T2DM) having at least 1 comorbid condition, BoT may be important to consider, especially among populations experiencing disparities. However, links between BoT and clinical outcomes are unclear. Using a cross-sectional survey and electronic health record data, we sought to determine associations between BoT (using a validated measure) and glycemic control (A1c) among low-income patients with T2DM in 6 safety net primary care clinics, and whether BoT and A1c were related to medication adherence and social determinants of health (SDOH). We used descriptive statistics and correlations, then ANOVA to compare 4 groups by high vs. low A1c (cut at 7%) and BoT (cut at median). Of 192 respondents, average age was 55 with 63% female and 64% non-white; 23% had low health literacy, 26% worried about housing, 35% reported medical-related financial difficulties, and 17% did not always have enough food. Average A1c was 7.6%. While there was no association between A1c and BoT (rho=0.01, p=0.86), both were independently associated with health literacy, perceived self-management self-efficacy, and diabetes-related distress (rho range 0.15-0.65, p=&lt;0.001-0.04). A1c was not associated with medication adherence, but BoT was (rho=0.24, p=0.001). Housing worry, financial difficulties, and food insecurity were higher, and adherence lower, in the High A1c - High BoT group than in the Low A1c - Low BoT group (p=0.006-0.01). For the High A1c - Low BoT and Low A1c - High BoT groups, BoT was more important than A1c for these associations. The relationships between BoT and A1c are complex, but SDOH and adherence may be important mediators. These may be appropriate intervention targets for glycemic control, particularly among low-income and minority patients. Determining causality requires further study.

Disclosure
E. A. Rogers: None. S. T. Manser: None. S. Arriaza: None. M. Linzer: Other Relationship; Self; American College of Physicians, CRICO Malpractice and Harvard University, Research Support; Self; Agency for Healthcare Research and Quality, American Board of Internal Medicine, American Medical Association, Institute for Healthcare Improvement, National Heart, Lung, and Blood Institute, National Institute for Nursing Research.

Funding
National Institutes of Health (K23DK118207)
512-P: Desire for and Experience of Shared Decision-Making and Associations with Patient-Reported Outcomes in Those with Diabetes
Authors: SYVERUD EMILY , MANSER SARAH T. , ARRIAZA STEVEN , ROGERS ELIZABETH A. 
Published: June 2021

Diabetes can be associated with distress and perceived treatment burden, which are more common among low-income and non-white populations and act as barriers to good health and quality of life. Interventions that focus on patient participation, such as shared decision-making (SDM), have been shown to improve diabetes outcomes. We sought to understand how participation in SDM is correlated with treatment burden, diabetes-related distress, patient perceived care quality, and diabetes self-management in adults with type II diabetes, and whether a patient’s desire for SDM influences those relationships. We recruited patients from six county hospital primary care clinics to complete a survey with items from validated scales for each of the above concepts along with demographics. We dichotomized responses based on median scores on the Desire to Participate in Shared Decision-Making (DPMD) scale and the Health Care Climate Questionnaire (HCCQ), a measure of the experience of SDM. We created 4 groups by high/low desire for and high/low experience of SDM, then compared mean scores for diabetes distress, perceived self-management, treatment burden, and care quality between the 4 groups using ANOVA. Of 194 respondents, average age was 54.5, with 63% identifying as female, 35% as white, 45% as Black or African-American, and 20% as of Hispanic or Latin origin. Those with high experience of SDM had significantly lower scores for diabetes distress and treatment burden and significantly higher scores for perceived care quality and self-management, regardless of their desire for SDM. Our findings suggest that SDM may be important for mitigating patient distress and treatment burden and improving self-management and satisfaction with care in a low-income minority population. Further research to explore a causal relationship is vital.

Disclosure
E. Syverud: None. S. T. Manser: None. S. Arriaza: None. E. A. Rogers: None.

Funding
National Institutes of Health (K23DK118207)
516-P: Objective and Subjective Physical and Mental Health Benefits in Older Adults with Cardiometabolic Risk after Diabetes Prevention Program (DPP)-Based Lifestyle Intervention
Authors: STERN HARRISON J. , MILLER RACHEL G. , CONLON RACHEL P.K. , LEVINE MICHELE D. , MARCUS MARSHA D. , VENDITTI ELIZABETH M. 
Published: June 2021

Physical function, health-related quality of life (HRQoL), and depressive symptoms are key outcomes for older adults (≥65y) enrolled in behavioral weight management, but less is known about relationships among these variables. We evaluated associations between changes in these measures after a 1-year DPP-based lifestyle program. Participants (N=322) were M±SD age 71.2y±4.3, BMI 33.8±5.1, 77% women, 13% Black, averaged 4 chronic conditions, and 31% had prediabetes. Most took blood pressure (67%) and lipid (52%) medications. Participants attended 12 in-person weekly groups, then were randomized to continued monthly contact by phone or newsletter, losing 7.4% (CI) (-8.9, -5.9) and 6.1% (-8.6, -3.6) of weight at 1 year, respectively. Goals included reducing calorie/fat intake, increasing lean protein, ≥150 minutes aerobic activity/week, and strength training. Physical function was measured via Short Physical Performance Battery (SPPB) gait speed, chair rise, and balance tests, perceived HRQoL via SF-12 Physical and Mental Component Summary (PCS and MCS), and mood via Center for Epidemiologic Studies Depression Scale (CES-D) at pre- and post-intervention. Associations between baseline-12 month changes in SPPB, HRQoL and CES-D were estimated in mixed-effect models. SPPB improved by 0.3±1.4 (p=0.001) in phone and 0.3±1.7 (p=0.02) in newsletter. Increased SPPB was associated with improved PCS (β=1.18, SE=0.20, p&lt;0.001) and CES-D (β=-0.50, SE=0.17, p=0.002) in all participants, and improved MCS in phone (β=0.19, SE=0.28, p=0.049) and decreased MCS in newsletter (β=-0.37, SE=0.22, p=0.049). After weight loss, regardless of follow-up mode, modestly improved physical function relates to greater perceived physical HRQoL and mood, but less change in perceived mental HRQoL. Future weight loss trials in high risk elders should evaluate how to optimize physical function and subjective well-being outcomes.

Disclosure
H. J. Stern: None. R. G. Miller: None. R. P. K. Conlon: None. M. D. Levine: None. M. D. Marcus: Advisory Panel; Self; Weight Watchers International, Inc. E. M. Venditti: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R18DK096405)
520-P: The Influences of Loneliness and Depression on A1C among Middle-Aged and Older Adults with Diabetes
Authors: HUANG YA CHING , GARCIA ALEXANDRA A. , CHO EMMA S. , KUO HSUANJU 
Published: June 2021

Purpose: Loneliness and depression are significant challenges for middle-aged and older adults, and are associated with worse overall health. Even before the COVID-19 pandemic, about 43% of adults aged 60 and above reported experiencing loneliness. People with diabetes (DM) are 2 to 3 times more likely to have depression than those without DM. Loneliness and depression often co-exist and each is likely to worsen DM outcomes. The aim of this study was to examine how loneliness and depression affect A1C levels among middle-aged and older adults with DM.
Methods: This study is a secondary analysis of data from the Midlife in the United States Refresher (MIDUS-R) survey that included a national sample of U.S. adults aged 25 to 74 years. We conducted correlation analyses and estimated a hierarchical logistic regression to predict people with A1C levels ≤ 7 or &gt; 7 using the following sets of predictors: 1) demographics and physical health (ethnicity, gender, education, age, and comorbidities), 2) family and friends support, and 3) psychological factors (loneliness and depression).
Results: The sample was composed of 92 participants with DM and A1C data in the MIDUS-R. Mean age was 57.37±11.83, 51% were male, and 68 % were non-Hispanic Whites; 39.1 % had A1C &gt;7. The average level of depression was low (CES-D mean 9.42) and loneliness was moderate (mean 12.43, range 1-28). Loneliness was correlated with A1C (r= .26, p&lt; .05); depressive symptoms (r= .71, p&lt; .001), family and friends support (r=.36, r=.38, respectively, both p&lt;.001). Only loneliness significantly predicted higher A1C levels in this analysis. People with higher levels of loneliness had increased odds of having an A1C &gt;7 (OR = 1.18, p &lt; .05) after controlling for depression and all other variables.
Conclusion: Loneliness is more prevalent and had a greater impact than depression on A1C level. Healthcare providers should assess patients for loneliness and reduce adverse health impacts by referring them for psychosocial interventions as needed.

Disclosure
Y. Huang: None. A. A. Garcia: None. E. S. Cho: None. H. Kuo: None.
530-P: Are Larger Support Networks More Helpful or Harmful for Adults with Type 2 Diabetes?
Authors: LEWIS BIANCA , KOLLIN SOPHIE R. , LEE AARON A. 
Published: June 2021

Background: Adults with diabetes often receive self-management support from family and friends (care partners) living in and outside of their home. Helpful involvement from care partners (CPs) has positive impacts on diabetes self-management. Less is known regarding the relationship between the number of CPs and the level of helpful and harmful involvement. We examined the relationship between the number of in and out-of-home CPs and helpful and harmful involvement in patients’ diabetes self-management.
Methods: Adults with type 2 diabetes (N=369) were recruited from a web-based panel. Participants completed the Family and Friend Involvement in Adults’ Diabetes (FIAD) scale and reported the number of in and out-of-home CPs who provide help with their diabetes self-management. A two-step hierarchical linear regression was used to examine the linear and quadratic trends between number of in and out-of-home CPs and helpful and harmful involvement in diabetes self-care, controlling for age, sex, ethnicity, and socioeconomic status.
Results: There was a positive linear relationship between the number of in and out-of-home CPs, and helpful and harmful involvement (p’s; range &lt; .001 to .003). The addition of quadratic terms accounted for a significant increase in explained variance in helpful and harmful involvement (p’s &lt; .001). There was a positive trend between the number of in and out-of-home CPs and helpful and harmful involvement among adults with up to approximately 5 CPs. In contrast, there was a negative trend between these variables among individuals with 5 or more CPs.
Conclusions: Patients with a relatively small or large number of CPs, receive less helpful and harmful support. Large CP networks are not necessarily indicative of high levels of helpful involvement in patients’ diabetes self-care. CP interventions should attempt to enhance helpful involvement while minimizing harmful involvement in these populations.

Disclosure
B. Lewis: None. S. R. Kollin: None. A. A. Lee: None.
533-P: Diabetes Related Stigma among Black and Hispanic Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: CRESPO-RAMOS GLADYS , FINNAN MOLLY , GONZALEZ JEFFREY S. , AGARWAL SHIVANI 
Published: June 2021

Objective: Young adults with T1D of racial/ethnic minority status suffer adverse outcomes compared with White peers. Diabetes-related stigma (DRS) is common and may contribute to poor outcomes in minority YA, but further study is needed.
Methods: We recruited non-Hispanic Black and Hispanic YA with T1D from pediatric and adult diabetes centers at Montefiore Medical Center in the Bronx, NY for a qualitative study to explore YA lived experiences with T1D, challenges to diabetes self-management, and healthcare interactions. We conducted semi-structured individual interviews, which were audio-recorded, transcribed, and analyzed for common themes until thematic saturation was achieved. We coded for DRS in YA responses using the Diabetes Stigma Assessment Scale (DSAS), which includes three domains for stigma due to having diabetes: 1) treated differently, 2) blame and judgment, and 3) identity concerns.
Results: We included 41 YA participants for analysis (mean age 21 yrs, 68% female, 73% Hispanic, 27% Black, mean HbA1c 10.3%). Seventy-eight percent of participants (n=32) qualified as having at least one experience consistent with DRS. Of those, approximately half of participants had experiences consistent with one domain of DRS, nine participants with two DRS domains, and three participants with all three domains. Each stigma domain (treated differently, blame and judgment, and identity concerns) was represented equally among participants with DRS experiences. Notably, several Black participants mentioned that they experienced race discrimination from healthcare providers related to diabetes self-management and outcomes.
Conclusions: In this sample of minority YA with T1D, DRS prevalence was very high and had some race-specific associations. Greater recognition of DRS and its contribution to poor outcomes among YA with T1D belonging to racial/ethnic minority groups is needed.

Disclosure
G. Crespo-ramos: None. M. Finnan: None. J. S. Gonzalez: None. S. Agarwal: None.

Funding
National Institutes of Health (K23DK115896)
539-P: Parental Anxiety and Accuracy of Risk Perception upon Receipt of Positive Results of Screening for Presymptomatic Type 1 Diabetes: Autoimmunity Screening for Kids (ASK)
Authors: RASMUSSEN CRISTY GENO , BAXTER JUDITH , DONG FRAN , BAUTISTA KIMBERLY A. , SEPULVEDA FLOR , FELIPE-MORALES DANIEL , REWERS MARIAN 
Published: June 2021

Screening for islet autoantibodies (IAb) followed by education and monitoring of children at high risk for type 1 diabetes (T1D) substantially reduces incidence of diabetic ketoacidosis at diagnosis. We assess parental anxiety and accuracy of risk perception as part of ASK screening, education and monitoring program.
The 10-y risk of clinical diabetes is 70% in children positive for multiple IAb, 50% with single high-affinity, and 2% with single low-affinity (confirmed twice). As of March 2020, ASK had screened for IAb 23,847 general population children and further monitored 280, including 136 with 50-70% high risk and 144 with 2% lower risk; 9% had a first degree relative (FDR) with T1D. At each visit, parental risk perception and anxiety were assessed using the State Anxiety Inventory (SAI), with a score &gt;40 denoting elevated anxiety. Reported here are results from the 1st visit (N=280) and for those with a 2nd visit (N=119).
At the 1st visit, parental anxiety was elevated (mean SAI=46.1) with no difference by child’s risk status, family history, or by which parent responded. SAI was significantly higher in ethnic minorities than in non-Hispanic whites (p&lt;0.0001). Anxiety decreased between the 1st and 2nd education and monitoring visit from a mean of 46.1 to 43.8 (p=0.024), most notably in parents of high risk children (44.9 to 42.7 p=0.009) and FDRs (44.6 to 38.6, p=0.059).
Accuracy of risk perception was low at 49% and did not improve at the 2nd visit. FDR compared to non-FDR (83% vs. 46%, p=0.004) and parents of high risk compared to low risk children had a more accurate risk perception (61% vs. 37% p &lt;0.0001).
Parental anxiety after learning of a child’s positive screening result decreased rapidly in families enrolled in monitoring. However, accurate perception of T1D risk appears less malleable during the initial 3-6 months of the monitoring. Tailored intervention for parents with inaccurate risk perception may be warranted.

Disclosure
C. Geno rasmussen: None. J. Baxter: None. F. Dong: None. K. A. Bautista: None. F. Sepulveda: None. D. Felipe-morales: None. M. Rewers: Advisory Panel; Self; Provention Bio, Inc., Consultant; Self; RTI, Research Support; Self; Janssen Research & Development, LLC, JDRF.

Funding
JDRF (3-SRA-2018-564-M-N)
544-P: Communication between Adolescents/Young Adults and Health Care Providers during Routine T1D Care
Authors: ZINN MARY E. , WANG CHRISTINE H. , BRYANT BREANA , MONAGHAN MAUREEN 
Published: June 2021

Background: Adolescents and young adults (AYAs) are at higher risk for diabetes self-care challenges and elevated A1c. Understanding AYA/health care provider (HCP) communication may provide insight to better support T1D management. The current study examined content and quality of AYA/HCP communication during routine T1D care.
Methods: Thirty-two AYAs (M age=20.5 ± 9.1 yrs; 53.1% male; 43.8% non-Hispanic Black; M A1c=8.± 1.4%) and 9 HCPs (100% female) participating in an RCT promoting AYA health communication had a routine T1D visit audio-recorded and transcribed. A coding framework was developed to assess communication content and quality, including: AYA initiation, self-disclosure, preparation, and future planning; HCP goal setting, supportive language, problem-solving, education/information sharing, and warnings/threats. Coders double and triple-coded transcripts until 90% agreement was reached. Chi square analyses evaluated associations among codes.
Results: Routine T1D visits were primarily attended by AYAs alone (78.1%), ranging from 8-45 min (M=30.3 ±9.3). AYAs and HCPs spoke 27.0% and 69.1% of the visit, respectively. T1D adherence, lifestyle adherence, and developmental issues were discussed in all visits (100%); insurance, mental health, and T1D support systems were each discussed in 53.1% of visits. AYA preparation (e.g., bringing glucose values, regimen knowledge) was positively associated with HCP supportive language (X2(1,N=32)=5.7, p=.02) and HCP education (X2(1,N=32)=8.3, p&lt;.01). HCP warnings/threats were identified in 25% of visits; 75% of AYAs in these visits had A1c levels ≥7.0%.
Conclusion: Results highlight reciprocal AYA-HCP communication. Improving AYA preparation for T1D care visits may facilitate more efficient and informative AYA-HCP interactions, potentially leading to improved T1D outcomes. Future studies will evaluate associations among communication and T1D outcomes over time, including A1c and transition to adult care.

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

Funding
American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.)
553-P: The Type 1 Diabetes High-Fidelity Wraparound (T1D HFW) Program: An Option for the Management of High-Risk Youth?
Authors: SCHREIBER JUSTIN , NEVIN AMY G. , JONES LAUREN , PAYNE MONICA W. , NASH KENNETH C. , MUZUMDAR RADHIKA , LIBMAN INGRID 
Published: June 2021

Despite advances in management, many young adolescents with T1D continue to struggle. Psychosocial factors play a major role. The T1D HFW Program is an innovative strategy to improve the adherence to medical regimens, including self-management and self-efficacy in high-risk youth. It is based on HFW, an evidence-based behavioral health concept described as a structured, team-based and individualized process that includes members who have experience either living with or raising a child with T1D. The aim of this pilot study is to test the feasibility and impact of this intervention in youth 11 to 16 years with T1D followed in a large academic diabetes center who are struggling with their management as defined by poor glycemic control and/or repeated emergency room visits and/or hospitalizations. Outcomes include assessment for behavioral, psychosocial and diabetes related measures with validated instruments. Seventeen youth enrolled and participated so far (58% females, 58% Caucasian, 23% African American, mean age 14±1.4 years, T1D duration 7.5±3.5 years, HbA1c at entry 10.3±2.3%, 65% with a deterioration in HbA1c, 45% prior diabetes related hospitalizations). A significant percent (57%) reported at least one traumatic experience including bullying (66%), witnessing violence (50%), physical/emotional abuse (33%). To date, eight families have transitioned out of the program after a mean of 6.5 months with 62.5% showing improvement and 25% no deterioration in HbA1c. Youth scoring positive for moderate depression on the PHQ-9 went from 27% to 9%. 1/3 of youth indicated positive results for generalized anxiety by the Screen for Child Anxiety Disorders (SCARED) with no change upon finishing the program. 60% of caregivers indicated a positive score on the Diabetes Distress Scale at start, which decreased to 20%. The T1D HFW program through personalized plans with identified support systems may be a promising strategy for youth struggling with T1D.

Disclosure
J. Schreiber: None. A. G. Nevin: None. L. Jones: None. M. W. Payne: None. K. C. Nash: None. R. Muzumdar: None. I. Libman: Advisory Panel; Self; Novo Nordisk.

Funding
Children’s Hospital of Pittsburgh Foundation