bluuebunny/crossref_metadata_2025_split huggingface dataset:
632-P: Anterior vs. Posterior Circulation for Below-Knee Amputations in Patients with Severe Peripheral Arterial Disease
Authors: WALTERS ELLIOT , COERDT KATHLEEN , WANG JING , BEKENY JENNA C. , NIGAM MANAS , ATTINGER CHRISTOPHER 
Published: June 2019

Background: The posterior flap, utilizing the gastrocnemius muscle, is a common technique for closure of a below knee amputation. This flap is based on perfusion from the deep posterior compartment arteries of the lower leg (posterior tibialis and peroneal). The gastrocnemius gets additional blood supply from the sural arteries originating from the proximal popliteal artery. As peripheral arterial disease is a major indication for below-knee amputation the deep posterior compartment blood supply may be compromised and this flap must rely on reconstitution from the sural arteries. The purpose of this study is to compare the post-operative outcomes of below-knee amputations with and without perfusion of the deep posterior compartment.
Methods: Medical records were reviewed for patients receiving below-knee amputations with a posterior muscle flap from 2010-2017 who also received angiography of the affected limb.
Results: There were 135 patients identified. Patients excluded from analysis included 15 with no patent vessels below the popliteal artery, 41 with 3-vessel runoff, and 22 with runoff to a combination of AT and either PT or peroneal arteries. There were 16 patients with popliteal runoff only to the anterior tibialis (and patent sural arteries), 14 patients had run-off only to the PT, 17 had run-off only to the peroneal artery, and 10 patients had run-off to both the PT and peroneal arteries. There was no significant difference in time to healing, ambulation, complications, or conversion to AKA when anterior tibialis only perfusion is compared to any combination of posterior tibialis and peroneal circulation (p&gt;0.05).
Conclusions: Successful post-operative outcomes can be accomplished with a posterior based flap despite the absence of the deep posterior compartment arteries because of compensatory perfusion through the sural arteries.

Disclosure
E. Walters: None. K. Coerdt: None. J. Wang: None. J.C. Bekeny: None. M. Nigam: None. C. Attinger: Consultant; Self; Acelity, Integra LifeSciences.
633-P: Assessment of Calf Skeletal Muscle in Individuals with Diabetes and a Foot Ulcer Using Diffusion MRI
Authors: EDALATI MASOUD , HASTINGS MARY , SORENSEN CHRISTOPHER J. , MUELLER MICHAEL J. , ZHENG JIE 
Published: June 2019

Aim: This study is to investigate changes in microstructure in the calf muscles of patients with type 2 diabetes mellitus (DM) and foot ulcers.
Methods: 42 subjects were recruited: 14 without DM (WDM), 19 DM, and 9 DM and ulcer (DMU). They all underwent non-contrast diffusion imaging scans in a 3T MRI scanner, at rest and during a plantarflexion exercise with a fixed resistance.
Results: Reserve data (exercise/rest) of major diffusion indexes for medial gastrocnemius (MG) and soleus (SOL) were calculated for analysis. The indexes were: Fractional Anisotropy (FA), Mean Diffusivity (MD), primary eigenvalue λ1, fiber length, and fiber angle. Diffusional and fiber changes (P&lt;.05) were evident for the MG muscle in the DM and DMU groups (larger diffusional reserve values and larger fiber loss were observed in the DMU group) compared to the WDM group (Figure 1). The DMU was the only group that showed statistically significant diffusional variations (reserve FA, MD, and λ1) for the SOL muscle (P&lt;.05).
Conclusion: Diffusion imaging was able to identify DM associated muscle microstructure dysfunction in the calf.

Disclosure
M. Edalati: None. M. Hastings: None. C.J. Sorensen: None. M.J. Mueller: None. J. Zheng: Consultant; Self; KBI international.

Funding
National Institutes of Health
664-P: What Do Youth with Type 1 Diabetes (T1DM) and Caregivers Know about Cardiovascular Disease (CVD) Risk and Reduction?
Authors: KRALL JODI , RUPPERT KRISTINE , DIAZ ANA M. , FINNEY JESSICA , SIMINERIO LINDA M. , LIBMAN INGRID 
Published: June 2019

Risk factors for CVD, the leading cause of premature death in adults with T1DM, are under-recognized and/or undertreated in youth with T1DM, suggesting a need for enhancing prevention and early self-management education efforts. As a first step, this cross-sectional study was conducted to learn about youth with T1DM and their caregivers’ understanding of CVD in relation to DM. Teenagers and young adults with T1DM (n=80; 18.1±1.5y, 41% female, 86% white) attending a DM clinic at a large pediatric academic center and their caregivers (n=64) were surveyed about CVD-DM awareness and self-management practices. Clinical indicators of CVD risk (hemoglobin A1c (HbA1c), blood pressure (BP), and lipid profile) were extracted from medical records. Only 24% youth and 41% caregivers reported that anyone had ever talked to them about the connection between DM and CVD, with the most frequent source being doctors. Merely 14% of youth and 27% caregivers reported having a good/very good understanding of the connection between DM and CVD. Interestingly, 71% of youth and 81% caregivers correctly listed CVD prevention behaviors (e.g., healthy eating, being active), with 35% youth and 44% caregivers listing actions specific to DM care (e.g., good blood glucose control). Most youth and caregivers correctly identified the recommended testing frequency for HbA1c (81% and 78%) and BP (81% and 86%), with fewer youth familiar with the annual testing of lipid profile (41%). A majority of youth and caregivers also correctly listed recommended target values for HbA1c (70% and 77%), but fewer knew target values for BP (25% and 49%) and LDL cholesterol (6% for both groups). In comparison, percentage of youth meeting recommended targeted values for clinical indicators of CVD risk were 29% for HbA1c, 45% for BP, and 70% for LDL cholesterol. These results strongly support a need to raise awareness and address CVD risk and reduction practices as part of ongoing diabetes self-management education.

Disclosure
J. Krall: None. K. Ruppert: None. A.M. Diaz: None. J. Finney: None. L.M. Siminerio: None. I. Libman: Consultant; Self; Novo Nordisk Inc.
669-P: Factors to Improve Attendance at Diabetes Self-Management Education Classes
Authors: WOLF RACHEL , BARNES CATHERINE S. , CAUDLE JANE , KRISHNAPURA SHREYAS G. , DUPONT JACQUELINE L. , CRAWFORD ROCHANDA J. , DICKERSON PATRICE L. , ZIEMER DAVID C. 
Published: June 2019

Formal diabetes self-management education (DSME) improves glycemic control. Yet, many patients referred to DSME do not attend. This study examined differences between patients referred to DSME who attended class (PA) and those who did not (PN) to assess factors that might be associated with attendance.
Methods: The study was conducted at an urban safety net hospital over two months. Phone interviews (128) were conducted with a convenience sample of patients after the scheduled DSME class (43 PA and 85 PN) to assess reason for attendance or not. Medical records supplied data on demographics, insurance status, and co-morbidities.
Results: DSME overall attendance was 32% of 197. While obesity was associated with increased likelihood of attendance (OR 2.67, P &lt; .05), overall disease burden was not. Attendance did not differ by age, sex, diabetes duration, insurance status, or A1c. PA and PN reported similar reasons for planning to attend (general knowledge, 36%; “told to”, 32%; dietary information, 24%). Primary reasons for not attending were time conflicts (31%), poor health (24%), lack of perceived need (24%), and transportation (22%). Excluding those PN who denied perceived need for DSME, 64% of PN wanted to reschedule. Thus, lack of attendance may be related more to barriers than lack of interest. PN wanting knowledge were more likely (OR 6.7 p&lt; 0.001) to want to reschedule and those just “told to” go (OR 0.24 p&lt; 0.05) or felt no need (OR 0.15 p&lt; 0.05) were less likely to reschedule.
Conclusions: Addressing both external and internal factors should improve DSME attendance. Flexible/negotiated scheduling, greater variety of class times/locations, ease of rescheduling, and access to alternative transportation options may address external barriers. To address perception of a lack of need for DSME, additional strategies such as clear communication of DSME benefits by clinical providers are needed to enhance attendance.

Disclosure
R. Wolf: None. C.S. Barnes: None. J. Caudle: None. S.G. Krishnapura: None. J.L. Dupont: None. R.J. Crawford: None. P.L. Dickerson: None. D.C. Ziemer: None.
674-P: Glycemic Management Practice Guideline Combined with a Multidisciplinary Champion Team Approach Increased the Use of Basal Bolus Insulin Regimen and Reduced the Use of Sliding Scale Insulin
Authors: BOGUN MAGDALENA M. , ZAGOREN ELEANOR , ACKERMAN KEVIN , CIOLEK ALANA M. 
Published: June 2019

Basal-bolus insulin (BBI) therapy is recommended for treatment of hyperglycemia in the inpatient setting, but many patients still receive sliding scale insulin (SSI) that has been shown to be less effective. To evaluate the transition from insulin drip to subcutaneous insulin therapy we performed a retrospective chart review spanning four months in the cardiothoracic intensive care unit (CTICU) at our institution. Of the patients in the unit who were transitioned from insulin drip, 84% (n=63) were transitioned to sliding scale insulin, while only 16% (n=12) were transitioned to basal bolus insulin therapy. Of those patients treated with basal bolus insulin, 33% (n=4) had a delay in basal insulin administration, while 17% (n=2) of patients experienced interrupted basal insulin therapy. In order to increase the use of basal bolus insulin and reduce the use of sliding scale, we developed a glycemic practice guideline which focused on when and how to transition from insulin drip to basal bolus insulin therapy. We launched a multidisciplinary champion team who assisted with the implementation of the guideline in the CTICU. After implementing the guideline for one year, we found the use of basal bolus therapy increased from 16% (n=12) to 68% (n=50), and use of sliding scale decreased from 84% (n=63) to 22% (n=16), (p=0.008). Furthermore, patients who were treated with basal bolus insulin therapy had less delay and interruption of basal insulin by 21% and 7%, respectively, although the difference was not statistically significant (p=0.10). Additional studies are necessary to determine whether our guideline, combined with a multidisciplinary team approach, would affect clinical outcomes.

Disclosure
M.M. Bogun: None. E. Zagoren: None. K. Ackerman: None. A.M. Ciolek: None.
678-P: Drivers of Weight Loss in a CDC-Recognized Virtual Diabetes Prevention Program
Authors: PAINTER STEFANIE L. , LU WEI , BOLLYKY JENNIFER 
Published: June 2019

Background: Over 84 million adults in the U.S. have prediabetes. The CDC National Diabetes Prevention Program (DPP) provides a 12-month structured program to achieve weight loss and increase physical activity to reduce the risk of developing type 2 diabetes.
Methods: A retrospective analysis was performed using data from 658 participants enrolled in the Livongo DPP with a recorded start weight during 2016-2017 and who completed at least 12 lessons, thereby meeting the CDC DPP standards for recognition. Self-monitoring behaviors including weigh-ins, food logging, activity and coach-participant interactions were analyzed at 6 and 12-months. Multiple regression analysis was performed using demographics, self-monitoring and interactions to determine predictors of weight loss at 12-months.
Results: Participants were a mean age of 54 years (SD 10.8), with start weight of 199 pounds (SD 43.7), college educated (82%), and female (72%). On average, participants lost 6.1% of their starting body weight at 6-months and 6.4% at 12-months with 25.2% of participants losing ≥10% at 12 months. Logistic regression analysis showed that each food log was associated with an increase of 0.25% weight loss, a week of 150 active minutes was associated with 0.07% of weight loss, and each lesson completed was associated with 0.21% of increased weight loss.
Conclusions: Overall, participants engaged in the Livongo DPP lost &gt;6% of their start weight with continual weight loss throughout program. More than 25% of highly engaged participants lost ≥10% of their start weight. Food logging was relatively more impactful on weight loss than achieving weeks with 150 minutes of activity completed or lesson attendance.

Disclosure
S.L. Painter: Employee; Self; Livongo Health. W. Lu: None. J. Bollyky: Employee; Self; Livongo Health. Stock/Shareholder; Self; Livongo Health.
684-P: Assessment of Individual Self-Management Using the Novel LMC Skills, Confidence, and Preparedness Index (SCPI)
Authors: ARONSON RONNIE , LI AIHUA , BROWN RUTH E. , ORZECH NAOMI , LYONS ASHLEY , WALKER ASHLEIGH 
Published: June 2019

Objective: The SCPI was developed to assess knowledge, confidence and preparedness, for the AADE7 Self-Care Behaviours™, in a clinically meaningful, easy to use measure; with immediate feedback to the healthcare providers (HCP). This final version, an electronic 23-item, 7-point Likert questionnaire, was evaluated for validity, reliability (Part 1) and responsiveness to an intervention (Part 2).
Methods and Results: Part 1: 405 participants (200 T1D and 205 T2D; duration 15 ± 12 years (mean ± SD); A1C 7.7 ± 1.3%) completed the SCPI (completion time 4.9 ± 4.3 minutes). Internal consistency was high: intraclass correlation (ICC) was 0.93 overall (p&lt;0.01) with a range of 0.84 to 0.88 for each subscale of Skill, Confidence and Preparedness. There was good external validity in correlation with A1C for the total score (T1D r=-0.26; T2D r=-0.20) (p&lt;0.001) and for each of the subscales. Demographic variables (age, sex, education, ethnicity and income) were not associated. Test-retest reliability after a 1-week interval was high (r=0.79, P&lt;0.001).
Part 2: 51 subjects with A1C &gt; 8.0% (17 T1D and 34 T2D; duration 15 ± 11 years; A1C 9.3 ± 1.0%) were enrolled in a comprehensive education program (6 visits over 4 months) targeting areas identified by the SCPI as needing improvement. At completion, mean A1C had improved by 1.2 ± 0.2% (mean ± SE, p&lt;0.001). Total SCPI score and each of the three subscores similarly increased significantly compared to baseline (p&lt;0.01). Among ‘education responders’ (A1C improvement &gt;0.5% with no therapy change), A1C improvement was correlated with the change in total SCPI scores (r=-0.3, p=0.17).
Conclusions: The SCPI is a highly valid and reliable, easy to use, electronic tool with immediate guidance to the HCP. In general populations with both T1D and T2D, SCPI scoring correlates with glycemic control and is unaffected by unrelated demographic factors. It is effective as a guide to educational intervention and patient gains correlate with SCPI score improvement.

Disclosure
R. Aronson: Research Support; Self; AstraZeneca, Becton, Dickinson and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Senseonics. A. Li: None. R.E. Brown: None. N. Orzech: None. A. Lyons: Consultant; Self; Novo Nordisk Inc. A. Walker: Other Relationship; Self; Medtronic.
688-P: Factors Associated with Diabetes Prevention Program (DPP) Compliance and Weight Loss among Low Income Participants
Authors: DESAI JAY R. , O'CONNOR PATRICK J , TAYLOR GRETCHEN L. , JOHNSON SARA , GARRETT JOYCE E. , RINN SARAH , VUE-HER HOUA 
Published: June 2019

Achieving 5% weight loss in the DPP is challenging. We examine factors associated with compliance and weight change in low income participants.
The We Can Prevent Diabetes study enrolled 854 Medicaid beneficiaries (93 DPP groups) for 16 weekly core sessions with. Financial incentives for attendance and weight loss were offered to 568 participants (63 DPP groups). Participants were aged 18-74 years, BMI ≥ 25 kg/m2, had prediabetes, and enrolled in Medicaid. Compliance measures were attendance, self-reported physical activity, and food logs. Patient factors were sex, age, race/ethnicity, primary language, BMI, education, marital status, chronic and mental health conditions. Program factors were incentives, lifestyle coach (YMCA or clinic staff), and DPP group size. Analyses examined bivariate associations with three weight trajectories (gain, stable, loss). Factors significant at p&lt;0.25 were included in regression models examining compliance and weight trajectories.
Participants (N=647) who attended 4+ sessions were analyzed, with 450 eligible for incentives. Patient factors significantly associated (p&lt;0.05) with attendance were aged 45-64 years (OR=1.5), aged 65-84 years (OR=3.6) and presence of a chronic condition (OR=2.0). Those associated with weight change were aged 45-64 years (OR=1.4), English speaking (OR=0.4), and being Hispanic (OR=0.5). At the program level, incentives were associated with attendance (OR=2.9) but not weight change. Clinic lifestyle coach was associated with weight change (OR=1.6). Participants with 8+ sessions (OR 1.8), having an average of more than 150 minutes/week (OR 2.1), and food log documentation (OR 1.6) were more likely (p&lt;0.05) to lose weight.
In culturally diverse low income DPP participants, incentives improve attendance but not weight loss. Use of clinic-based coaches and attention to cultural factors, such language, may enhance program effectiveness.

Disclosure
J.R. Desai: None. P.J. O'Connor: None. G.L. Taylor: None. S. Johnson: None. J.E. Garrett: None. S. Rinn: None. H. Vue-Her: None.

Funding
National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases
694-P: Assessing Social Support in Diabetes Camp
Authors: BEEBE CHRISTINE A. , JOYCE MONICA T. , ALESIA TERESA 
Published: June 2019

Social and family support in diabetes predicts self-efficacy, adherence, and positive health outcomes. Peer and family support are explicit strengths of youth possessing resilience to flourish despite challenges of diabetes. Interest in strength-based assessment and interventions in pediatric diabetes practices is increasing in recognition that youth spend significant time away from home and management responsibilities shift away from parents. Nearly 150 diabetes camps reach 25,000 children annually. Camps demonstrate improved self-efficacy and self-confidence. We examined whether youth attending a sports-based day camp exhibit resilience factors that can impact diabetes-related distress levels related to participating in exercise. With parent consent, 44 youth (8-17 year) completed the Diabetes Strengths and Resilience Measure (DSTAR) the first day of camp. Factors related to diabetes confidence and management skewed high with scores of often or almost always for most of the 12- item survey. Mean parental help/support with diabetes was high at 3.6 (of 4) as 90% of youth identified they often/almost always get parental help. Friend support was the lowest scoring factor with mean of 2.6 for youth telling friends about diabetes. Often or almost always was chosen by 50% of youth, 32% sometimes, and 18% never. Counting on friends if I need help scored lowest (mean 2.1) as 35% chose never/rarely, 21% sometime, and 44% often/almost always. Parent surveys indicated 100% of children are physically active 1 hour/day nearly every day (70% 5-7 days/week, 30% 2-4 days/week). Hypoglycemia frequency was 5.5/month (44% &gt;9).
In conclusion, youth with type 1 diabetes who are physically active and at risk for frequent hypoglycemia do not share their diabetes needs with friends and rarely feel they can count on friends to help them (such as recognizing/treating exercise related hypoglycemia). Camps are non-clinical venues to assess social support and intervene with non-traditional age-appropriate education.

Disclosure
C.A. Beebe: Consultant; Self; Xeris Pharmaceuticals, Inc. M.T. Joyce: None. T. Alesia: None.
713-P: Predictors of Reach and Patient Engagement in a Program Involving Family Supporters of Adults in Phone-Based Diabetes Management
Authors: STOLL SHELLEY C. , PIETTE JOHN , TRIVEDI RANAK B. , LEE AARON A. , OBROSKY D. SCOTT , MOR MARIA K. , HEISLER MICHELE , ROSLAND ANN-MARIE 
Published: June 2019

Many adults with diabetes have family or friend ‘supporters’ involved in their care. Adult-supporter dyads were recruited to a trial comparing usual care to a 12-month program to engage and train supporters. Potentially eligible patients with T2DM and either HbA1c&gt;8% or high systolic BP were identified via medical records. Patients randomized to the program received biweekly automated calls prompting reports on diabetes status, with tailored feedback to patients and supporters. Before primary care appointments, health coaches conducted a ‘visit prep call’ to improve dyad engagement in the visit. We examined patient characteristics predicting enrollment, and patient, supporter, and call characteristics predicting visit prep and automated call completion via separate multi-level regression models. Of 1119 contacted, 239 dyads (21%) enrolled. Patient predictors of enrollment included younger age (M=60y enrolled vs. 62 not, p &lt;.01), and reason qualifying (BP+HbA1c criteria 30% enrolled, HbA1c only 22%, BP only 16%, p&lt;.01). Of 123 dyads randomized to the program, 87 completed 12 months, and 32 are still enrolled. For 328 eligible visits, patients with high school-only education (AOR=5.7 vs. college degree, p&lt;.01) and higher baseline SBP (AOR=1.2 per 10mmHg, p=.04) were more likely to complete prep calls. Among 2465 eligible automated calls, patients were more likely to complete calls if they had high satisfaction with their primary care team (AOR 1.4, p=.03). Those with higher baseline HbA1c (AOR 0.75, p=.06) trended towards less call completion. Patient insulin use, health literacy, patient activation, and diabetes distress did not predict completion of either type of call.
In conclusion, high BP predicted enrollment and engagement in a dyadic-based diabetes program more than high HbA1c. Programs emphasizing the importance of BP in preventing diabetes complications may increase participant engagement.

Disclosure
S.C. Stoll: None. J. Piette: None. R.B. Trivedi: None. A.A. Lee: None. D. Obrosky: None. M.K. Mor: Stock/Shareholder; Spouse/Partner; AbbVie Inc. M. Heisler: None. A. Rosland: None.

Funding
U.S. Department of Veterans Affairs (IIR 14–074-1); Michigan Center for Diabetes Translational Research (NIDDK5P60-DK09292); Michigan Claude D. Pepper Older Americans Independence Center (NIA AG-024824)