bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Mindset and Health Outcomes for Adolescents with Type 1 Diabetes
Authors: NALLY LAURA , MUELLER CLAUDIA 
Published: June 2018

Background: Health mindset theory is a novel approach to the study of health outcomes in pediatric populations. Health mindsets have been found to influence how individuals perceive illness and have been linked to health outcomes in adolescents with T1D. Specifically, individuals with a “fixed” mindset of health view illness more negatively and have worse outcomes than those with a “growth” mindset who believe that health can be improved through effort.
Methods: A cohort of adolescents with T1D was followed across the transition from pediatric to adult care to assess differences in their health outcomes over time. We predicted that having a growth mindset would be a protective factor for young adults as they take greater control over their health care.
Results: Ninety-one participants aged 12-19 with T1D were recruited, with 70 transitioning to adult care during the study period. 61% had a growth mindset while 39% had a fixed mindset of health. Overall, average A1c after transition was lower for participants with a growth vs. a fixed mindset. The most notable difference was found for participants who had the highest A1c before transition (&gt;10%). In this group, growth-mindset adolescents showed a significant improvement in A1c levels compared to those with a fixed mindset (p&lt;.05). Further, a greater percentage of adolescents with a growth (28%) vs. a fixed (9%) mindset was able to reach a target A1c of less than 7%. Age at time of transition (Mean=19 years) was similar for those with fixed and growth mindsets.
Conclusion: In this study of adolescents with T1D, having a growth mindset was linked to better glycemic outcomes after transitioning to adult care. Improvement in A1c was greatest for those young adults with a growth mindset who had the poorest glycemic control before transition. This suggests that health mindset might interact with changes in age or maturity level, particularly for young adults, and so may prove to be a powerful target for efforts to improve health maintenance in this population.

Disclosure
L. Nally: None. C. Mueller: None.
Examination of Accuracy of Self-Reported Blood Glucose Using mHealth Data Collection
Authors: WARNICK JENNIFER , WESTEN SARAH C. , ALBANESE-O'NEILL ANASTASIA , SCHATZ DESMOND , HALLER MICHAEL J. , JANICKE DAVID 
Published: June 2018

Introduction: Daily self-monitoring of blood glucose (SMBG) is essential for type 1 diabetes (T1D) management. Adherence to SMBG is often suboptimal during adolescence. SMBG paper diaries are often inaccurate compared to glucometer readings. The current study aimed to compare self-reported SMBG values gathered using ecological momentary assessment via smartphones to glucometer readings.
Methods: Youth (n=54, 11-21 years, 59.3% male) with T1D received 3 text messages/day for 10 consecutive days containing REDCap surveys inquiring to SMBG values. SMBG values from glucometers were obtained during the same period. Based on a previously developed system, paired values were compared and categorized as accurate or discrepant. A discrepancy was categorized as: omission (i.e., glucometer reading with no self-reported SMBG value), addition (i.e., self-reported SMBG value with no glucometer reading), alteration (i.e., self-reported SMBG value different by &gt;10 mg/dL from glucometer value), or digit transformation (i.e., 164 instead of 146). Self-reported values were categorized further to reflect whether patients reported a more clinically favorable or unfavorable profile.
Results: A significant positive correlation was found between glucometer and self-reported SMBG values for all matched pairs (r=.628, p&lt;.001). Out of 817 pairings, 39.3% of the self-reported values were congruent to glucometer readings and 60.7% were discrepant. Of the discrepant, 45% were alterations, 40.9% were additions, 13% were omissions, and .01% were digit transformations. Also, 54.5% of self-reported SMBG appeared clinically favorable, while 45.5% appeared clinically unfavorable.
Conclusions: These findings are consistent with previous studies comparing paper SMBG diaries to glucometers in a pediatric population. Self-reported mHealth data is likely to produce discrepant SMBG values compared to glucometers. Providers are urged to use objective blood glucose devices for clinical decisions.

Disclosure
J. Warnick: None. S.C. Westen: None. A. Albanese-O'Neill: None. D. Schatz: None. M.J. Haller: None. D. Janicke: None.
Grp78 Is Critical for Beta-Cell Maturation and Survival
Authors: SHARMA ROHIT B. , ZHENG XIAOYING , GABLASKI BRIAN , KIM JASON K. , LEE AMY S. , ALONSO LAURA C. 
Published: June 2018

Endoplasmic reticulum (ER) stress causes beta cell loss and dysfunction in T1D and T2D. Glucose regulated protein 78 (Grp78) is an abundant, widely expressed ER chaperone with functions including peptide translocation and folding, calcium storage, and regulating activity of the Perk, Ire1 and Atf6 unfolded protein response (UPR) pathways. Whole-body Grp78 deletion in mice is lethal at E3.5 days. Despite its critical importance, the impact of Grp78 deletion in beta cells has not yet been reported. Mice lacking both copies of Grp78 in beta cells (Grp78flox x Ins1CreThor) developed insulin-deficient diabetes by 2 weeks of age; heterozygotes remained normal. Islet architecture was disturbed in KO pups, with fewer beta cells than alpha cells (14.8±1.7% beta cells-KO, 70.5±3.8%-WT), reduced beta cell mass (13.5±1.7mg-KO, 69.7±6.4mg-WT), and abnormal cellular arrangement, with alpha and beta cells interspersed throughout islets. Reduced beta cell number was likely due to increased cell death; TUNEL+ beta cells were increased early, by 2 weeks of age (2.6±0.4%-KO, 0.1±0.0%-WT), whereas proliferation was not reduced until 4 weeks. Intriguingly, when BG was still normal, an increase in bi-hormonal glucagon/insulin cells was observed at 3-5 days (7.1±0.6%-KO, 3.0±0.2%-WT) and 2 weeks (7.7±0.6% in KO, 2.2±0.2% in WT) of age, suggesting defective fetal maturation, de-differentiation or trans-differentiation. Pdx1 staining was heterogeneously lost in insulin+ cells. Acute deletion of Grp78 in ex vivo mouse islet cells, human islet cells and the human EndoC-BH1 beta cell line strongly reduced Grp78 RNA/protein, induced compensatory chaperone Grp94, and activated all three UPR pathways. Grp78 knockdown increased beta cell death (AnnexinV staining, Chop and Txnip) and caused loss of differentiation markers Pdx1, Nkx6.1, Mafa and Neurod1, and induction of Ngn3, a fetal beta cell marker.
In summary, Grp78 is critically important for beta cell survival and plays an unexpected role in maintaining beta cell differentiation markers.

Disclosure
R.B. Sharma: None. X. Zheng: None. B. Gablaski: None. J.K. Kim: None. A.S. Lee: None. L.C. Alonso: None.
The Design and Preliminary Evaluation of a Mobile Health Application TangTangQuan in Management of Type 1 Diabetes in China
Authors: LING PING , LUO SIHUI , YAN JINHUA , ZHENG XUEYING , YANG DAIZHI , ZENG XIFENG , WENG JIANPING 
Published: June 2018

Objective: To assess the effectiveness of mobile health application TangTangQuan (TTQ) in management of type 1 diabetes (T1D) in China.
Methods: TTQ is designed to provide diabetes self-management education (DSME) for patients with T1D.The innovation of TTQ is to break the isolation of individual T1D patients by socializing their self-management data, and let them find the “patients like me.” TTQ included four major modules: personal diabetes diary, games for DSME, peer support communities and online education courses. Patients recorded and uploaded their diabetes diary via TTQ, and peer patients or family members were able to make comments, or share their own experiences, or interact with the up loaders under the posts. Free download and registration of TTQ was available in major APP stores for mobiles in China since September 2015. The self-report demographic and clinical data were collected through TQQ.
Results: During September 2015 and December 2017, a total of 7641 patients (M/F, 3716/3925) aged 21.28±14.43 years, with duration of T1D 2.50 (1.00,6.90) years, have signed up and joined the management of TTQ, from 21 provinces in China. Fifty two percent were 18 to 45 years old and 41% were less than 18 years old. Twenty four percent of them were active in peer support communities including sharing their experiences in management of T1D. Among 2903 patients with duration of diabetes ≥1 year who have used TTQ for ≥1 year,435 have continuous record for 1 year of self-meter blood glucose (SMBG) at least 4 times per day in TTQ. Among these patients, SMBG frequency was 2.43/week(1.40,13.13) and 2.88/week(0.63,11.92) (P=0.967), HbA1c was 6.59±1.40% and 6.40±1.39%(P=0.002), the frequency of hypoglycemia was 6.75/week (4.00,11.50) and 6.25/week (2.75,9.67) (P=0.005) before and after one year use of TTQ, respectively.
Conclusions: TTQ has the potential to be a novel intervention for engaging T1D patients and their families in positive communication to support DSME.

Disclosure
P. Ling: None. S. Luo: None. J. Yan: None. X. Zheng: None. D. Yang: None. X. Zeng: None. J. Weng: None.
Neuropathy-Related Unsteadiness and Psychosocial Outcomes in Diabetes—Preliminary Findings
Authors: BROWN STEVEN J. , BOULTON ANDREW J. , VILEIKYTE LORETTA , REEVES NEIL D. 
Published: June 2018

Diabetes is a well-established risk factor for psychological distress and reduced quality of life (QoL). This may be part due to biomechanical challenges posed by diabetic peripheral neuropathy (DPN)-related unsteadiness leading to increased risk of falling and reduced physical activity (PA). This cross-sectional study explores relationships between physical (DPN-unsteadiness and PA) and psychosocial outcomes (depression, fear of falling [FoF], and QoL). The preliminary results of 15 type 2 DM people with DPN (age: 67 years; 13M; VPT 24V) indicate that quality of life (NeuroQoL) and depression (Hospital Anxiety and Depression Scale) are strongly associated with objective DPN-unsteadiness (Berg Balance test: r=-.64, p=.01 and r=.63, p=.01; respectively) and FoF (Falls Self-Efficacy Scale: r=.61, p=.02 and r=-.55 p=.03; respectively). Moreover, DPN-unsteadiness (Berg balance score: 47 ±6) and FoF are associated with reduced vigorous exercise PA levels (r=.53, p=.04 and r=-.51, p=.05; respectively), as well as total moderate PA levels (r=-.45, p=.09 and r=.45, p=.09; respectively); measured by General Practice Assessment Questionnaire. Finally, FoF correlates strongly with DPN-unsteadiness (r=-0.79, p&lt;0.001), demonstrating a potential reason why balance impairment may have the negative impact upon PA and QoL. Whilst prospective data are needed to solidify these findings, the preliminary results are robust and support the strong links between the biomechanical impact of DPN and psychosocial outcomes, including depression and fear of falling, and reduced QoL. These data indicate that there is an unmet need for the development of multifaceted interventions that address both psychological distress and biomechanical challenges experienced by patients with this debilitating complication of diabetes.

Disclosure
S.J. Brown: None. A.J. Boulton: None. L. Vileikyte: None. N.D. Reeves: None.
Does Gender Moderate the Relations between Shared Responsibility and Health Outcomes among Adolescents with T1D?
Authors: ABUJARADEH HIBA , SEREIKA SUSAN M. , COHEN SUSAN M. , HELGESON VICKI 
Published: June 2018

Shared responsibility (SR) where both parents and adolescents are involved in diabetes management is optimal for reducing psychological distress and improving diabetes outcomes. Few studies examined whether gender moderates the relations between SR and health outcomes. This study examined whether gender moderates the relations of SR to distress and diabetes outcomes during the transition into adolescence. A secondary analysis of longitudinal study of 132 adolescents with T1D and their parents was conducted. Adolescents were 10 to 14 years, 72 girls and 60 boys. All measures were taken annually for 5 years. Both reported on SR. Adolescents reported on distress (depressive symptoms, anxiety, and anger) and self-care. HbA1c was obtained at the clinic visit. Linear mixed models were used to assess if gender moderates the relations between SR and health outcomes.
Results: Concurrent analyses showed that gender moderated the relation between parent-reported SR and HbA1c (p=.007) and child-reported SR and anger (p=.048). At early adolescence, parent-reported SR was associated with lower HbA1c for girls but higher HbA1c for boys. For middle-stage adolescence, SR was associated with higher HbA1c for girls but lower HbA1c for boys. For older adolescents, SR was associated with lower HbA1c for boys but unrelated to HbA1c for girls. Among young and older adolescents, child-reported SR was associated with less anger for boys but unrelated to anger for girls. At middle-stage adolescence, SR was associated with less anger for girls but more anger for boys.
Conclusion: gender moderated the relations between SR and some aspects of health outcomes during transition adolescence in different patterns. SR was associated with better glycemic control among young girls and older boys, and was associated with less anger among boys in general. Healthcare providers need to consider adolescent’s gender when recommending parental involvement in diabetes management for better health outcomes.

Disclosure
H. Abujaradeh: None. S.M. Sereika: None. S.M. Cohen: None. V. Helgeson: None.
Randomized Trial of a Tailored Cognitive Behavioral Intervention in Type 2 Diabetes with Comorbid Depressive and/or Distress Symptoms—Twelve-Month Outcomes from COMRADE
Authors: CUMMINGS DOYLE M. , LUTES LESLEY , PATIL SHIVAJIRAO , HAMBIDGE BERTHA , CARRAWAY MARISSA , LITTLEWOOD KERRY , ADAMS ALYSSA , SOLAR CHELSEY , EDWARDS SHEILA , GATLIN PEGGY 
Published: June 2018

Patients with type 2 diabetes (T2D) and co-morbid depressive and/or distress symptoms have poor glycemic control and worse health outcomes. This prospective randomized controlled trial evaluated the effectiveness of a 16-session severity tailored cognitive behavioral intervention plus lifestyle change counseling (n = 67; IG=intervention group) delivered by trained staff compared to usual care (n = 72; CG=control group), in 139 rural adult patients (mean age = 52.6 ± 9.5 years.; 72% black; BMI = 37.0 ± 9.0) with uncontrolled (mean HbA1c = 9.6 ± 2.0) T2D (52% on insulin) and co-morbid depressive (PHQ-2) or distress (DDS-2) symptoms at screening in an academic primary care clinic. At baseline and at 12-month follow-up: height, weight, BP, A1c, diabetes distress (DDS-17), depressive symptoms (PHQ-9), self-care behaviors (SDSCA), empowerment (DES), and medication adherence (ModMAS) were measured using validated instruments. There were no differences between groups at baseline. Between group (IG vs. CG) differences at 12-months follow-up were significant for changes from baseline in diabetes-related distress (-0.83 ± 0.88 vs. -0.15 ± 0.92; p = 0.001), regimen-related distress (-1.12 ± 1.vs. -0.31 ± 1.22; p = 0.001), depressive symptoms (-3.39 ± 5.00 vs. -0.90 ± 6.17; p = 0.01), self-care behaviors (+1.10 ± 1.30 vs. +0.58 ± 1.45; p = 0.03), and medication adherence (+1.00 ± 2.0 vs. +0.17 ± 1.0; p = 0.02). Differences in change in A1c (-0.92 ± 1.81 vs. -0.31 ± 2.04; p = 0.06) were substantially greater in the intervention group and achieved borderline significance. There were no significant differences in glycemic response patterns by race or gender. A tailored cognitive behavioral intervention significantly improves behavioral outcomes and glycemic control in rural black and white patients with T2D and co-morbid depressive and/or distress symptoms.

Disclosure
D.M. Cummings: None. L. Lutes: None. S. Patil: None. B. Hambidge: None. M. Carraway: None. K. Littlewood: None. A. Adams: None. C. Solar: None. S. Edwards: None. P. Gatlin: None.
Hypoglycemia Contributes to Increased CVD Mortality with HbA1c &lt;6.0%
Authors: RHEE MARY , KURGANSKY KATHERINE E. , HO YUK-LAM , GAGNON DAVID R. , RAGHAVAN SRIDHARAN , VASSY JASON L. , CHO KELLY , GONZALEZ ADRIANA , KHAN FARAH N. , STAIMEZ LISA R. , FORD CHRISTOPHER N. , WILSON PETER W. , PHILLIPS LAWRENCE S. 
Published: June 2018

Better diabetes control generally reduces development of complications, but those with HbA1c &lt;6.0% have increased cardiovascular (CVD) mortality. Since the cause is unknown, we studied the potential contributions of hypoglycemia, using VA and Medicare databases. 297,263 Veterans with diabetes (ICD-9 codes and diabetes Rx) had ≥4 primary care provider (PCP) visits in 2002-2003, baseline data including age, sex, race, ethnicity, BMI, non-HDL cholesterol, systolic blood pressure (sBP), smoking, ≥1 HbA1c, ≥3 outpatient random plasma glucose (RPG) levels, follow-up through 2012, and survived at least 1 year after A1c measurement. The 40,429 with A1c &lt;6.0% (A1c&lt;6) had mean age 66 year, were 98% male, 16% black and 6.5% Hispanic, had BMI 31, eGFR 71, sBP 139, 81% ever smoked, 51% had CVD at baseline, 48% used sulfonylureas and 13% insulin, with mean HbA1c 5.5%, and RPG 125 mg/dl, while 90,574 with HbA1c 6.0-6.9% (A1c6-6.9) had HbA1c 6.5% and RPG 141 (both p&lt;0.001), but were otherwise clinically comparable. In fully adjusted Cox proportional hazard models, A1c&lt;6 had increased CVD mortality compared to A1c6-6.9 (HR 1.07, p&lt;0.001). However, within 1 year after baseline, A1c&lt;6 also had increased frequency of both outpatient RPG &lt;70 (8.4% vs. 6.0%, p&lt;0.001), outpatient point of care glucose (POCG) &lt;70 (0.34% vs. 0.29%, p=ns), and emergency visits with hypoglycemia (EDHYPO, 0.28% vs. 0.24%, p=ns). Moreover, in Cox models including HbA1c (&lt;6.0 -6.9, -7.9, -8.9, ≥9.0%), hypoglycemia measured by (i) outpatient RPG or POCG levels &lt;70 or (ii) EDHYPO, was independently associated with increased CVD mortality, fully adjusted HR 1.18 and 1.49, both p&lt;0.001. At all HbA1c levels, RPG or POCG &lt;70 predicted CVD mortality more consistently than EDHYPO.
Conclusion: Hypoglycemia-associated CVD mortality occurs in general clinical practice-especially with outpatient glucose &lt;70 mg/dl-and increased mortality with HbA1c &lt;6.0% may be due in part to hypoglycemia. Management should be aimed to optimize control but limit the risk of hypoglycemia.

Disclosure
M. Rhee: None. K.E. Kurgansky: None. Y. Ho: None. D.R. Gagnon: None. S. Raghavan: None. J.L. Vassy: None. K. Cho: None. A. Gonzalez: None. F.N. Khan: None. L.R. Staimez: None. C.N. Ford: None. P.W. Wilson: None. L.S. Phillips: Other Relationship; Self; DIASYST Inc.. Research Support; Self; Amylin Pharmaceuticals, Eli Lilly and Company, Novo Nordisk Inc., Sanofi-Aventis, PhaseBio Pharmaceuticals, Inc., Roche Diabetes Care Health and Digital Solutions, AbbVie Inc., Vascular Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., GlaxoSmithKline plc., Pfizer Inc.. Other Relationship; Self; Novartis Pharmaceuticals Corporation, Merck & Co., Inc..
Proteomic Profile of Circulating Inflammatory Proteins Associated with 10-Year Risk of ESRD in T1 and T2 Diabetes—Enrichment for TNF Receptor Superfamily Members
Authors: NIEWCZAS MONIKA , SKUPIEN JAN K. , NAIR VIJI , SMILES ADAM , PARK JIHWAN , SATAKE EIICHIRO , SIMEONE CHRISTOPHER A. , TSAY JOHN , JU WENJUN , KRETZLER MATTHIAS , SUSZTAK KATALIN , KROLEWSKI ANDRZEJ 
Published: June 2018

We conducted an untargeted proteomic profiling of circulating inflammatory proteins using SOMASCAN platform to find those that predicted 10-year ESRD risk in two cohort study. Subjects with Type 1 Diabetes (T1D) served as a discovery cohort and a T2D cohort was used in validation. We identified a kidney risk inflammatory signature (KRIS) that robustly predicted progression to ESRD. The signature comprised 17 proteins out of 194 examined. KRIS was enriched for members of TNFR Superfamily (p=0.007) including TNFR1, TNFR2, TNFRSF19, TNFRSF19L, TNFRSF21 and TNFRSF27. Other KRIS proteins included IL15RA, IL17F, DAF, CLM6, TNFSF15, CCL14, CCL15, CSF1, TIMD3, IL1R1 and IL18R1. Hazard ratio (95% CI) for the top KRIS protein, TNFR1 was 3.6 (2.8, 4.6), p &lt; 10-25. KRIS was neither enriched in receptors for other cytokines nor in cytokine ligands. Pathway analyses pointed to candidate therapeutic targets and aligned them by ranks. Eight proteins are currently targeted with compounds used for other clinical indications. Kidney tissue expression analysis and urinary proteomics suggested a systemic source of KRIS proteins.
In summary, our study identifies and validates a powerful protein signature enriched in TNFRSF members associated with 10-year ESRD risk in diabetes. These findings should inform future drug development strategies.

Disclosure
M. Niewczas: None. J.K. Skupien: None. V. Nair: None. A. Smiles: None. J. Park: None. E. Satake: None. C.A. Simeone: None. J. Tsay: None. W. Ju: None. M. Kretzler: Research Support; Self; AstraZeneca, Novo Nordisk Inc., Boehringer Ingelheim GmbH, National Institute of Diabetes and Digestive and Kidney Diseases, Eli Lilly and Company, Gilead Sciences, Inc. K. Susztak: Research Support; Self; Regeneron Pharmaceuticals, Inc., Boehringer Ingelheim Pharmaceuticals, Inc., GlaxoSmithKline plc., Merck & Co., Inc., Eli Lilly and Company, Ono Pharmaceutical Co., Ltd.. A. Krolewski: None.
Clinic-Wide Screening of Fear of Hypoglycemia in Mothers and Fathers of Children with Type 1 Diabetes
Authors: MAJIDI SHIDEH , O'DONNELL HOLLY , BENSON KYLIE , DRISCOLL KIMBERLY A. 
Published: June 2018

Background: The American Diabetes Association (ADA) recommends anxiety screening in individuals with type 1 diabetes (T1D); however, screening in parents is not addressed. This study describes fear of hypoglycemia (FOH) in parents who were screened as part of their children’s routine T1D clinic visit.
Methods: Mothers (n=234) and fathers (n=79) completed the Hypoglycemia Fear Survey - Parent comprising 3 subscales: Maintaining High Blood Glucose (BG), Worry/Helplessness About Low BG, and Worry About Negative Social Consequences. Scores of ≥7, ≥24, and ≥9, respectively, were used as clinical cutoffs. Higher scores indicate greater fear/worry about hypoglycemia.
Results: Child characteristics were: 53% female; mean age = 13.9±2.2 years; mean A1C = 9.3±2.2%, mean T1D duration = 5.1±4.1 years; 58% CSII. Percentage of mothers and fathers exceeding the clinical cutoffs were: 18%, 14% on Maintaining High BG; 15%, 3% Worry/Helplessness About Low BGs; and 14%, 1% Worry About Negative Social Consequences. Compared to fathers, mothers reported significantly more helplessness about low BGs (t(173.6)=3.24, p=0.001), but not more worry about negative social consequences (t(223.4)=1.42, p=0.16), or engaging in behaviors to maintain high BGs (t(290)=0.68, p=0.50). Parents of older children (≥13 years) worried equally about hypoglycemia (p&gt;0.05), but reported engaging in fewer behaviors to maintain high BGs than parents of younger children (10-12 years) (t(307)=3.27, p&lt;0.001).
Conclusions: FOH is common in both mothers and fathers. Mothers reported more feelings of helplessness than fathers, whereas both mothers and fathers of younger children reported engaging in more behaviors to maintain high BGs than parents of older children. These results support the need to screen parents - not just patients with T1D - for FOH and provide intervention when indicated. Consideration should be given to including recommendations about FOH screening parents in the ADA Medical Standards of Care.

Disclosure
S. Majidi: None. H. O'Donnell: None. K. Benson: None. K.A. Driscoll: None.