bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal Changes in Depression and Glycemia in Adults with Type 1 Diabetes
Authors: TRIEF PAULA M. , FOSTER NICOLE C. , CHAYTOR NAOMI , HILLIARD MARISA E. , KITTELSRUD JULIE , JASER SARAH , MAJIDI SHIDEH , CORATHERS SARAH , BZDICK SUZAN , ADKINS DEANNA , WEINSTOCK RUTH S. 
Published: June 2018

To assess change in depression over ≥4 years in adults with type 1 diabetes (T1D) and the association between change in depression and glycemic outcomes, we examined PHQ-8 data in adults in the T1D Exchange Clinic Registry with T1D duration ≥ 1 year (N= 2547; 57% female, 92% non-Hispanic white, year 1 age 43±16 years). PHQ-8 score ≥10 defined “depressed.” Linear regression was used to assess association of continuous outcomes and depression; logistic regression was used for categorical outcomes. At year 1/year 5, 9%/11% were depressed. In this sample, 126 (5%) had Persistent Depression (depressed at year 1 and year 5), 112 (4%) Resolved Depression (depressed at year 1, not at year 5), 148 (6%) New Year 5 Depression (not depressed at year 1, depressed at year 5), and 2161 (85%) Not Depressed at year 1/year 5. Of those depressed at year 1, 53% were depressed at year 5; of those not depressed at year 1, 6% were depressed at year 5. Participants with persistent depression/new year 5 depression had a significant increase (↑) in A1c [adj mean ↑ 0.5± 0.2/0.5± 0.2; adj mean 8.1±0.1 for both; adj P’s=0.001]; those not depressed at year 1/year 5 showed a trend in ↑A1c [0.3±0.1; adj mean 7.8±0.1; adj P=0.04]. Those with resolved depression did not show change in A1c [0.2±0.2; adj mean 7.7±0.2; adj P=0.28]. Those with persistent depression/new year 5 depression were more likely to report new year 5 DKA (DKA year 5 | no DKA year 1) than those not depressed at year 1/year 5 (adj P’s=0.03/0.04). There were trends for those with persistent depression to be more likely to report new year 5 severe hypoglycemia (SH) than those not depressed (11.1% vs. 4.8%); and for those with resolved depression to be less likely to report new year 5 SH (3.6 vs. 4.8%, adj P’s=0.09/0.11). Depression category was not associated with change in BMI (adj P=0.80). As a continuous variable, ↑in PHQ-8 was associated with ↑ in A1c (adj P&lt;0.001), but not with new year 5 SH or BMI change (adj P&gt;0.50). Depression (persistent or new year 5) has a negative impact on glycemic control over time. Adults with T1D should be screened and treated for depression.

Disclosure
P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. N.C. Foster: None. N. Chaytor: None. M.E. Hilliard: None. J. Kittelsrud: None. S. Jaser: None. S. Majidi: None. S. Corathers: None. S. Bzdick: None. D. Adkins: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases.
Study on the Effect of Cerium Oxide Nanocubes on Full-Thickness Cutaneous Wound Healing of Type 2 Diabetic Rats
Authors: HAN YANFEI , LI LINDONG , LIU YANJUN , WANG YOU , YAN CHUNHUA , SUN LINGDONG 
Published: June 2018

Objective: To explore the effect and mechanism of cerium oxide nanocubes on the cutaneous wound healing of Goto-Kakizaki (GK) rats.
Methods: A total of 90 GK rats with full-thickness wounds were equally divided into three groups according to different treatments: normal saline (NS), recombinant human epidermal growth factor (rhEGF), and cerium oxide nanocubes solution (CONS). Two round cuts were made on the rats' dorsum from epidermis to the muscle layer. On days 3, 7, 10, 13, 16 and 21 post operation, five rats in each group were killed and made into specimens. Histological evaluation were conducted and the protein and mRNA levels of epidermal growth factor (EGF) and tumor necrosis factor (TNF-α) were analyzed with enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (PCR) technology. In addition, the levels of superoxide dismutase (SOD) and catalase (CAT) were detected by ELISA.
Results: Compared with the other two groups, the CONS-treated group had less inflammatory cell infiltration, more fibroblasts and smaller granulation tissue area in HE stained tissue micrographs. Meanwhile, Masson stained tissue micrographs showed thicker, more compact and more regular collagenous fiber. In CONS-treated rats, the wound healing rate on days 7 and 10 after surgery was significantly higher compared with other groups (p&lt;0.05). On days 7, 10 and 13, the levels of TNF-α protein as well as TNF-α mRNA in the CONS-treated group were lower than in the NS-treated group (p&lt;0.05). On days 7 and 10, SOD, CAT and EGF protein levels in the CONS-treated group were higher when compared to the NS-treated group (p&lt;0.05), while the expression of EGF mRNA in the CONS-treated obviously increased from day 3 till day 13.
Conclusion: The mechanism of cerium oxide nanocubes promoting experimental diabetic wound healing may be related to reducing inflammatory reaction and promoting the synthesis of antioxidants and growth factors.

Disclosure
Y. Han: None. L. Li: None. Y. Liu: None. Y. Wang: None. C. Yan: None. L. Sun: None.
Diabetes Self-Management Education Program Effect on Glycemic Control and Insulin Dosing in Poor Diabetes Literacy Patients from Urban Areas in Mexico City—Therapeutic Education Underuse and Insulin Overuse
Authors: SILVA-TINOCO RUBÉN , MEZA DANIELA G. , MARTINEZ DAVID GARCIA , OROZCO JAVIER , ROMERO-IBARGUENGOITIA MARIA ELENA , DE LA TORRE-SALDAÑ VIRIDIANA A. , RAMOS GARCIA JESUS A. , DOLORES MARÍA C. , CUATECONTZI ENEDINA TERESA 
Published: June 2018

Limited evidence exists on the efficacy of Diabetes Self-Management Education (DSME) in primary care urban population in low- and middle-income countries. This study evaluated the effect on glycemic control and insulin dosing in patients who attended an interdisciplinary educative structured program at Clínica Especializada en el Manejo de la Diabetes in México City-Iztapalapa in 2017. Intervention lasted 5 months and included individual and group sessions in a shared medical appointments model aimed at promoting self-care. In 252 patients with type 2 diabetes, diabetes literacy and self-care activities were assessed from the 10-item Spoken Knowledge in Low Literacy in Diabetes (SKILL-D, score 0-100) and the Summary of Diabetes Self-Care Activities (SDSCA, days/week), respectively. Women represented 67% and 59.6% had elementary or less education. Mean age was 55±10 years old, mean duration of diabetes was 13±8 years and 66% were on insulin treatment. SKILL-D and SDSCA scores increased from 22±19 to 80±16 and 2.5±1.4 to 4.7±1 days/week, respectively. HbA1c decreased from 9.3±2.1 to 6.7±1.1% (mean variation 2.5±2.1%; p&lt;0.001) and daily total insulin dose decreased from 37±17 to 23±13 units (mean variation 13.5±14.7 units; p&lt;0.001). Only in 22% another drug agent was added, in 18% insulin was discontinued and in 3% insulin started. Diabetes literacy and self-care activities were poor at the beginning of the study. This is a real-world study that showed that a non-pharmacological approach focused on promoting self-care, such as DSME, had in important effect on HbA1c reduction and insulin dosing in urban areas patients with low literacy, but also suggested an insulin over-prescription practice with lack of adherence/prescription to/of lifestyle interventions, before participation in this program.

Disclosure
R. Silva-Tinoco: Speaker's Bureau; Self; Novartis Pharmaceuticals Corporation. D.G. Meza: None. D. Garcia Martinez: None. J. Orozco: None. M. Romero-Ibarguengoitia: None. V.A. De La Torre-Saldañ: None. J.A. Ramos Garcia: None. M.C. Dolores: None. E. Cuatecontzi: None.
Multidisciplinary Predialysis Team Education for Patients with Diabetic Nephropathy Reduced Cost for Admission at the Induction of Hemodialysis, and Subsequent Mortality
Authors: HITOMI MAMIKO , SATO TERUKO , MORIYA TATSUMI 
Published: June 2018

Although a multidisciplinary individual team approach (MTA) has been thought to help prevent the progress of diabetic nephropathy (DN), its efficacy has not been fully examined. We compared the effect of an MTA on the hemodialysis (HD) course of 51 DN patients with that of 34 DN patients managed via a dietitian approach (DA) alone (total patients, n=85; male, n=58; age, 62±12 years; T2DM, n=81). In all cases, HD was initiated between January 2010 and May 2016. MTA staff members were doctors, dietitians, nurses, laboratory technologists, and pharmacists. Each intervention took 15-30 min at an outpatient clinic on the day of doctor visits. The team provided advice on nutrition, medication, medical exam, foot care, self-monitoring, and self-management. In the MTA group, the annual number of intervention sessions was higher, the cardiothoracic ratio was lower, and the cost per admission for HD induction was lower in comparison to the DA group (5.0±5.5/year vs.2.0±2.0/year, P=0.004; 53.1±6.6% vs. 57.3±7.4%, p=0.009; and 1.55±0.85 vs. 2.04±0.15 million JPY, p=0.029). Four patients in the MTA group and 9 in the DA group died during the observation period (likelihood ratio 5.381, p=0.020). A Kaplan-Meier survival analysis showed that the MTA group had superior patient survival (log rank p=0.009). The number of patients who underwent 24-h corrected urine tests 6 months before HD was higher in the MTA group (n=20 vs. n=5, likelihood ratio 6.281, p=0.025), while the urinary sodium excretion in 24 h urine collection was lower in the MTA group (8.2±2.2 g/day vs. 13.0±6.9, P=0.011).The stepwise regression analysis showed that the MTA and DA classifications mostly affected patient survival at the final observation (F=7.20, p=0.014).
In conclusion, the MTA provided good clinical and economic results for DN patients through improved self-management and an improved clinical course, even when implemented after the initiation of HD.

Disclosure
M. Hitomi: None. T. Sato: None. T. Moriya: None.
Novel Approach to Sarcopenia in Diabetic Patients Treated with GLP-1 Receptor Agonists (GLP-1RA)
Authors: IKEJIMA SHIN , KONDO SEIYA , SAKAI TAKENORI , TANIAI HISANORI , TAKAHASHI TOMOMI , UMEZU JUNKO , ISEKA MAMI , INOUE MAYA , NISHIHARA HARUMI , MURATA KAZUYA , HIRAI AIZAN 
Published: June 2018

Background: It is expected that GLP-1 Receptor Agonists (GLP-1RA) have not only glucose lowering effect but also weight loss and protection of diabetic kidney disease. On the other hand, sarcopenia and frailty is becoming important, because elderly diabetic patients increase in Japan. In the present study, we report about falling risk, dietary surveys and exercise therapy of diabetic patients treated with GLP-1RA.
Methods: The questionnaire was tested in type 2 diabetic outpatients treated with GLP-1RA at our hospital (mean age 65.7 years). The control group was the diabetic outpatient treated without GLP-1RA in nearly the same age range (mean age 63.6 years). We measured hand grip strength and one-leg standing (OLS) time. Participants were defined as patients with a high risk of falling, If their hand grip strength was ≤30kg(male) or ≤20kg(female) and their OLS time was &lt;20s. Especially if their OLS time was &lt;5s, defined as patients with a severe high risk of falling. We also analyzed their dietary surveys in three days. Finally, we planned original exercise program to patients with a high risk of falling, and investigated the effect of this exercise every month.
Result: A total of 194 cases (male, 61%; female, 39 %) were included in this study. The prevalence of patients with a high risk falling was 36.1%. In patients treated with GLP-1RA (92 cases) and without GLP-1RA (102 cases), the prevalence of patients with a high risk falling was 45.7% and 27.5%. In patient treated with GLP-1RA, the prevalence of patients with severe high risk falling was 27.5% in liraglutide group (51 cases) and was 36.6% in dulaglutide group (41 cases). Dietary surveys and the effect of exercise program are on-going.
Conclusion: These findings show that type 2 diabetic patients treated with GLP-1RA are high risk group of falling compared with patients treated without GLP-1RA. Therefore, in use of GLP-1RA, we should be careful of sarcopenia and frailty involves in weight loss and muscle atrophy. Exercise and diet therapy are important.

Disclosure
S. Ikejima: None. S. Kondo: None. T. Sakai: None. H. Taniai: None. T. Takahashi: None. J. Umezu: None. M. Iseka: None. M. Inoue: None. H. Nishihara: None. K. Murata: None. A. Hirai: None.
Weight Loss among Adults with Type 2 Diabetes Participating in the Diabetes Prevention Program
Authors: CARPENEDO DOROTA , BROKAW SARAH M. , TYSK SONJA , FERNANDES JESSIE , HELGERSON STEVEN D. , HARWELL TODD S. ,   MONTANA DIABETES PREVENTION PROGRAM STUDY GROUP
Published: June 2018

Evidence suggests substantial weight loss may be associated with remission of T2DM. We assessed weight loss in adults with T2DM participating in an intensive lifestyle intervention using the National Diabetes Prevention Program (DPP) curriculum. While enrollment was targeted toward adults at high-risk for T2DM, adults with T2DM who were referred by their primary care provider and received medical clearance to participate were also permitted to enroll in the DPP (N = 105). Seventy percent of these participants were female; the mean age and baseline BMI were 59.2 years (SD 8.9) and 38.7 kg/m2 (SD 7.7), respectively. The mean number of core sessions and total sessions (22 total sessions) completed by participants was 12.1 (SD 3.8) and 14.5 (SD 5.5). Sixty percent of participants achieved the physical activity goal of ≥150 minutes of moderate physical activity. Forty-six percent and 28% of participants achieved ≥5% and ≥7% weight loss respectively. Results from the multiple logistic regression models indicated that participants who self-monitored their fat intake consistently and met the physical activity goal were more likely to achieve the 7% weight loss goal and participants who self-monitored their fat intake consistently were more likely to achieve ≥5% weight loss (Table). Our findings suggest that many persons with T2DM can achieve substantial weight loss through participation in DPP lifestyle intervention.Table. Factors independently associated with achieving seven percent and five percent weight loss among participants with T2DM enrolled in the Montana Diabetes Prevention Program, 2008-2016.Achieved 7% weight lossat 4 monthsAchieved 5% weight lossat 4 monthsAdjusted Odds Ratio (95% CI)PAdjusted Odds Ratio (95% CI)PAge (years)60+0.82 (0.27-2.5)0.720.79 (0.27-2.32)0.6736-591.0Reference1.0ReferenceSexFemale1.(0.31-3.55)0.930.41 (0.13-1.33)0.14Male1.0Reference1.0ReferenceBaseline BMI (kg/m2)25.0-29.91.41 (0.29-6.93)0.690.69 (0.14-3.37)0.5330.0-34.91.04 (0.28-3.82)0.851.31 (0.39-4.47)0.5035.0+1.0Reference1.0ReferenceCore Self-monitored fat (weeks)14-165.67 (1.67-27.55)0.024.21 (1.07-16.57)0.027-132.07 (0.44-9.74)0.811.34 (0.39-4.63)0.410-61.0Reference1.0ReferencePhysical activity goalMet2.92 (0.86-9.88)0.082.76 (0.97-7.84)0.06Unmet1.0Reference1.0Reference*95% CI – Ninety-five percent confidence interval.

Disclosure
D. Carpenedo: None.S.M. Brokaw: None.S. Tysk: None.J. Fernandes: None.S.D. Helgerson: None.T.S. Harwell: None.
Provider Experience Drives Clinical Decision Making in T2DM—Insights from Realistic Training Simulations
Authors: ROBINSON KATIE , ESGRO ROBERT A. , SEIFERT DOUGLAS 
Published: June 2018

Rationale: Given the vast number of individual clinical scenarios and treatment options for patients with T2DM, clinical decision making is challenging. However, there is little evidence regarding the patient and provider characteristics that drive treatment selection.
Methods: Vindico Medical Education and Syandus partnered to create a virtual clinical training environment designed to identify and address drivers of treatment selection for patients with T2DM. The program featured three learner-centric clinical scenarios and evaluated participants in real-time, providing immediate, conversational feedback on the appropriateness of their decisions.
Results: For a newly-diagnosed patient with T2DM in need of treatment beyond metformin monotherapy, most providers selected an appropriate add-on agent with a preference for oral compounds [22% DPP-4 inhibitor, 26% SGLT2 inhibitor, 27% sulfonylurea (SU), 6% thiazolidinedione (TZD)], with the remainder selecting a GLP-1 RA (19%). The preference for oral agents persisted in a simulation of a patient with newly-diagnosed heart failure of which there were two most appropriate options based on patient characteristics (SGLT2 inhibitor, 63%; 37% GLP-1 RA 37%). Notably, when several classes of therapy were appropriate, providers with more clinical experience prefer newer agents (e.g., SGLT2 inhibitors, DPP-4 inhibitors, and GLP-1 RAs) vs. older agents (e.g., TZDs and SUs).
Conclusion: Providers prefer to treat patients with oral antidiabetes medications. More experienced providers prefer newer antidiabetes medications vs. their less-experienced colleagues, demonstrating the need for targeted education to junior providers on newer treatment options. Realistic clinical training simulations are an impactful tool to both educate providers on optimal clinical decision-making and identify drivers of clinical decision-making toward improved patient care.

Disclosure
K. Robinson: None. R.A. Esgro: None. D. Seifert: None.
Are Complications Preventable with Periodic Education via Telemedicine? A Study of 414 Compliant T2D Patients Followed Up for 19 Years
Authors: KESAVADEV JOTHYDEV , SHANKAR ARUN , DAVID ASHWIN , KRISHNAN GOPIKA , AJAI NEETHU A. , SANAL GEETHU , AJITH JAYSREE , JAYANTHI SOUMYA , RAMACHANDRAN LAKSHMY , JOTHYDEV SUNITHA 
Published: June 2018

Background: Despite availability of many new diabetes therapies, outcomes still remain very poor, with majority developing debilitating vascular complications. Landmark trials have demonstrated, complications could be prevented if patients keep achieving A1c, BP and cholesterol targets. Diabetes Tele Management System (DTMS®), a sophisticated software integrated with multidisciplinary team was initiated in our centre since 1998 for customised titration of medications, diabetes education (DE) and behavioural modifications through virtual consultations (VC) precluding frequent physical visits (PV).
Aim: To assess long-term impact of DTMS® over 19 years,in successfully averting complications in T2D.
Methods: Patients enrolled in DTMS® and adhering to customised VC, with follow-up data available for 19 years were de-identified. Subjects: n 414, baseline:age 50.10±9.22y, males 60.09%, T2D duration 11.44±6.85y Inclusion criteria: VC ≥ 1 in 3 mths, PV ≥ 1 in 3y, and attended group DE ≥ 1 in 3y. Exclusion criteria: CKD (4and5).
Results: Change from baseline at 19th y: A1c= -0.68%, LDL=-60.3 mg/dl, creatinine= 0.04 mg/dl, SBP/DBP= -7.2/-8.66 mmHg. New onset CKD= 0.24%, CAD/CVA=2.4%, deaths=3.86%. Average PV frequency 2.04/y, VC 1.2/month.
Conclusion: Vascular complications could be successfully prevented, in 93.5% of the T2D subjects followed up for 19 years via tele-management program.

Disclosure
J. Kesavadev: Advisory Panel; Self; Novo Nordisk India Private Limited. Speaker's Bureau; Self; Novo Nordisk India Private Limited. Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; MSD. Speaker's Bureau; Self; MSD. Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. A. Shankar: None. A. David: None. G. Krishnan: None. N.A. Ajai: None. G. Sanal: None. J. Ajith: None. S. Jayanthi: None. L. Ramachandran: None. S. Jothydev: None.
A Meta-analysis of Real-World Observational Studies on the Impact of Flash Glucose Monitoring on Glycemic Control as Measured by HbA1c
Authors: SEIBOLD ALEXANDER , WELSH ZOE K. , ELLS SARA , SCHLAEGER CHRISTOF 
Published: June 2018

Flash glucose monitoring is proven in randomized clinical trials to reduce the amount of time that people with type 1 or type 2 diabetes spend in hypoglycemia, with glucose below 3.9 mmol/L (70 mg/dL). Here we report a meta-analysis of real world observational studies on the impact of flash glucose monitoring on glycemic control as measured by HbA1c. A series of 17 studies were identified as reporting longitudinal HbA1c data in a total 1338 participants with type 1 (n=1112) or type 2 diabetes (n=226) using the FreeStyle Libre flash glucose monitoring system. Data included observations on children, adolescents and adults. The studies were reported in peer-reviewed published manuscripts, congress poster presentations and in-press data.
Meta-analysis of change in HbA1c was performed using trial as a random effect and weighting with the inverse of the within trial variance. Overall mean change in HbA1c was -0.56, 95% CI (-0.76, -0.36), with substantial heterogeneity between trials (I2=92.6%). Meta-regression was performed with the covariate initial HbA1c and treating trial as a random effect (Figure). No significant differences were detected based on length of study, type of diabetes (type 1 vs. type 2) or children vs. adults.

Disclosure
A. Seibold: Employee; Self; Abbott. Stock/Shareholder; Self; Abbott. Z.K. Welsh: Employee; Self; Abbott. Stock/Shareholder; Self; Abbott, AbbVie Inc. S. Ells: Employee; Self; Abbott. Stock/Shareholder; Self; Abbott. C. Schlaeger: Employee; Self; Abbott. Stock/Shareholder; Self; Roche Pharma.
Findings from a Diabetes Support Group—A Pilot Study
Authors: MALONEY LORI MCLEER , FLOOD JEREMY , ALAMUDDIN NAJI , MUKADDAM MONA AL 
Published: June 2018

Purpose: Diabetes Self-Management Education (DSME) is a crucial aspect of treating type 2 diabetes mellitus (T2DM). Daily individual decisions affect patient health, well-being, and long term outcomes. This pilot study evaluated what best educates and motivates patients to improve glucose control.
Method: 17 participants with T2DM were recruited from Penn Rodebaugh Diabetes Center to attend 3 monthly diabetes support group meetings, and receive American Association of Diabetes Educators education. Weight and hemoglobin A1C (A1C) were measured at baseline and completion. Fitbit Activity Trackers were provided, as well as bi-weekly communication to reinforce behavior change. Pre and post-study surveys assessed nutrition, activity, monitoring blood glucose, and taking medication. Two sided paired t-test was performed to compare change in A1C and weight. A type I error rate of 0.was used for statistical significance.
Results: 15 participants completed the study. DSME interventions resulted in a statistically significant decrease in mean A1C from 8.5% to 7.7% with a mean A1C reduction of 0.8% in 3 months (p-value=0.01). Mean weight decreased 4.80 lb (p-value=0.0001). 11 remained on same medications, and 1 required reduced insulin. 3 added a glucagon-like peptide receptor agonist (GLP-1RA), with 1 adding a sodium-glucose cotransporter-2 inhibitor. 7 increased daily steps wearing Fitbit, while 8 reported no motivation. 10 increased weekly exercise, and 11 increased daily activity. All benefited from bi-weekly reinforcement, and reported improved nutrition. Food replica models aided visual reinforcement.
Conclusion: DSME in a group setting can motivate self-care and reduce both A1C and weight, however, the study met challenges. Time per patient spent coordinating was substantial. Food models and phone communication to reinforce lifestyle modification were useful. Research is needed to determine what provides long-term sustainability in a busy clinical practice.

Disclosure
L. McLeer Maloney: None. J. Flood: None. N. Alamuddin: Consultant; Self; Novo Nordisk Inc.. M. Al Mukaddam: None.