bluuebunny/crossref_metadata_2025_split huggingface dataset:
655-P: Effect of an Interdisciplinary Care and Diabetes Self-Management Education Program on Weight among Persons with Social and Clinical Complex Profile
Authors: DELATORRE-SALDAÑA VIRIDIANA A. , SILVA-TINOCO RUBÉN , HERNÁNDEZ JORGE , GUZMAN EILEEN B. , CASTILLO-MARTÍNEZ LILIA , OREA-TEJEDA ARTURO , GALLARDO-RINCÓN HECTOR , MARTÍNEZ-ANZURES CARMEN , SEGOVIA ALMA , CUATECONTZI-XOCHITIOTZI TERESA 
Published: June 2019

People with diabetes/obesity, especially those on insulin treatment and with the intention of achieving glycemic control goal, may have more difficulty losing weight. Evidence suggests a relationship between social determinants of health (socio-economic status, education, etc.) and worst diabetes-related outcomes. We evaluated the change on weight in patients who attended an Interdisciplinary Care and Diabetes Self-management Education Program in a public primary care specialized diabetes clinic in Mexico City/Iztapalapa in 2018. In 327 persons with type 2 diabetes, body weight and composition were evaluated by bioelectrical impedance multifrequency analysis (Seca® 515/514, 50 Hz). Women represented 67%, 56% had elementary or less education and 63.9% had medium-low or lower socio-economic status. Mean age was 55±10 years old, mean duration of diabetes was 12±8 years, baseline weight was 72.9±16.1 kg and 68% were on insulin treatment. Drugs with recognized weight loss effect were not added. Weight loss was observed after the program: BMI 25-29.9 category (n=118) 1.4 kg (-0.4-2.9 95% CI, p=&lt;0.0001), in BMI 30-34.9category (n=77) 1.9 kg (0.3-4.2 95% CI, p=&lt;0.0001), and in BMI ≥35 category (n=61) 2.5 kg (0.3-5.2 95% CI, p=&lt;0.0001) of weight loss was observed. Proportion of patients with BMI≥30 and weight loss &gt;5% was 26.1%. Fat mass loss was 2.1 kg (0.3-3.1 95% CI, p=&lt;0.0001) in BMI≥30 category. Diet self-care behavior improved (2.6±1.6 to 5.4±0.9 days/week, p=&lt;0.0001), HbA1c decreased (9.45±2.0 to 6.7±1.2%, p=&lt;0.0001) as well as total daily insulin units (36.2±16.9 to 27.2±12.2 units, p=&lt;0.0001) among on-insulin treatment subjects. We show that this strategy non-primarily designed to lose weight but rather to propitiate diabetes empowerment had a valuable positive effect on weight in a real world-setting, even when the studied population has complex and adverse clinical and social features.

Disclosure
V.A. DeLaTorre-Saldaña: None. R. Silva-Tinoco: Speaker's Bureau; Self; Novo Nordisk Inc. J. Hernández: None. E.B. Guzman: None. L. Castillo-Martínez: None. A. Orea-Tejeda: None. H. Gallardo-Rincón: None. C. Martínez-Anzures: None. A. Segovia: None. T. Cuatecontzi-Xochitiotzi: None.
660-P: Nationwide Capacity Building Model in Gestational Diabetes Management for Primary Care Physicians in India
Authors: KUMAR PUSHKAR , BHALLA SANDEEP , CHANDWANI HARESH 
Published: June 2019

Background: Pregnancies complicated by GDM have fourfold increased risk of perinatal mortality and has a long-term health impact, with more than 50% of women with GDM going on to develop type 2 diabetes within 5-10 years of delivery. In India an estimated 4 million women have GDM.
Aim: To highlight the components of a PAN India training model specifically designed to enhance the knowledge, skills, and core competencies of Primary Care Physicians (PCPs) in the management of GDM.
Methodology: Addressing the issue of dearth of trained professionals in specialized area like gestational diabetes by building the capacity of PCPs is an important strategy towards improving GDM management. A four modular course was developed jointly by Public Health Foundation of India and Dr. Mohan’s Diabetes Education Academy to train primary care physicians with strong course curriculum, vetted and approved by the eminent panel of national experts constituting of eminent endocrinologists and gynecologists.
Result: Certificate Course in Gestational Diabetes Mellitus (CCGDM) has trained 3200 participants and covered 26 states, 3 Union Territories, 257 districts and 437 cities in the last 4 cycles. This model has been adopted by five state governments- Gujarat, Madhya Pradesh, Meghalaya, Tripura and Uttarakhand for training their medical officers. Out of the trained participants, 52% were post- graduates and 39% belonged to Government sector. The robust monitoring mechanism and precise certification method led to 90% pass percentage and 92% of trained physicians claimed that it helped them in better diagnosis, timely referral and management of GDM patients with significant knowledge improvement.
Conclusion: Focusing on GDM by training PCPs is a low-cost intervention both to improve maternal and child health as well as to prevent future diabetes. This is a well- defined progressive training model to build capacity among doctors in GDM Management and has the potential to be adopted by low income countries.

Disclosure
P. Kumar: None. S. Bhalla: None. H. Chandwani: None.
670-P: Provider Medication Use Changes for Better and Worse with Education
Authors: SARKAR SUNANDA , BARNES CATHERINE S. , CAUDLE JANE , JOHN SMITHA M. , CLARK KYRA P. , HEIMAN ERICA , VOLCY JUDITH C. , SCHMIDT STACIE , ZIEMER DAVID C. 
Published: June 2019

ADA guidelines for type 2 diabetes recommend metformin (MET) at all A1c levels, combination (COMBO) therapy at higher A1c levels and insulin (INS) for symptoms or A1c &gt; 10. Current provider adherence to guidelines and the ability of educational session to alter that are unclear.
Methods: We assessed provider medication use before and after didactic diabetes medication and case management sessions designed to encourage multi-combination therapy and guideline adherence. Surveys asked 163 participants to report preferred drug regimens to be used for 6 patient cases: newly diagnosed (NEW) or established (EST) diabetes patients with A1c of 7.5 (LO), 9.5 (MID) or 10.5 (HI).
Results: MET use was remarkably low at higher A1c’s (69% HI, 85% MID, 98% LO) at baseline. After sessions, MET use improved significantly to 84%, 94%, 99%. COMBO (no-INS) was most frequently chosen for MID A1c levels: NEW 67%/EST 43%; compared to 13%/23% for LO 7%/5% HI. In the higher A1c cases, COMBO use increased dramatically with sessions to: 83%/72% MID, 30%/16% HI (all p&lt; 0.005). Use of sulfonylureas decreased for 5 of the 6 cases. Changes in INS use were nuanced. Few providers (2%/4%) chose insulin for LO A1c; this decreased to near 0 after the sessions. INS was used in the majority of patients with HI A1c. INS use decreased significantly in favor of COMBO, not only for MID A1c (38%/51% to 13%/26%), but also for HI (93%/94% to 70%/84%).
Summary: Initially, guideline adherence was sub-optimal (underutilization of MET, COMBO and at HI A1c of INS). Short Provider Education sessions improved practices. Use of COMBO’s less likely to cause hypoglycemia increased substantially. However, appropriate INS at HI A1c also decreased.
Conclusion: There is a need for more training for better use of the antidiabetic armamentarium by primary care providers. Provider education emphasizing COMBO advantages improves planned prescribing patterns, but careful message tailoring is needed to avoid unintended consequences.

Disclosure
S. Sarkar: None. C.S. Barnes: None. J. Caudle: None. S.M. John: None. K.P. Clark: None. E. Heiman: None. J.C. Volcy: None. S. Schmidt: None. D.C. Ziemer: None.

Funding
Sanofi U.S.
676-P: The Efficacy and Safety of Careful Management of Self-Dose-Adjustment Intervention of Basal Insulin by the Nurse in Outpatients with T2DM
Authors: HU XILING , YANG XUBIN , DENG HONGRONG , GUO XIAODI , YAO BIN 
Published: June 2019

Background: Basal insulin therapy is widely used in patients with type 2 diabetes mellitus (T2DM). After giving the initial dose, the follow-up of the patients from the doctors, including the dose adjustment and the hypoglycemia, is not sufficient in China, which influences the glucose control obviously. Thus, we intended to invest if the patients with T2DM would benefit from careful follow-up and management of the basal insulin therapy by the nurse.
Methods: The patients with T2DM who were ≥ 18 years old and glycosylated hemoglobin A1c (HbA1c) &gt; 7% were eligible for the 12-week study. After they were randomized to the control group and the careful care group, glargine was added to them. All of the patients accepted the routine guidance by the doctor. In addition to that, patients in the careful care group were guided to adjust their insulin dose 2-6U to reach the glucose target and followed-up at the 1, 2, 4, 8, 12 weeks by the Diabetes Specialist Nurses. The laboratory indices and questionnaire were assessed at baseline and at the end of the study.
Results: Four hundred and twenty-three patients (53.6 ± 14.3 years) in the control group and four hundred and twenty-six patients (54.7 ±13.4 years) in the careful care group finished the 12-week study. The patients in the careful care group had greater reduction of fasting plasma glucose (-2.64±0.44mmol/L vs. -1.63±0.53mmol/L, P&lt;0.05) and HbA1c (-2.8±0.5% vs. -1.8±0.5%, P&lt;0.05), higher improvements of the score of diabetes knowledge (6.10 ± 0.76 vs. 2.87± 1.72, P&lt;0.001), the score of Diabetes Empowerment Scale-Short Form (39.07 ± 17.82 vs. 26.93 ± 19.17, P&lt;0.05), and the score of self-management ability (including diet, exercise, etc., P&lt;0.05), compared with the control group. The hypoglycemic percentages were similar between them (17.73% vs. 20.65%, P=0.279).
Conclusions: The careful follow-up and management of self-insulin dose adjustment by Diabetes Specialty Nurses is effective and safe in patients with T2DM.

Disclosure
X. Hu: None. X. Yang: None. H. Deng: None. X. Guo: None. B. Yao: None.
685-P: Insights into Online Delivery of the National Diabetes Prevention Program
Authors: ELY ELIZABETH , JABRAH RAJAI 
Published: June 2019

The National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations working together to build a nationwide delivery system for a lifestyle change program proven to prevent or delay onset of type 2 diabetes in adults with prediabetes. In 2015, the Diabetes Prevention Recognition Program (DPRP), the quality assurance arm of the National DPP, began recognizing lifestyle change programs delivered through an online platform, meaning participants log into course sessions via a computer, tablet, or smart phone. In November 2018, the total number of participants ever enrolled in the program reached 250,000. Those in online programs have now exceeded the number in in-person programs (144,122 vs. 109,951), despite the fact that online participation is not currently covered as part of the Medicare Diabetes Prevention Program. Among men eligible for participation in the program, more were found to enroll in online programs (65.6%) than in-person programs (34.4%), while among women, the difference was not as great (54.4% online and 45.6% in-person). With respect to age, eligible participants aged 18-44 enrolled in online programs at a rate of 75.5%, while eligible participants 65+ enrolled in in-person programs at a rate of 81.8%, seeming to show that younger participants prefer online, while older participants prefer in-person. Hispanic and white participants enrolled in online at a higher rate than in-person (54.9% and 62.4%), while 51.6% of black participants enrolled in in-person over online. Mean weight loss is used to determine the effectiveness of programs. Participants strive to lose at least 5% of their starting body weight over 12 months. When only eligible participants who were fully engaged for at least 9 of the 12 program months were considered, mean weight loss was found to be 6.3% for in-person programs and 5.4% for online programs. The addition of online programs has allowed the National DPP to reach underserved populations with prediabetes with favorable results.

Disclosure
E. Ely: None. R. Jabrah: None.
687-P: Early Detection of Insulin-Derived Amyloid Deposits in Abdominal Wall and the Management of Insulin Injection Site Using CGM and Abdominal Wall CT Examination
Authors: HIRAI AIZAN , HIRAI KEIJI , NISHIHARA HARUMI , SASAKI JUNKO , SUDO TOMIKO , FUJIMURA KOJI , KAGEYAMA TAKAHIRO 
Published: June 2019

Purpose: Long-term injection of insulin preparations causes subcutaneous amyloid deposits called "insulin balls", leading to impaired blood glucose control due to delayed absorption of the drugs. In order to get therapeutic effects of insulin, proper selection of the injection site is quite essential. Subcutaneous amyloid deposition in abdominal wall can be detected by CT examination. The present study was conducted to establish a method for detection of insulin-derived amyloid deposits and the management of insulin injection site by the combination of continuous blood glucose monitoring (CGM) and abdominal wall CT examination.
Methods: The present study included 120 T2DM patients who were treated with insulin preparations over 5 years. Two weeks CGM was performed using Free Style Libre Pro. In case of significant day-to-day variation in blood glucose control, abdominal wall CT was performed to detect amyloid deposition.
Results: As shown in Figure, abdominal wall CT revealed that subcutaneous amyloid deposition is caused not by ultra-short acting insulin but by long-acting insulin. Blood glucose control was stabilized by insulin injection avoiding amyloid deposits detected by CGM and CT.
Conclusion: CGM and abdominal wall CT examination are useful tools for early detection of amyloid deposition by insulin and optimization of injection site.

Disclosure
A. Hirai: None. K. Hirai: None. H. Nishihara: None. J. Sasaki: None. T. Sudo: None. K. Fujimura: None. T. Kageyama: None.
69-LB: Postprandial 2-hr Rise in Insulin Is a Strong Predictor of Glycemic Responses to Different Meals in Healthy and Prediabetic Individuals: The PREDICT I Study
Authors: FRANKS PAUL W. , BERRY SARAH , CHAN ANDREW T. , DAVIES RICHARD J. , DREW DAVID A. , SPECTOR TIM D. , VALDES ANA M. 
Published: June 2019

Objective: Postprandial glucose is a predictor of later diabetes and vascular complications. The study aims to identify determinants of inter-individual variability in postprandial responses in healthy and prediabetic individuals.
Methods: A multi-centre study in the UK and the U.S. assessed the postprandial insulin, glucose and triglyceride responses to a dietary challenge (50g fat and 85g carbohydrate) in the clinic. The inter-individual variability in postprandial glycemic responses was then measured over 2 weeks for isocaloric meals of different macronutrient content using a continuous glucose monitor (CGM). Interim analyses of the 30- and 120-min insulin rises and meal content contributions to the incremental glucose area under the curve (iAUC) were performed in 573 individuals (age 47.5 (19-66) years, BMI 25.7 (17-53) kg/m2; F=76%; n=108 with HbA1c &gt; 5.7% [prediabetic]).
Results: A machine learning algorithm showed that 29% of variation in glucose iAUC of at home meals was explained by the meal’s macronutrient content. In clinic, the 30min insulin postprandial rise (strongly associated with same meal’s glucose iAUC r=0.39 p=1.25x10[-20]) was not correlated with at-home postprandial glucose iAUCs in healthy (r=-0.012 p=0.62) or prediabetic (r=-0.074 p=0.17) individuals after adjustment for age, sex and BMI. However, 2hr insulin rise was significantly associated in healthy (r=0.13 p=1.6 x 10[-7]) and prediabetic (r=0.22 p=3.2x10[-5]) individuals, explaining 15% of the variance in glucose iAUCs. This was the same for all meals regardless of macronutrient content.
Conclusions: The 2hr postprandial insulin rise is a predictor of glycemic responses to different meal types. Ongoing exploration in PREDICT I using additional environmental, genetic and microbiome variables should advance our ability to predict an individual’s response to food.

Disclosure
P.W. Franks: Board Member; Self; Zoe Ltd. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk A/S, Novo Nordisk Foundation, Sanofi, Servier. S. Berry: Consultant; Self; Zoe Ltd. A.T. Chan: Consultant; Self; Bayer AG, Janssen Pharmaceuticals, Inc., Pfizer Inc. R.J. Davies: Employee; Self; Zoe Global Limited. D.A. Drew: Consultant; Spouse/Partner; PathAI. T.D. Spector: Stock/Shareholder; Self; Zoe Global Ltd. A.M. Valdes: Consultant; Self; Zoe Ltd Global. Research Support; Self; Pfizer Inc.

Funding
UK National Institute for Health Research; UK Wellcome Trust; Zoe Global Limited
693-P: Baseline Characteristics and Self-Care Behavior Goals of Adolescents with Type 1 Diabetes Enrolled in MyDiaText™
Authors: KAUSHAL TARA , KATZ L. E. , MAROWITZ MICHELLE E. , JOSEPH JANET , RITTER DEAN P. , LIPMAN TERRI H. 
Published: June 2019

Background: Adolescence is associated with suboptimal diabetes control, with average HbA1C levels of 9.0%. Adolescents are highly engaged in mobile technology; over half report sending text messages at least daily. Text messaging (TM) is most commonly used technology in adolescents with type 1 diabetes (T1D). Pilot studies have demonstrated TM to be a useful tool in diabetes education. MyDiaText™ is a website and TM platform created to support behavior change in adolescents with T1DM. Enrollment in a randomized controlled trial (RCT) using MyDiaText™ began in August 2018.
Objective: To report the baseline characteristics, self-care behaviors, and engagement in a TM intervention for T1D education and support in a diverse population.
Methods: Subjects were recruited from the CHOP Diabetes Center. Enrollment criteria for the trial included: 12-18 years, &gt;1 year from diagnosis and point-of-care HbA1C &gt; 8%. Adolescents selected an AADE7™ Self-Care Behavior (SCB) goal on which to focus. Those in the intervention group received daily educational and motivational text messages. Self-Care Inventory (SCI), 14 questions scored 1-5, and HbA1C were obtained at baseline. Engagement index, defined as number of responses/total messages received, was calculated by the application.
Results: There were 107 subjects (average age = 15.8 years {45.8% M, 52.3% F, 1.9% other; 60 (56.1%) W, 33 (30.8%) B, 10 (9.3%) mixed race and 4 (3.7%) other; 11 (10.2%) identified as Hispanic}) enrolled. “Monitoring” was most common SCB selected, 45 subjects (42.4%). Mean (range) baseline HbA1C was 10.0% (8.0-14.1). Mean baseline SCI score was 3.36 (1.07-5.0). Engagement was 60% or greater for 74% of subjects in treatment arm.
Conclusions: A diverse population of adolescents with T1D and suboptimal control preferred text messaging support for blood glucose monitoring and demonstrated high engagement in MyDiaText™. Further analyses will determine the efficacy of MyDiaText™ on diabetes outcomes.

Disclosure
T. Kaushal: None. L.E. Katz: None. M.E. Marowitz: None. J. Joseph: None. D.P. Ritter: None. T.H. Lipman: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (2T32DK063688-11-12 to L.E.K.)
696-P: The CDC Web-Based Diabetes Self-Management Education and Support Toolkit
Authors: HOUSTON JACQUELYN , EDWARDS LAURA E. 
Published: June 2019

Diabetes self-management education and support (DSMES) provides an evidence-based approach to empower people with diabetes to navigate self-management decisions and activities, and has been shown to improve health outcomes. Despite the evidence that DSMES services are cost-effective and have a positive impact on diabetes-related outcomes, they are underutilized. To address this problem, the Centers for Disease Control and Prevention (CDC) developed a DSMES toolkit to increase access to and participation in DSMES services among people with diabetes and to promote health care provider referrals. The toolkit explains the process for securing recognition or accreditation of DSMES services. It offers resources to assist in maximizing reimbursement, eliminating barriers to participation, and linking DSMES to quality measures. The toolkit suggests improving access to DSMES through shared medical appointments, pharmacies, and telehealth. It describes the four critical times to refer persons to DSMES and provides tools to assist with making referrals. National experts from the American Diabetes Association and the American Association of Diabetes Educators, certified diabetes educators (CDE), and public health professionals informed the content of the toolkit. Participants from six state health departments; three DSMES services (pharmacy, federally qualified health center, local health department); and experts from the CDC (pharmacist CDE, nurse diabetes educator, project officer, endocrinologist) tested the toolkit and found it easy to use with relevant information that will be helpful in addressing barriers and challenges to improving access to and participation in DSMES. Expanded use of and referrals to DSMES can help ensure that people with diabetes receive the support they need to successfully manage their diabetes and prevent or delay serious and costly complications. The DSMES toolkit can assist diabetes and public health professionals in working together to address underuse of DSMES.

Disclosure
J. Houston: None. L.E. Edwards: None.
697-P: Final Outcomes of a 5-Year National Effort to Increase Awareness, Availability, Referrals, and Coverage for the CDC-Recognized Diabetes Prevention Programs and DSMES Programs
Authors: MENSA-KWAO AUGUSTINA , MENSA-WILMOT YVONNE , FARRIS KIMBERLY D. , BOWEN SHELLY-ANN , THUMMALAPALLY SHARANYA , MURPHY MONICA D. , RUTLEDGE GIA E. 
Published: June 2019

CDC’s State Public Health Actions 1305 Cooperative Agreement funded all 50 state health departments and DC for 5 years to increase the use of diabetes self-management education and support (DSMES) programs and the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) through strategies such as implementing referral policies in health care systems.
Objectives: (1) Describe activities implemented by states to increase awareness, access, utilization, and coverage of DSMES and CDC-recognized LCPs; (2) share findings from baseline to year 5 for CDC-recognized LCPs and DSMES-related activities, and (3) describe facilitators and barriers to implementing prevention and management programs. Qualitative and quantitative data were abstracted from state health departments’ annual evaluation and progress reports and health impact statements. Qualitative data were analyzed using thematic analysis. Quantitative data were analyzed to determine year-to-year percent change from baseline to Year 5. Common activities implemented by recipients included establishing new programs, securing insurance coverage for programs, and using marketing strategies to educate patients about the National DPP LCP and DSMES programs. Outcomes from baseline to year 5 will be shared on the total number of American Diabetes Association recognized/American Association of Diabetes Educators accredited DSMES programs and the number of people who had at least one encounter with a program. Key facilitators for and challenges to increasing program utilization for DMSES and the National DPP will be shared. Findings provide relevant data on best practices to support and scale the National DPP and DSMES programs for improved health outcomes in diabetes. Findings will inform the implementation of sustainable strategies for National DPP and DSMES programs and shape future technical assistance to recipients.

Disclosure
A. Mensa-Kwao: None. Y. Mensa-Wilmot: None. K.D. Farris: None. S. Bowen: None. S. Thummalapally: None. M.D. Murphy: None. G.E. Rutledge: None.