bluuebunny/crossref_metadata_2025_split huggingface dataset:
689-P: The Effect of Multidisciplinary Intervention on Diabetes Control in Patients with Poor Glycemic Control
Authors: GABAY LINOY , MENASHE IDAN , YEHOSHUA ILAN 
Published: June 2019

Many studies recommend that efficient diabetes care should be provided by a multidisciplinary team, but the optimal team composition and the independent contribution of each type of health professional on the studied outcomes are not well known. Additionally, real world evidence is needed to better understand the effectiveness of group approach strategies.
Objectives: to examine the effect of multidisciplinary intervention and group therapy on diabetes control.
Methods: A retrospective cohort study was performed among poorly controlled type 2 diabetes patients (HbA1c≥9%) insured by Maccabi Health Services, between 2012-2015. At the end of two-year follow-up (2013-2014), patients were divided into 2 groups, well controlled (HbA1c≤8%) and poorly controlled diabetes (HbA1c≥9%). Visits to each health professional (family physician/nurse/diabetic nurse/dietitian/etc.) and participation in diabetic group seminars were compared between these groups. Multivariable logistic regression was performed to assess the optimal multidisciplinary team composition associated with glycemic control.
Results: Of 8,811 eligible patients with HbA1c≥9% at baseline, 2,753 (31.2%) reached well-controlled diabetes and 3,929 (44.6%) remained poorly controlled. In multivariate analysis, primary care physician, dietitian and exercise specialist visits were significantly associated with glycemic control (p&lt;0.05).
Visits to a dietitian and exercise specialist improved glycemic control by 18% and 16% respectively, and care by family physician improved it by 1%.
In a multivariable model accounting for the number of visits to each provider and glycemic control, each additional group session improved the likelihood of achieving glycemic balance by 13%.
Conclusion: These results suggest that the optimal treatment of poorly controlled diabetes is a multidisciplinary team consists of physician, dietitian and exercise specialist, combined with diabetes group education.

Disclosure
L. Gabay: None. I. Menashe: None. I. Yehoshua: None.

Funding
Maccabi Healthcare Services
690-P: Building a Healthy Temple: A Faith-Based Diabetes Self-Management Support Program
Authors: WILMOTH SUMMER R. , CARRILLO LEAH , PAN MEIXIA , CHAVARRIA DIANA , WILHITE BRADLEY , PARRA-MEDINA DEBORAH , HE MEIZI 
Published: June 2019

Background and Objective: Type 2 diabetes disproportionally affects Hispanics. Diabetes self-management is key to preventing its life threating complications. Most Hispanics affiliate with churches, presenting a promising venue for delivering diabetes self-management support (DSMS) program. “Faith-placed” (FP) programing refers to health intervention implemented in church setting; while "faith-based" (FB) signifies integrating spirituality with health interventions. Building a Healthy Temple DSMS Program integrates spirituality with DSMS to improve diabetic outcomes.
Setting and Subjects: Predominantly Hispanic churches in Texas; Diabetic churchgoers.
Methods: This 13-week cluster-RCT assigned 18 churches to: 1) FB Group receiving a Health Sermon, 6-session DSMS, and 6-session Healthy Bible Study delivered by trained church lay leaders; or 2) FP Group receiving 6-session DSMS accompanied by a 7-session partial attention control curriculum delivered by outside professionals. Key outcome measures included HbA1c, BMI, waist circumference (WC), DSM Self-efficacy and diabetes quality of life (DQL) using the Problem Areas in Diabetes Scale (PAID). Data are collected at baseline, 6, 9, and 12 months. Intervention effects were determined using Linear mixed-effect models, controlled for age, gender and baseline corresponding outcome measures.
Preliminary Results: To date, 3 FP (n=48) and 3 FB churches (n=49) have delivered interventions and collected 9 month data. Post intervention, the FB Group appears to have a lower HbA1c than the FP Group (6.56 vs. 6.79; p=0.095). Single-group sub-analyses showed that only the FB Group sustained a 4% HbA1c reduction at 9 months (p&lt;0.05), and a 16% increase in DSM Self-efficacy scores at 6 and 9 months (p&lt;0.05). Compared to baseline, both groups significantly reduced WC and PAID scores (i.e., improved DQL) at 6 and 9 months.
Conclusions: Integrating spirituality with DSMS could lead to improved diabetes outcomes among Hispanic diabetic churchgoers.

Disclosure
S.R. Wilmoth: None. L. Carrillo: None. M. Pan: None. D. Chavarria: None. B. Wilhite: None. D. Parra-Medina: None. M. He: None.

Funding
American Diabetes Association (1-17-ICTS-029 to M.H.)
7-LB: Dichloroacetate Improves Cognitive Function during Hypoglycemia in T1DM Patients
Authors: GROSKREUTZ DEREK , TRICO DOMENICO , TAI NINGWEN , BELFORT-DEAGUIAR RENATA , LEVENTHAL JESSICA , LAM WAI , KNIGHT MARI-LYNET , GANNON JENNA , HERZOG RAIMUND I. 
Published: June 2019

Magnetic Resonance Spectroscopy (MRS) studies have suggested that exposure to recurrent hypoglycemia (RH) reduces brain cortical Pyruvate Dehydrogenase (PDH) flux in animal models. Examination of rat cortical RNA for inhibitory PDH kinase (PDK) isoform expression patterns identified a two-fold upregulation of PDK4 (p&gt;0.01) after three episodes of hypoglycemia. To date no study has examined the functional role of PDH complex inhibition in the cognitive deficits associated with hypo in patients with T1DM. In a randomized controlled cross-over trial of 11 intensively treated T1DM subjects we examined whether PDK inhibition by dichloroacetate (DCA; 12.5mg/kg), which maintains PDH in its active state might restore cognitive function, counterregulatory hormonal responses and symptoms during clamped hypoglycemia (target 50mg/dL). Cognitive testing included measures of visual matching ability and short term visual and auditory memory as well as the ability to manage conflicting information while ignoring task-irrelevant information. Symptom ratings during hypoglycemia were measured using a modified Edinburgh scale. We found that DCA ingestion is associated with increased performance related to visual memory (DCA: 89% correct vs. Placebo: 69% correct, p=0.049), as well as a faster response time during the multitasking test (549ms DCA vs. 603ms placebo; p=0.028). On the Edinburgh scale, patients reported lower ratings of warmness during hypoglycemia with DCA vs. Placebo (2.5 vs. 3.6; p=0.075). Furthermore, we did not observe an effect of DCA on CRR hormonal responses. These results suggest that inhibition of PDH flux by enhanced PDK activity significantly contributes to cognitive impairment under hypoglycemia and may contribute to subjective symptoms and possibly hypoglycemia awareness. We therefore conclude that strategies focusing on reactivation of oxidative glucose metabolism in the brain may play an important role in mitigating the negative impact of hypoglycemia on cognitive function.

Disclosure
D. Groskreutz: None. D. Trico: None. N. Tai: None. R. Belfort-DeAguiar: Research Support; Self; Silver Palate Kitchens, Inc. J. Leventhal: None. W. Lam: None. M. Knight: None. J. Gannon: None. R.I. Herzog: Consultant; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc.

Funding
JDRF
70-LB: Fat Mass and Obesity-Associated rs9939609 Gene Variant Is Related to Fasting Glucose in Children with Mental Health Conditions
Authors: WIEDEMAN ALEJANDRA M. , NGAI YING FAI , HENDERSON AMANDA M. , PANAGIOTOPOULOS CONSTADINA , DEVLIN ANGELA M. 
Published: June 2019

Over one million Canadian children are estimated to have a mental health condition, such as depression, anxiety, and attention deficit hyperactivity disorder. Many are treated with second-generation antipsychotics (SGA). In some children, SGA treatment is associated with excessive weight gain and metabolic complications including a 3-fold greater risk for type 2 diabetes. We currently have no way to identify SGA-treated children at risk for metabolic complications. The goal of our study is to determine if the fat mass and obesity-associated gene (FTO) rs9939609 variant is associated with metabolic complications in SGA-treated children. A cross-sectional population of SGA-treated (n=232) and SGA-naïve (n=378) children (≤18y) were recruited through Child and Adolescent Psychiatry at BC Children’s Hospital. Participants were genotyped, metabolic markers assessed; dietary intakes were estimated in a subset of children (n=79). The FTO rs9939609 variant genotype frequencies were not different between SGA-treated (TT 44%, TA 38%, AA 18%) and SGA-naïve (TT 42%, TA 39%, AA 19%) children. An interaction was found between SGA status and FTO genotype for fasting glucose (p=0.014). In SGA-naïve children, the A allele carriers compared to non-carriers had higher fasting glucose (4.95 vs. 4.78 mmol/L; p=0.001) in a model adjusted for age, sex, ethnicity, and zBMI. This difference was not observed in SGA-treated children. Daily energy intakes of A allele carriers were not significantly higher compared to non-carries in SGA-treated (1855 vs. 2087 kcal) and SGA-naïve (1606 vs. 1871 kcal) children. Our findings suggest that the A allele of the FTO rs9939609 variant is associated with higher fasting glucose in SGA-naïve children with mental health conditions.

Disclosure
A.M. Wiedeman: None. Y. Ngai: None. A.M. Henderson: None. C. Panagiotopoulos: Advisory Panel; Self; Dexcom, Inc. A.M. Devlin: None.

Funding
BC Mental Health & Substance Use Services
702-P: Perceptions of Caribbean Type 2 Diabetes Patients towards Insulin Prescription and Therapy
Authors: EZENWAKA CHIDUM E. , ONUOHA PHILIP C. , EXTAVOUR RIAN MARIE , YEARWOOD SAFIYA S. 
Published: June 2019

Background and Aim: Previous research studies have shown that poorly controlled type 2 diabetes patients do not receive insulin therapy because of the resistance of the patients to insulin prescription. This study aimed to assess the belief of Caribbean insulin-naive type 2 diabetes patients on insulin therapy.
Methods: We recruited 510 insulin-naive type 2 diabetes patients who have had diabetes for at least five years for a questionnaire interview. The questionnaire was a modified version of a validated research questionnaire previously used by other researchers. Data collected was analysed with SPSS software using chi-square to test for significances.
Results: The majority of the patients were females, of East Indian descent, have had diabetes for more than 10 years and take more than two different diabetes medications daily. About 67% and 81% of the patients do not believe that insulin therapy will cause them hypoglycaemia and weight gain respectively. Similarly, a significant percent do not believe that taking insulin will interfere with their normal lifestyle activities (72.2%, p=0.048). Although, a majority (64%) of the patients believe that taking insulin translates to personal failure in optimal blood glucose control, an overwhelming percent (90%) do not believe that taking insulin will cause people to treat them differently. Whereas a majority of the patients do not believe that taking insulin will be helpful in preventing long-term diabetes complications (63.9%, p=0.001), 51% thought that switching to insulin therapy would make them feel better within six months.
Conclusion: Contrary to several reports, this study shows that insulin-naïve Caribbean type 2 diabetes patients do not have a significant negative perception towards insulin therapy. This finding might be related to the socio-cultural background of the patients studied.

Disclosure
C.E. Ezenwaka: None. P.C. Onuoha: None. R. Extavour: None. S.S. Yearwood: None.

Funding
University of the West Indies at St. Augustine
704-P: Tailoring of a Pragmatic MA Health Coaching Intervention for Diverse T2D Populations
Authors: CLARK TAYLOR , GALLO LINDA , EUYOQUE JOHANNA A. , SAVIN KIMBERLY L. , BRAVIN JULIA I. , SANDOVAL HALEY , LEDESMA DUVIA LARA , PHILIS-TSIMIKAS ATHENA , FORTMANN ADDIE L. 
Published: June 2019

To address the burgeoning primary care demand-capacity imbalance, team-based models using medical assistants (MAs) to provide evidence-based, disease self-management support have been proposed. Randomized controlled trials (RCT) have shown MA health coaching improves clinical outcomes in chronic disease populations; however, pragmatic research is needed to evaluate effectiveness and feasibility in real-world health settings. Thus, we adopted a unique, cluster RCT to compare MA health coaching with usual care in N=600 adults with T2D, plus HbA1c ≥8.0% and/or SBP ≥140 mmHg, and/or LDL-C ≥100 mg/dL. Importantly, this in-progress trial examines implementation and outcomes across two very distinct settings: a federally qualified health center (Site A; majority Hispanic/Spanish-speaking, low SES patients; M age = 58.2) and a large, private insurance-based health system (Site B; majority non-Hispanic white/English-speaking, middle/upper SES; M age = 73.4). To facilitate integration with routine clinic processes, existing MAs are trained to perform at top of license, and EMR-based risk stratification identifies qualifying patients presenting to clinic each day. MA health coaches join primary care visits to understand the care plan and provide self-management support in conjunction with medical visits and by phone for 1 year. Dosage and intervention components (medication reconciliation, assessment, goal setting, lab review) are tailored to patient needs. A process evaluation revealed differences between Sites A and B in session frequency (M = 7 ± 3 vs. 4 ± 2), duration (M = 20 ± 15 vs. 14 ± 10 minutes), and focus (healthful eating vs. blood pressure monitoring) (all ps&lt;.05). Marked differences in the need for, and focus of self-management support parallel the relative differences in clinical control in these two distinct T2D populations (M A1c = 10.4 ± 1.8 vs. 9.4 ± 1.7%; M LDL-C = 142.1 ± 34.6 vs. 129.5 ± 21.7 mg/dL, ps&lt;.05). Valuable, site-based implementation successes and challenges will be presented.

Disclosure
T. Clark: None. L. Gallo: None. J.A. Euyoque: None. K.L. Savin: None. J.I. Bravin: None. H. Sandoval: None. D. Lara Ledesma: None. A. Philis-Tsimikas: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc., Glooko, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Stock/Shareholder; Spouse/Partner; Ionis Pharmaceuticals, Inc., Novo Nordisk Inc. A.L. Fortmann: None.

Funding
National Institutes of Health
71-OR: Dynamic Nrf2 Expression in Cutaneous Wounds Regulates Skin Reepithelialization
Authors: VILLARREAL PONCE ALVARO P. , DAVID JOSHUA A. , TIRUNEH MELAT WORKU , ABDOU SALMA , SULTAN DARREN , KWONG JENNIFER , KUHN JOSEPH , RABBANI PIUL S. , CERADINI DANIEL 
Published: June 2019

Diabetic ulcers are chronic cutaneous complications that amount to more than $50M in healthcare costs and are the leading cause of lower extremity amputations. In part, diabetic wound repair pathology results from over-production of reactive oxygen species (ROS) that stem from mis-regulation of Nrf2, a master transcriptional regulator of antioxidant genes. While regulation of Nrf2 and redox balance is critical for proper wound repair, the precise role of Nrf2 in coordinating wound regeneration is unclear. Here, utilizing an in-depth analysis of Nrf2 in the wound environment, we uncover an indispensable role of epithelial Nrf2 in promoting adult cutaneous re-epithelialization. Through spatio-temporal expression analysis and chromatin immunoprecipitation, we show mis-regulation of Nrf2 in diabetic wounds results from defective nuclear translocation of Nrf2 in epithelial cells of the wound environment (WT 96.97±3.58% vs. Diabetic 22.5±16.40%). Integrating K14-CreER;Nrf2flox/flox double transgenic mice, we demonstrate epithelial-specific deletion of Nrf2 results in a significant wound healing delay that is reminiscent to the diabetic wound burden (Control 16±0 days vs. Diabetic 32±0 days vs. KO 33±2 days). In addition to compromised proliferation indicated by reduced expression of Ki67+ in the epidermis (Control 66.36±7.63% vs. KO 25.78±4.01% p=0.0004), Nrf2-null keratinocytes exhibit reduced capacity to migrate in explant cultures. Using high-throughput transcriptome analysis and ex vivo functional assays, we show a prominent role of Nrf2 in regulating epidermal migration by governing directly governing onset of epithelial-to-mesenchymal transition (EMT) by regulating expression of Snai1 and Twist1 (5.6 and 8.9-fold reduction, respectably), two important regulators of EMT. Together, we provide evidence demonstrating the importance of Nrf2 in regulating critical events underlying wound repair and highlight its value as a promising agent in therapeutic intervention.

Disclosure
A.P. Villarreal Ponce: None. J.A. David: None. M. Worku Tiruneh: None. S. Abdou: None. D. Sultan: None. J. Kwong: None. J. Kuhn: None. P.S. Rabbani: None. D. Ceradini: None.

Funding
American Diabetes Association/Pathway to Stop Diabetes (1-16-ACE-08 to D.C.)
710-P: The Relationship between Health Literacy, Cardiovascular Disease Knowledge, and Diabetes Prevention Knowledge in Middle Eastern Patients at a Free Clinic
Authors: KAWATA CHRISTOPHER , JIANG LUOHUA 
Published: June 2019

This study's purpose was to investigate the level of health literacy, cardiovascular disease (CVD) knowledge and diabetes prevention knowledge, as well as the relationship among them, in the Middle Eastern population. A survey was conducted among the Middle Eastern patients of a free health clinic to obtain information on the health literacy and knowledge of these patients. A total of 73 surveys were collected and analyzed in this study. Print literacy and numeracy were strongly correlated with each other (r=0.4949, P&lt;0.0001). Both print literacy and numeracy were significantly correlated with the Diabetes Prevention knowledge score (print literacy: r=0.2764, P=0.0179; numeracy: r=0.4110, P=0.0003), but not with the CVD knowledge score. The Diabetes Prevention knowledge score had a high correlation with the CVD knowledge score (r=0.6980, P&lt;0.0001). Furthermore, print literacy was significantly associated with self-reported health status (r=0.2637, P=0.0242). Our results support that health literacy was associated with some disease-specific knowledge and self-reported health status in the Middle Eastern population. Future research that includes measures of health behaviors and objective measure of health status could help provide more insight into the interactions between these variables in this understudied population.

Disclosure
C. Kawata: None. L. Jiang: None.
711-P: Factors Associated with Insulin Adherence in Patients Initiating Insulin Therapy: A Three-Month Prospective Study
Authors: MA SHIHMING , WANG RUEY HSIA , LEE CHUN MING , HSU HUI-CHUN , LEE TAO-CHUN , CHEN SIH-YU 
Published: June 2019

Background: Insulin therapy is the most effective treatment to achieve optimal glycemic control in patients with type 2 diabetes (T2DM), while insulin adherence is crucial to achieve optimal glycemic control in insulin-treated patients. Understanding factors associated with insulin adherence in patients initiating insulin therapy will help to improve long-term insulin adherence.
Method: This study was a 3-month prospective study. One hundred and twenty-six (63 males and 63 females) patients with T2DM who were initiating insulin therapy were recruited. At baseline, when patients accepted receiving insulin therapy, demographic data (age, sex, duration of diabetes), psychosocial factors (health literacy, diabetes distress, quality of life, perceived benefits of insulin therapy, and perceived barriers of insulin therapy) were measured by self-reported questionnaires. Clinical data (HbA1c levels, body mass index) were collected from medical records. Adherence to insulin injection was measured by the 8-item Moriskey Medication Adherence Scale (MMAS) after 3 months of initiating insulin therapy. Higher score MMAS indicated poorer insulin adherence.
Results: The mean age of participants was 59.11 years (SD: 13.30). Baseline diabetes distress (r=0.202, p=0.024), quality of life(r=-0.227, p=0.010), and perceived benefit of insulin therapy (r=-0.189, p=0.035) significantly correlated with 3-month insulin adherence. Age, sex, baseline HbA1c levels, duration of diabetes, body mass index, health literacy, and perceived barriers of insulin injection did not significantly associate with insulin adherence.
Conclusion: Baseline psychosocial factors rather than demographic data and clinical data are associated with insulin adherence 3 months later. To improve insulin adherence, healthcare providers should address the diabetes distress, QoL, and perceived benefit of insulin therapy when educating patients initiating insulin therapy.

Disclosure
S. Ma: None. R.H. Wang: None. C. Lee: None. H. Hsu: None. T. Lee: None. S. Chen: None.
719-P: Inducible Estrogen-Related Receptor Alpha Overexpression Stimulates Skeletal Muscle Oxidative Metabolism and Improves Exercise Endurance in Mice
Authors: LI JING , HAMILTON ANGELICA , HUSS JANICE M. 
Published: June 2019

Aerobic exercise promotes skeletal muscle insulin sensitivity by enhancing glucose uptake and storage and by increasing mitochondrial oxidative capacity. Exercise-responsive transcriptional pathways that regulate metabolism represent potential therapeutic targets to combat insulin resistance. The ERRα nuclear receptor regulates mitochondrial oxidative metabolism and is required for the skeletal muscle metabolic response to exercise. In the current study investigated whether ERRα expression is sufficient to drive exercise-induced adaptations in muscle. We generated conditional ERRα transgenic mice that overexpress human ERRα in a tetracycline-inducible and skeletal muscle-specific manner (ERRαMOEiHSA). Dox-induced ERRαMOEiHSA (versus non-induced) mice exhibited reddening in glycolytic muscles, a characteristic of oxidative muscle. Mitochondrial content was increased in these muscles, based on mtDNA quantitation and citrate synthase activity. Consistently, ERRα-overexpressing muscles had higher O2 consumption rates and increased glycogen content. To determine if these metabolic changes altered exercise capacity, run performance was assessed in untrained mice. Dox-induced ERRαMOEiHSA mice tested at constant speed (endurance test) or at increasing speeds (aerobic test) ran longer compared to controls. Post-run blood glucose levels were higher in both testing paradigms, which may be due to greater reliance on β-oxidation and higher basal glycogen stores in ERRα-expressing muscles. Using ChIP and reporters assays we showed that ERRα directly activates gene encoding the catalytic (Ppp1ca) and regulatory subunits (Ppp1r3c) of protein phosphatase 1, involved in hormonal and contractile-activity control of glycogen metabolism. Collectively, these results demonstrate that short-term ERRα activation promotes muscle metabolic adaptations and exercise performance similar to exercise training.

Disclosure
J. Li: None. A. Hamilton: None. J.M. Huss: None.

Funding
American Diabetes Association (1-18-IBS-103 to J.M.H.)