bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depression and Anxiety Associated with Complications after Foot and Ankle Surgery in Diabetic Patients—Comparison with a Nondiabetic Population
Authors: KIRBY KRISTIN , HOBIZAL KIMBERLEE , SHEPHERD RENEE , WIZE TRESA 
Published: June 2018

The purpose of this study is to evaluate and compare the complications rates in diabetic patients with a history of depression and anxiety than those without diabetes following foot and ankle surgery. Diabetes and a diagnosis of depression have shown to increase post-surgical complication rates in other specialities including cardiothoracic surgery and plastic surgery. 1patients who were surgically treated by one surgeon at one hospital with foot and ankle conditions were retrospectively reviewed, identifying 28 patients with diabetes, 14 diabetic patients with depression, 1 with anxiety and 2 with both depression and anxiety. In comparison, there were 78 patients without diabetes identified and of those 78 subjects, 22 had depression, 3 with anxiety and 9 with both depression and anxiety. The primary outcomes evaluated were the rates of post-surgical complications and glycemic control. Diabetes, depression and anxiety was confirmed by diagnosis history and treatment. Most common complications included superficial soft tissue infection (SSI) and incisional dehiscence/delayed healing. Diabetic patients with a history of depression and anxiety had a 1.8 times higher likelihood to develop a post-surgical complication. Patients with diabetes with a history of a psychological disorder showed a complication rate of 28%. The complication rate associated with a psychological disorder without diabetes was 15%. In the 1patients, a psychological disorder was noted in 60% of the diabetic patient cases and for the group without diabetes was noted to be 43.5%. The mean HgbA1c of the 28 diabetic patients without complications included a mean of 6.5.
The presence of depression and anxiety in a diabetic patient negatively impacts the outcomes of patients undergoing foot and ankle surgery resulting in a higher likelihood of post-surgical complications in compared to those without diabetes.

Disclosure
K. Kirby: None. K. Hobizal: None. R. Shepherd: None. T. Wize: None.
Comparison of Microbiological Results of Two Bone Sampling Methods in Diabetic Foot Osteomyelitis—Debridement vs. Operation
Authors: ZOU MENGCHEN , HU PING , PAN YANLING , LUO XANGRONG , JIANG YA , XUE YAO-MING , CAO YING , GAO FANG 
Published: June 2018

The purpose of this study is to compare the microbiological results of debridement bone samples with those of corresponding results of operation bone samples for patients with diabetic foot osteomyelitis, using 16s rRNA high-throughput sequencing approach. We prospectively recruited 24 diabetic foot patients with osteomyelitis, and obtained 9 bone samples during surgery(Ds-Group) and 16 bone samples from debridement(Dd-Group). We compared the differences between debridement and operation procedures based on microbiological study of bone samples via 16s rRNA sequencing, using Ion PGM™ System Sequencer. It was obvious that microbes in Ds-Group, with narrower distribution, were more stable in alpha and beta diversity analysis. As for genera, totally 14 dominant genera were separated, and the average of Ds-Group and Dd-Group were respectively 10.44 and 9.44, with no statistically significant difference(P&gt;0.05). Halomonas spp. and Prevotella spp. were the predominant genera of Ds-Group and Dd-Group respectively. Ds-Group had significant more Anaerococcus spp., Dialister spp. and Pseudomonas spp. than Dd-Group(P&lt;0.05), but less Halomonas spp. and Nesterenkonia spp. than Dd-Group(P&lt;0.05). There were no difference in other dominant genera, such as Bacteroides spp., Finegoldia spp., Fusobacterium spp., Parvimonas spp., Prevotella spp., Proteus spp., Staphylococcus spp., Streptococcus spp. and Veillonella spp.(P&gt;0.05). We might draw a conclusion that though surgical operation was a little bit more accurate than debridement, microbiological study of bone samples from debridement could be capable enough for the diagnosis and treatment guidance of diabetic foot osteomyelitis.

Disclosure
M. Zou: None. P. Hu: None. Y. Pan: None. X. Luo: None. Y. Jiang: None. Y. Xue: None. Y. Cao: None. F. Gao: None.
Maternal and Paternal Exercise Regulates Offspring Metabolic Health and Beta-Cell Phenotype
Authors: ZHENG JIA , WAGNER ANA B.A. , PRINCE NOAH B. , SO KAWAI , MUL JORAM , DIRICE ERCUMENT , HIRSHMAN MICHAEL F. , STANFORD KRISTIN I. , KULKARNI ROHIT , GOODYEAR LAURIE J. 
Published: June 2018

Maternal and paternal environment are critical factors in determining risk for obesity and diabetes in offspring. Maternal exercise in mice can prevent the detrimental effects of maternal high-fat feeding on offspring metabolic health, whereas the effects of paternal exercise on offspring are less clear. Little is also known about the effects of maternal or paternal exercise on offspring beta cells, a major factor in glucose homeostasis. We determined the effects of maternal, paternal and maternal+paternal exercise on offspring glucose tolerance and beta cell morphology. Male sires were housed ± running wheels for 3 weeks before breeding (4.4±0.8 km/day) and dams were housed ± running wheels for 2 weeks before breeding (8.4±0.5 km/day) and during gestation (4.7±0.5 km/day). All male and female breeders were fed a high-fat diet. Four groups of male offspring were studied: both parents sedentary (Sed); maternal exercise only (Mat Ex); paternal exercise only (Pat Ex); maternal+paternal exercise (Mat+Pat Ex) (n=5-8 litters/group). Offspring were sedentary and separate cohorts were studied at weaning, 52, and 80 weeks. Post-weaning, offspring were fed a chow diet. There was no effect of parental exercise on offspring glucose tolerance at weaning. At 52 weeks, offspring of exercised parents had ∼25% lower fasting blood glucose concentrations vs. Sed (all p&lt;0.01), and glucose tolerance was improved in Mat Ex (33%), Pat Ex (35%), and Mat+Pat Ex (50%) vs. Sed (p&lt;0.001). Mat Ex, Pat Ex and Mat+Pat Ex had decreased beta cell size (40%) and mass (40%), whereas islet size and density were only decreased in offspring from Mat+Pat Ex parents (28% and 40%, respectively). Older offspring (80 weeks) from all three parental exercise treatments displayed improved glucose tolerance (p&lt;0.05). Maternal and paternal exercise in high-fat fed parents has profound positive effects on offspring glucose tolerance during adulthood and older age that may be linked to adaptations in the endocrine pancreas.

Disclosure
J. Zheng: None. A.B.A. Wagner: None. N.B. Prince: None. K. So: None. J. Mul: None. E. Dirice: None. M.F. Hirshman: None. K.I. Stanford: None. R. Kulkarni: None. L.J. Goodyear: None.
Microstructure Dysfunction May Be More Severe in Diabetes than in Peripheral Arterial Disease—A MRI Diffusion Tensor Imaging Study
Authors: EDALATI MASOUD , SORENSEN CHRISTOPHER J. , HASTINGS MARY , ZAYED MOHAMED A. , MUELLER MICHAEL J. , ZHENG JIE 
Published: June 2018

Aim: This study aims to assess the changes in water molecule diffusion properties during exercise of calf muscles in nondiabetes and individuals with type 2 diabetes mellitus (DM) and peripheral arterial disease (PAD).
Methods: Twenty subjects were examined in three groups using a 3T MRI scanner: 5 participants without DM and PAD (WDM), 11 with DM only, and 4 with PAD only. We used a custom-made MRI compatible ergometer that allows a constant exercise load. Diffusion tensor imaging (DTI) indices including fractional anisotropy (FA), mean diffusivity (MD), and percentage fiber length changes were calculated for medial, lateral gastrocnemius (MG, LG), and soleus (SOL) muscles.
Results: Among all muscles, MD increased during exercise in both patient groups with significant difference in the DM (P&lt;0.05). Significant differences in FA and MD between WDM and PAD during exercise were observed in LG and SOL muscles (P&lt;0.05). The DM group showed slightly greater fiber length reduction compared to other groups (P&lt;0.05).
Conclusion: While FA and MD showed similar values in DM and PAD groups, fiber length changes appeared more in DM than that in PAD. It suggests that the severity of microstructure dysfunction may be equal to or greater in DM compared to PAD.

Disclosure
M. Edalati: None. C.J. Sorensen: None. M. Hastings: None. M.A. Zayed: None. M.J. Mueller: None. J. Zheng: None.
Reducing Basal Insulin 90 Minutes before Exercise Protects Against Hypoglycemia Better than Insulin Suspension at Exercise Onset in T1D—The OmniTIME Results
Authors: ZAHARIEVA DESSI , MCGAUGH SARAH M. , POONI RUBIN , VIENNEAU TODD , LY TRANG T. , RIDDELL MICHAEL 
Published: June 2018

Guidelines for T1D suggest reducing basal insulin delivery 60 to 90 min before aerobic exercise. In this study, participants with T1D on CSII (Omnipod®, Insulet) (n=13) were randomized in a crossover design to three basal rate reduction strategies pre-exercise. All participants completed three 60 min aerobic exercise sessions (walking, ∼50% VO2max). Basal insulin delivery was reduced by; a) -80%, 90 min pre-exercise; b) -50%, 90 min pre-exercise or; c) -100% at exercise onset. Basal rates were resumed post exercise and participants then took 75% of usual bolus with a standardized meal. Pre-exercise blood glucose (BG) was similar in all conditions (9.5 ± 2.8 mmol/L). The mean BG drop during exercise was greater (p&lt;0.05) in the -100% (-4.2 ± 3.3 mmol/L) compared to the -50% and -80% conditions (-3.3 ± 2.4 vs. -2.0 ± 2.1 mmol/L), respectively. In the -100% condition, seven (54%) participants had hypoglycemia (hypo), whereas in the other two conditions only one hypo event occurred (8%, p&lt;0.001). Meal related BG responses after exercise were similar among all conditions.
In summary, reducing basal insulin delivery by 50-80% 90 min before aerobic exercise better mitigates hypo risk vs. basal suspension or disconnection at exercise onset. Basal rate reductions well in advance of exercise do not cause pre-exercise hyperglycemia or meal related rebound hyperglycemia.

Disclosure
D. Zaharieva: Speaker's Bureau; Self; Medtronic, Ascensia Diabetes Care. S.M. McGaugh: None. R. Pooni: None. T. Vienneau: Employee; Self; Insulet Corporation. Stock/Shareholder; Self; Insulet Corporation, GlaxoSmithKline plc. T.T. Ly: Employee; Self; Insulet Corporation. M. Riddell: Speaker's Bureau; Self; Medtronic. Consultant; Self; Eli Lilly and Company, JAEB Center For Health Research, Xeris Pharmaceuticals, Inc.. Research Support; Self; Insulet Corporation. Speaker's Bureau; Self; Insulet Corporation. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Ascensia Diabetes Care. Stock/Shareholder; Self; Zucara Theraputics. Other Relationship; Self; JDRF.
Parents with Type 1 Diabetes—Children's Role in Self-Management
Authors: KRALL JODI , HELGESON VICKI , VAN VLEET MEREDITH , LEE EUNJIN , SIMMS MARYJANE , KORYTKOWSKI MARY T. , BERG CYNTHIA 
Published: June 2018

Family members are a potential resource to support DM self-management, but how children are involved in their parents’ T1DM has not been well explored. The purpose of this study was to examine parents’ perceptions of the role children play in their DM care. Young, middle-age, and older adults with T1DM (n=85) and their romantic partners (n=55) participated in interviews during which they described their children’s knowledge and involvement in DM care. Interviews were transcribed and responses coded. All parents reported that children knew of their DM, which they learned about progressively from a young age, first being aware of blood glucose (BG) checks and devices. Some parents felt that children, particularly younger ones, detracted from DM management on occasion (e.g., nursing infant, caring for busy toddler), but this was usually expected and considered transient. Conversely, parents reported children to be accepting and understanding of the ways that DM affected their family experiences (e.g., pause to check and/or treat low BG), while also taking on a level of responsibility or concern (e.g., carrying a snack for treatment, worry about driving). Regardless of child age, many parents did not want DM to burden children and limited their involvement in DM care. When asked about DM-related behaviors, parents rated “making parent feel better about DM” as the most frequently occurring behavior. Only 3% of parents who used continuous glucose monitors and/or insulin pumps (n=60) said that children received notifications. Almost 40% of parents (n=33) expressed concern that children would develop DM. Parents, and more so partners, requested resources to enhance child awareness and preparedness to support parents with DM as well as ways to learn how to better communicate as a family and share perspectives on how DM affects individual family members. Diabetes educators should consider developmentally and relationally appropriate ways to engage children of parents with T1DM in education and self-management.

Disclosure
J. Krall: None. V. Helgeson: None. M. Van Vleet: None. E. Lee: None. M. Simms: None. M.T. Korytkowski: Advisory Panel; Self; Novo Nordisk Inc.. Other Relationship; Self; JAEB Center For Health Research. C. Berg: None.
Digging Deep into Diabetes—Barriers to Achieving Glycemic Control in Diabetic Patients in a Resident-Run Clinic
Authors: HAWATMEH SARA , MEIER MAGGIE , QAIYUM OSMAN , FARHAN ASGHAR MUHAMMAD , TALEBIAN AMIR , KAUR HARINDERJEET , HAQUE RAMZA , SHAILLY RAJAT , KAWSAR HAMEEM 
Published: June 2018

Introduction: Diabetes mellitus (DM) affects over 29 million Americans with an estimated annual cost of $245 billion. Diabetes in patients with multiple comorbidities, financial, and/or social hardships pose challenges to achieve target hemoglobin A1c (HbA1c). We investigated the barriers to achieve the HbA1c goal in patients in a federally funded resident-run clinic.
Methods: Among diabetic patients in our clinic, 29% had a HbA1c &gt;9.0 in 2016. We reviewed these patients’ medical records, and interviewed them to identify the barriers in achieving HbA1c ≤9.0. Interviews were used to assess their knowledge about diabetes, perceived self-efficacy of disease management, confidence level regarding treatment plan, and the patient’s declaration of barriers of diabetic management. Then, we conducted an intervention to include regular telephone follow-up and clinic visits to ensure adequate supplies, medication refills, and diet and medication compliance. We have also engaged social service workers to address issues with transportation, medication costs and insurance coverage.
Results: A total of 87 patients with HbA1C &gt;9.0 qualified for the study, 94% were African American with female predominance (55%). Average age was 52.2 years and average BMI was 33.32 kg/m2. Average HbA1c was 11.5%. We were able to reach 59 patients to interview. Of those reached, 98% knew they had DM, 83% knew about HbA1c, but only 32% knew their last HbA1c. Major obstacles to achieve HbA1C goal are noncompliance with diabetic diet (29%), inability to afford medications (22%), inadequate medication refills (25%) and forgetting to take medication (20%). After 3 months of intervention, average hemoglobin A1c dropped to 9.7% from 11.5%, and 34 (58%) patients had an absolute decrease in their HbA1c from pre-intervention period. HbA1C dropped below 9% in 12 patients (20%). The intervention is currently ongoing.

Disclosure
S. Hawatmeh: None. M. Meier: None. O. Qaiyum: None. M. Asghar: None. A. Talebian: None. H. Kaur: None. R. Haque: None. R. Shailly: None. H. Kawsar: None.
Diabetes Distress—Provider Perspectives
Authors: JOHN ANN-MARIE 
Published: June 2018

Purpose: Though many studies focus on patient perspectives of diabetes distress (DD), provider perceptions of DD require further investigation. Defined as the diabetes-specific distress related to the emotional and behavioral burden of living with type 2 diabetes (T2DM), DD is a major psychological challenge to self-management. The purpose of this qualitative study was to explore how primary care team members identify factors that contribute to DD future intervention.
Methods: Eighteen care providers from three rural nurse-managed interprofessional clinics located in Northern Virginia participated in the study. Using purposive sampling, providers were interviewed to obtain perspectives on DD in the management of T2DM. Face-to-face interviews were conducted, digitally recorded, and transcribed. Two researchers coded the transcripts into themes. Data collection and analysis occurred sequentially using a constructivist grounded approach.
Results: Provider narratives identified a lack of awareness of DD in their experiences with T2DM-related psychological and emotional challenges in a low-income, immigrant, underserved patient population. When asked about DD, most participants discussed the biomedical aspects of diabetes management, such as diet, exercise, medications, and blood glucose management. The key facilitator identified by the few participants who recognized DD was the interdisciplinary team practice model. Perceived barriers included: 1.) limited knowledge of DD by the healthcare team, 2.) under recognition of DD in reported practice, 3.) time constraints, and 4.) limited clinical experience with treating or referring patients with DD to appropriate mental health services.
Conclusions: The American Diabetes Association (ADA) Standards of Medical Care in Diabetes recommends ongoing assessment and monitoring of DD to prevent and delay its progression. Therefore, the challenge is to enhance provider understanding of DD and promote strategies and activities that help reduce DD and improve diabetes outcomes.

Disclosure
A. John: None.
Weight Loss Achieved by Participants with Hypertension/Elevated Blood Pressure in a Diabetes Prevention Program
Authors: BROKAW SARAH M. , CARPENEDO DOROTA , TYSK SONJA , FERNANDES JESSIE , HELGERSON STEVEN D. , HARWELL TODD S. ,   MONTANA DIABETES PREVENTION PROGRAM STUDY GROUP
Published: June 2018

In light of new national guidelines by the AHA/ACC that recommend lifestyle intervention as the primary mode of treatment for adults with hypertension (HTN), we assessed weight loss achieved by adults that had a HTN diagnosis and/or a measured blood pressure (BP) ≥140/90 mm Hg in an intensive lifestyle change intervention provided by lifestyle coaches using the National Diabetes Prevention Program (DPP) curriculum. From 2008-2016, 6,418 participants enrolled in the Montana DPP, and 55.8% (n=3,582) had HTN/BP on enrollment. Participants with HTN/BP were significantly older, weighed more at baseline, had greater fasting glucose, and attended more sessions than did other participants (Table). After the 16-week core sessions four months), participants in both groups achieved significant weight loss. Results from the logistic regression model indicated that the factors independently associated with achieving 7% weight loss were being female [AOR 0.57, 95% 0.44-0.74], having low prediabetes risk score of 3-8 [AOR 0.60, 95% 0.40-0.89], meeting the physical activity goal [AOR 1.46, 95% 1.17-1.82], and self-monitoring fat for 7-13 weeks [AOR 5.66, 95% 4.10-7.81] and 14-16 weeks [AOR 12.81, 95% 8.87-18.49]. These data suggest, the DPP is likely an effective method to support adults with HTN/BP in making recommended lifestyle changes and decreasing an important blood pressure risk.Table. Participant baseline characteristics and outcomes during the 16-week core (four months), by hypertension/BP status, Montana DPP, 2008-2016.Hypertension/BP ≥140/90 (N = 3,582)No Hypertension/BP &lt;140/90 (N = 2,828)Mean (SD)Mean (SD)Age (Years)55.8 (11.6)51.2 (12.5)*Baseline BMI (kg/m2)37.1 (7.3)35.2 (7.0)*Baseline fasting blood glucose (mg/dL)101.4 (13.7)98.5 (13.3)Sessions attended15.0 (6.1)14.7 (6.0)*Weight change (kg)-5.1 (5.3)-4.8 (5.3)*% (n)% (n)Sex (Female)79.1 (2,836)85.2 (2,406)*Prediabetes risk score (low 3-8)7.9 (108)12.7 (109)Met ≥150 min/week physical activity goal58.3 (1,867)57.7 (1,449)Self-monitored fat intake 14-16 weeks30.8 (1,015)26.0 (659)*Achieved ≥5% weight loss47.4 (1,701)46.0 (1,300)Achieved ≥7% weight loss goal31.7 (1,138)30.0 (848)*P≤0.05

Disclosure
S.M. Brokaw: None. D. Carpenedo: None. S. Tysk: None. J. Fernandes: None. S.D. Helgerson: None. T.S. Harwell: None.
HCP and Patient Perspectives on Basal Insulin Titration
Authors: UZOIGWE-SMITH CHIOMA , LEVIN MARGARITA , PFAFF DOUGLAS B. , MOCARSKI MICHELLE , HAMERSKY CAROL M. , POLONSKY WILLIAM 
Published: June 2018

Little is known about the discussion regarding titration at the time basal insulin is initiated for people with type 2 diabetes (T2DM) and about how titration occurs in the real world. This qualitative study investigated attitudes and practices of health care professionals (HCPs) and patients associated with basal insulin titration. Twelve virtual focus groups, comprising 23 HCPs (8 endocrinologists, 15 primary care physicians) and 22 adult patients with T2DM whose length of time since starting basal insulin was ≤ 4 years, were recruited from panels from across the U.S. from June to August 2017. Fifteen of 23 HCPs (65%) reported that they typically discussed titration at the time basal insulin was first prescribed. Twelve of 23 (52%) discussed target blood glucose (BG) ranges in initial conversations. Thirteen of 23 (57%) said most of their patients did not completely understand elements of the titration discussion. Of 16 HCPs who discussed what they do when their patients appear overwhelmed by or do not comprehend treatment instructions, 9 would start most of their patients on HCP-guided titration, 5 would delay titration and 2 would encourage self-titration without delay. HCPs on average reported 43% of their adult T2DM patients reached their A1c target within 6 months; they also reported 40% of their self-titrating patients ever reached their A1c target. Seventeen of 22 patients (77%) began titration when basal insulin was prescribed, and recalled injection and dose adjustment instruction from initial conversations. Twelve of 22 (55%) felt they were provided insufficient context on expectations around increasing insulin and/or how long titration could take. Four patients said they linked dose increases to personal failure. Eleven of 22 patients identified as self-titraters. Of 16 patients aware of their A1c or BG targets, 5 (31%) achieved them and 3 of 5 patients took ≥ 12 months to do so. HCPs and patients revealed patients often do not understand the basal insulin titration process and often do not achieve treatment goals.

Disclosure
C. Uzoigwe-Smith: Employee; Self; Novo Nordisk Inc.. M. Levin: None. D.B. Pfaff: None. M. Mocarski: Employee; Self; Novo Nordisk Inc.. Stock/Shareholder; Self; Novo Nordisk A/S. C.M. Hamersky: Employee; Self; Novo Nordisk Inc. W. Polonsky: Consultant; Self; Abbott, AstraZeneca, Dexcom, Inc., Sanofi, Novo Nordisk Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Servier, Ascensia Diabetes Care, Merck & Co., Inc., MannKind Corporation, Glooko, Inc., Roche Diabetes Care Health and Digital Solutions.