bluuebunny/crossref_metadata_2025_split huggingface dataset:
Virtual Simulation Improves Clinical Decision-Making in Managing Type 2 Diabetes
Authors: LARKIN AMY , HANLEY KELLY L. , WARTERS MARTIN , LITTMAN GWEN S. 
Published: June 2018

This study was conducted to determine if online, virtual patient simulation (VPS)-based continuing medical education (CME) intervention that engages clinicians in a practical learning experience could improve performance of diabetologists/endocrinologists (D/Es) and primary care physicians (PCPs) in the management of T2D and sleep problems. The CME VPS intervention comprised one patient presenting at 2 different points. The VPS platform allows learners to order lab tests, make diagnoses, and prescribe treatments in a manner matching the scope and depth of actual practice. Learners’ choices were analyzed using a sophisticated decision engine. Tailored clinical guidance (CG), based on current evidence and expert recommendation, was provided following each decision. Learners were given the opportunity to modify their decisions after receiving CG. Decisions were collected post-CG and compared with each user’s baseline (pre-CG) decisions using a 2-tailed paired t-test to determine P values. Through November 2017, significant improvements were documented among participating learners after clinical guidance (D/Es n=19; PCPs n=391): Diagnosis of uncontrolled T2D: 40% absolute improvement among PCPs (3% pre-CG vs. 43% post-CG; P&lt;.001) and 26% improvement among D/Es (0% pre-CG vs. 26% post-CG; P=.004)Diagnosis of insomnia: 31% absolute improvement among PCPs (28% pre-CG vs. 58% post-CG; P&lt;.001) and 537 improvement among D/Es (11% pre-CG vs. 47% post-CG; P=.003)Insomnia treatment: 56% absolute improvement among PCPs (10% pre-CG vs. 66% post-CG; P&lt;.001) and 42% improvement among D/Es (11% pre-CG vs. 53% post-CG; P&lt;.001)Intensification of T2D treatment: 36% absolute improvement among PCPs (28% pre-CG vs. 64% post-CG; P&lt;.001) and 35% improvement among D/Es (29% pre-CG vs. 65% post-CG; P=.013)
This study demonstrates that VPS that immerses and engages the clinical learners in an authentic and practical learning experience can improve evidence-based clinical decisions related to the management of T2D.

Disclosure
A. Larkin: None. K.L. Hanley: None. M. Warters: None. G.S. Littman: None.
User Experience with a New Smartphone Application for Blood Glucose Monitoring (BGM) in an Information-Motivation-Behavioral Skills (IMB) Model Study
Authors: FISHER WILLIAM , STUHR ANDREAS , WALLACE JANE , ZHUPLATOV SERGEY , BAILEY TIMOTHY S. , PARDO SCOTT 
Published: June 2018

The CONTOUR®NEXT ONE BGM system (BGMS) includes a wireless-enabled BG meter that links to the CONTOUR®Diabetes app installed on a mobile device. The system, based on the IMB model, detects and reports patterns of BG readings and provides guidance for self-management. The IMB model emphasizes the need for actionable information, motivation to act, and behavioral skills for acting effectively, to strengthen self-management of diabetes. This 6-week study with 46 insulin-using individuals with diabetes assessed the BGMS with the CONTOUR®Diabetes app Version 2 Prototype. Participant appraisal of the BGM/app system was positive on multiple dimensions (Table 1). Participants strongly agreed/agreed that using this BGM/app system provided them with a better understanding of their disease (98%), helped them feel more engaged with their diabetes management program (91%), they felt more motivated to adhere to their health care provider's therapy and testing recommendations (76%), that the “My Patterns” pattern recognition feature was helpful in managing their diabetes (73%), and that they found themselves testing more frequently throughout the day (56%).

Disclosure
W. Fisher: Consultant; Self; Bayer AG, Ascensia Diabetes Care, Roche Diabetes Care Health and Digital Solutions. A. Stuhr: Employee; Self; Ascensia Diabetes Care. J. Wallace: Employee; Self; Ascensia Diabetes Care. S. Zhuplatov: Employee; Self; Ascensia Diabetes Care. T.S. Bailey: Research Support; Self; Abbott. Consultant; Self; Abbott. Speaker's Bureau; Self; Abbott. Research Support; Self; Ambra BioScience, Ascensia Diabetes Care, Becton, Dickinson and Company. Consultant; Self; Becton, Dickinson and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Calibra Medical. Consultant; Self; Calibra Medical. Research Support; Self; Companion Medical, Dexcom, Inc., Glooko, Inc., GlySens Incorporated, Lexicon Pharmaceuticals, Inc., Eli Lilly and Company. Consultant; Self; Eli Lilly and Company. Speaker's Bureau; Self; Eli Lilly and Company. Research Support; Self; Medtronic MiniMed, Inc.. Consultant; Self; Medtronic MiniMed, Inc.. Speaker's Bureau; Self; Medtronic MiniMed, Inc.. Research Support; Self; Novo Nordisk Inc.. Consultant; Self; Novo Nordisk Inc.. Speaker's Bureau; Self; Novo Nordisk Inc.. Research Support; Self; Sanofi. Consultant; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Senseonics. Consultant; Self; Intarcia Therapeutics, Inc.. Research Support; Self; Versartis, Inc., Xeris Pharmaceuticals, Inc., MannKind Corporation. S. Pardo: Employee; Self; Ascensia Diabetes Care.
Impact of Certified Diabetes Educators following Preapproved Protocols on Diabetes Self-Care Behaviors—Results of the REMEDIES 4D Trial
Authors: JOHNSON KRYS M. , MALMI MARKKU , KUO SHIHCHEN , ZGIBOR JANICE C. 
Published: June 2018

Diabetes self-care behaviors (DSCBs) play a significant role in controlling risk factors for diabetes-related complications when practiced consistently. Our objective was to evaluate changes in DSCBs in people with type 2 diabetes from primary care practices participating in the REMEDIES 4D study. REMEDIES 4D was a clustered, randomized trial in which certified diabetes educators (CDEs) implemented standardized treatment protocols to intensify treatment for glucose, lipid or blood pressure control. Fifteen practices and their patients were randomized to the intervention (n=175) or usual care (n=65). Eligible participants had uncontrolled HbA1c, blood pressure, or LDLc. The intervention group received diabetes self-management education in addition to treatment intensification, while the usual care group participated in monthly support groups for one year. DSCBs were measured via the Summary of Diabetes Self-Care Activities scale (SDSCA). Two-sample t-tests were conducted to examine differences in adherence to recommended daily diabetes self-care behaviors between the intervention and usual care groups. The population was 49% male with a mean age of 61 years. The main results of the trial demonstrated a significant 1% decline in HbA1c in the intervention group and no significant change in the usual care group. At baseline, intervention participants tested blood glucose (BG) an average of 4.3 days compared with usual care 3.0 days (P=0.232). At follow-up, intervention participants tested BG an average of was 4.9 days, 1.3 days more frequently than the control group (P=0.004). There was no significant difference between groups for adherence to the self-care behaviors of general diet, specific diet, exercise, or foot care. These findings suggest that CDEs following standardized treatment protocols will improve adherence to recommendations for daily blood glucose testing which may enable patients to maintain better glycemic control.

Disclosure
K.M. Johnson: None. M. Malmi: None. S. Kuo: None. J.C. Zgibor: None.
National Snapshot of State Health Department Outcomes and Lessons Learned from Implementing Diabetes Self-Management Education and Support Programs and National Diabetes Prevention Programs
Authors: RUTLEDGE GIA E. , ANAND MEENU , MENSA-WILMOT YVONNE 
Published: June 2018

In 2013, CDC developed the State Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke, a five-year cooperative agreement which combined the efforts of four divisions to fund 50 state health departments (SHDs) to implement strategies to work through health systems and communities to prevent chronic disease and reduce complications from multiple chronic diseases. The Division of Diabetes Translation recommended several strategies to support type 2 diabetes prevention and diabetes management. The strategies focused on 1) increasing referrals to CDC-recognized lifestyle change programs operating under the National Diabetes Prevention Program (National DPP); 2) securing the program as a covered benefit for state or public employees and Medicaid beneficiaries; and 3) increasing referrals to, coverage for, and availability of diabetes self-management education and support (DSMES) programs. Quantitative analysis of SHD performance measures data shows that from baseline to year 4, there was an increase in access to and participation in DSMES and the National DPP. Qualitative analysis of SHD workplans identified program accreditation, technical assistance, partnerships, reimbursement for DSMES, and flexible scheduling for patients as key facilitators for increased DSMES program utilization. SHD grantees reported reimbursement availability, practice/provider referral policies, and having standard curricula as facilitators to implementing the National DPP lifestyle change program.

Disclosure
G.E. Rutledge: None. M. Anand: None. Y. Mensa-Wilmot: None.
Cardiovascular Disease (CVD) Decision Aid for Youth with Type 1 Diabetes (T1DM)—Perspectives of Health Care Providers (HCPs) with Pediatric-Onset T1DM
Authors: KRALL JODI , LIBMAN INGRID , AFREEN SAMINA , SIMINERIO LINDA M. 
Published: June 2018

CVD is the leading cause of premature death in people with T1DM, yet many individuals are unaware. Strategies to engage youth in CVD prevention and lifelong disease management are needed. The purpose of this study was to gain insight from HCPs about a shared decision making (SDM) aid centered on CVD modifiable risk factors (A1c, blood pressure (BP), and cholesterol), and designed to present facts, risks/benefits, and actionable steps relevant to teenagers. Five HCPs with pediatric onset T1DM, age 27-30y, working in a pediatric DM center, participated in multiple focus groups, to iteratively guide development of the SDM aid. Based on their experience in having T1DM and providing DM care to youth, HCPs offered perspectives on the aid in terms of value, content, delivery, and support mechanisms. Feedback was transcribed and summarized. HCPs agreed that introducing the topic of CVD to teenagers was important. Reflecting on their own experiences, HCPs regretted that the topic was not discussed during their pre-adult care conversations, which they said contributed to their unawareness of CVD prevention at the time. In terms of content, HCPs found the aid to be well suited for the intended audience, easy to understand, and not overwhelming. They thought illustrations were helpful to convey key facts and prevention messages, and voiced that even if it would be unlikely that their patients would have abnormal BP or lipids presently, educating about target values and testing intervals would be beneficial in preparation for adulthood. HCPs did not anticipate that the aid would cause distress, noting it was well balanced, informative, but not intimidating and refrained from scare tactics. HCPs unanimously agreed they would use the aid with patients (and parents), and recommended applying it when reviewing lab results.
In summary, HCPS endorsed using the SDM aid to guide CVD discussions with youth. Studies are ongoing to assess its impact on youth with T1DM.

Disclosure
J. Krall: None. I. Libman: Consultant; Self; Novo Nordisk A/S. S. Afreen: None. L.M. Siminerio: None.
Training Nursing Staff to Improve Diabetes Care for Long-Term Care Facility (LTCF) Residents
Authors: HUBBERD ABEGAIL L. , HERNANDEZ CHRISTINA M. 
Published: June 2018

One out of four people age 65 and older residing in a long term care facility (LTCF) has type 2 diabetes (T2DM). Care and management of this population is a challenge for nurses and other providers. American Diabetes Association Guidelines (2017) recommend application of individualized HbA1c targets for LTCF residents, especially for those with compromises in clinical and functional status.
A needs assessment in a local LTCF identified deficiencies in the provision of evidence-based T2DM care for this LTCF population. This quality improvement (QI) project strove to 1) educate nurses about these residents’ needs and 2) incorporate the use of best practice diabetes standards in the nurse practitioner’s practice by providing in-service education. Specifically, emphasis was placed on HbA1c and finger stick monitoring, eye exams, and foot care.
Results indicated that educational in-services were an effective approach to improving knowledge concerning care of complex TD2M patients. The Advanced Practice Registered Nurse (APRN) (60% to 100%), the 3 registered nurses (63% to 87%) and 9 licensed vocational nurses (63% to 71%) increased in knowledge from baseline to the final 10 question post-test.
However, ophthalmology and podiatry referrals were not ordered routinely because of APRN, staff, and organizational resistance. Per an audit of 22 patient charts, utilization of standardized orders improved routine T2DM care. There were 13 HbA1c due and 12 were ordered (92%); the one renal panel that was due was ordered, and all 5 urine to albumin creatinine ratio were ordered. In addition, the APRN has awareness to evaluate discrepancies between HbA1c results and finger stick values.
QI projects in LTCFs may be difficult to implement and sustain related to staff turnover, understaffing, high patient acuity, and organizational and provider opposition. APRNs must advocate for continual utilization of evidence-based practice guidelines for all LTCF residents.

Disclosure
A.L. Hubberd: None. C.M. Hernandez: None.
Diabetes Inside—Following the Long-Term Impact of a Diabetes Quality Improvement (QI) Initiative in Primary Care
Authors: GUNASEKARAN UMA , FURMAN ROY E. , RODRIGUEZ KELLIE M. , ELIZABETH OBIALO E. , KASSA SENTAYEHU , SANTINI NOEL O. , FURMAN ELISE , MENEGHINI LUIGI 
Published: June 2018

In collaboration with the ADA, we implemented a QI project to improve glycemia in patients with type 2 diabetes (T2D) and poor glycemic control (A1C &gt; 9%) receiving care in a large urban safety net health system. The 18-month initiative focused on developing shared medical appointments for insulin initiation and management, supported by a primary care QI committee, educational interventions and development of EMR tools to facilitate diabetes management and documentation. We report 2-year data following implementation of the QI intervention.
Of 23,611 individuals (mean age 58 years) with 73,849 A1C data points over a period of 3 years 60% were female; 57% Hispanic white, 27% non-Hispanic Black, 9% non-Hispanic white; 62% received charity care, 30% Medicare/Medicaid, 5% commercial insurance. Control charts first demonstrated statistically significant increases in insulin use in poorly controlled patients followed by statistically significant improvement in population glycemic control (A1C average) and proportion of patients with A1c&gt;9% (see figure).
A primary care-based QI initiative targeting patients with T2D and A1C &gt; 9% led to appropriate increases in insulin prescriptions, which was followed by a system-wide improvement in diabetes control.

Disclosure
U. Gunasekaran: None. R.E. Furman: Consultant; Self; Novo Nordisk Inc.. K.M. Rodriguez: None. E. Obialo: None. S. Kassa: None. N.O. Santini: None. E. Furman: None. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association.
An Interdisciplinary Team Approach to Managing Diabetes in a Patient-Centered Medical Home
Authors: LAMIE STEVEN M. , BAILLOD JANET C. , ROCKAFELLOW STUART D. , GIBBS MARILYN B. , SCHEPPERLY DEBRA 
Published: June 2018

Background: Our private practice Patient-Centered Medical Home (PCMH) clinic proposed a pilot team-based program where patients would be seen between physician visits by an interdisciplinary team comprised of our CDE, Clinical Pharmacist, and Care Manager with the goal of helping to improve glycemic goals.
Methods: Patients age 18 or older with an A1c greater than 8.0 were identified through registry review and invited to participate. Team providers were under the supervision of the project lead physician. Number of visits was individualized for each patient. Visits centered on diabetes education, goal setting, and motivational interviewing. The project was pre-defined to have been successful if 15% of patients achieved improved control.
Results: A recruitment goal of 100 was targeted and 107 patients were identified and enrolled. One hundred and six patients completed the pilot program. Average A1c at the beginning of the study was 9.1%. A1c decreased to 8.2% at the end of pilot, a 0.9% decrease. A1c ranged from 8.0 to 14.5% at pilot initiation. At the end of the pilot A1c ranged from 5.1 to 10.8%. This represents a change of -7.4 to +1.8%. Seventy patients (65%) achieved improved A1c. Forty four (41%) patients achieved an A1c less than 8.0%. An additional 26 (24%) patients had improvement in A1c. Patients had an additional 7 visits on average. Average blood pressures declined by 2.7 mmHg systolic and 0.11 mmHg diastolic. Microalbumin to creatinine ratio testing increased to 95% compliance, an increase of 20%. Appropriate statin use was unchanged at 79% of patients.
Conclusions: The majority of pilot enrollees improved their diabetic control over the course of the pilot program. The pre-specified level for success was exceeded. This project demonstrates the ability of a private practice with limited resources to seek creative solutions and partnerships to improve patient care of challenging and complex patients.

Disclosure
S.M. Lamie: Speaker's Bureau; Self; Sanofi-Aventis. J.C. Baillod: None. S.D. Rockafellow: None. M.B. Gibbs: None. D. Schepperly: None.
Projecting Long-Term Diabetes Complications through a BRAVO-Based Mock Simulation for Promoting Diabetes Prevention Program (DPP)
Authors: SHAO HUI , YANG SHUANG , FONSECA VIVIAN , JI XU , SHI LIZHENG 
Published: June 2018

Correctly understanding consequences of diabetes is essential for motivating prediabetic patients to join the diabetes prevention program (DPP). The overall population estimates on diabetes complications may be lower than individual’s risk estimates which are subjective to their life expectancy. This study using a newly developed diabetes model aimed to project major diabetes complications, conditioning on a range of survival lengths. 2011-2016 National Health and Nutrition Examination Survey data were used to generate a nationally representative sample of newly diagnosed diabetes patients. The Building, Relating, Validating, Acting and Validating Outcomes (BRAVO) diabetes simulation model was used to project the long-term risks of diabetes complications for the NHANES sample. The cohort of simulated patients were followed up for 20/40 years, conditioning on zero mortality (i.e., mock simulation experiment) and cumulative incidence during the follow-up periods for each complication were recorded. The average age of newly diagnosed diabetes was 51.66 y. For diabetes patients who have survived for 20 years after diabetes onset, the probabilities for diabetes complications were: MI (20.4%), stroke (7.8%), congestive heart failure (CHF, 10.6%), angina (13.4%), revascularization surgery (RS, 54.4%), end-stage renal disease (ESRD, 11.7%), severe pressure sensation loss (SPSL, 56.6%), and blindness (27%). For diabetes patients who have survived for 40 years after diabetes onset, the probabilities of diabetes complications were: MI (55.8%), stroke (24.3%), CHF (46.1%), angina (34.4%), RS (85.8%), ESRD (31.7%), SPSL (86.9%), blindness (64.9%). The presentation of diabetes complications for a long survival time could help prediabetes patients better assess diabetes impact on health. The BRAVO-base decision support simulation could serve as a tool to educate prediabetes population on benefits of diabetes prevention program.

Disclosure
H. Shao: None. S. Yang: None. V. Fonseca: Consultant; Self; Abbott. Board Member; Self; American Association of Clinical Endocrinologists. Consultant; Self; Eli Lilly and Company. Stock/Shareholder; Self; Amgen Inc.. Consultant; Self; Asahi Kasei Corporation, AstraZeneca, Novo Nordisk Inc., ADOCIA, Intarcia Therapeutics, Inc., Sanofi-Aventis. X. Ji: None. L. Shi: None.
You Can Build It, and They Will Come—Working with Industry Allies to Build Successful Continuing Education Programs for Your Hospital
Authors: ANTINORI-LENT KELLIE , TURKA JOANNE F. , HAWKINS KATHRYN 
Published: June 2018

One of the most important responsibilities of inpatient diabetes educators is ensuring patients admitted to the hospital with diabetes are prepared for discharge. Not all hospitals have a diabetes educator on staff. Some, only one. Either way, the educational needs, the training and preparation for discharge, must be addressed. Our 520-bed acute care hospital has 1 diabetes educator. With 40% of all patients having diabetes, a team, not 1 individual, was needed. An interactive, interdisciplinary, entertaining, boot camp-style class was created. The mission: train staff nurses, dietitians, and pharmacists to be both comfortable and confident with teaching diabetes self-management skills at the bedside. The goal: ensure diabetes patients were thoroughly prepared and safe for discharge. The cost of implementing a successful program can be a barrier to program development. To overcome this, diabetes educators who worked in industry were invited to be a part of the program. We worked closely with our Lead Nurse Planner and the Continuing Education office to be certain all policies were followed. To measure the program’s success, a pre-and post-quiz and survey were given to participants. Evaluation of quiz scores demonstrate improved understanding of key patient education information. Evaluation of the surveys reveal improved understanding and confidence with teaching diabetes “survival skills.” Class evaluations are nothing but positive. In 3 years, Diabetes Boot Camp has spread to 5 other hospitals and trained more than 250 nurses, dietitians, and pharmacists. New in 2017, the survey and quiz are mailed to participants 6 and 12 months post-class. This is to evaluate the retention and usefulness of the class over time. A Diabetes Boot Camp2 was also created. Held once thus far, this class focuses on providing healthcare providers hands on experience with insulin pumps and sensors as well as learning how to care for hospitalized patients who wear these devices.

Disclosure
K. Antinori-Lent: Consultant; Self; Becton, Dickinson and Company. J.F. Turka: None. K. Hawkins: Employee; Self; Dexcom, Inc..