bluuebunny/crossref_metadata_2025_split huggingface dataset:
647-P: Role of Diabetes Educators in Providing Insulin Pump Training for School Nurses and School Physicians—Kuwait Experience
Authors: RAHME ZAHRA , MESBAH NAGLAA , ALJASER FAHED , SAAD EGLAL , TAHA NEHAD ABDULRAHEEM 
Published: June 2019

Objective: to investigate the impact of basic insulin pump training for school nurses and physicians on knowledge and confidence in caring for type1 diabetes[T1D] students using insulin pump therapy [IPT].
Methods: In groups of 15 healthcare professionals, a pediatric diabetologist and 3 diabetes educators (who are certified pump trainers) provided basic pump training for 137 healthcare providers, who were novice to IPT. For a duration of 4 hours, the training included 2 interactive lectures about IPT, management protocols of hyperglycemia, hypoglycemia and ketosis, followed by hands-on insulin pump workshop. Pre and post knowledge assessment about IPT management was performed using a 10-item knowledge questionnaire. Pre and post confidence level were assessed with a 9-item questionnaire using Likert’s scale T.
Results: 62 school nurses (7males) mean age 41.5 ± 11.7, with school experience of 8.8 ± 9.1 y and 75 school physicians (13 males), mean age 36.25 ± 6.2, with school experience 3.4 ± 1.5 y; attended the mentioned training. Pre and post knowledge assessment and confidence level scores were compared using Pearson’s correlations. Significant improvement in knowledge were found for both schools' physicians (r=0.007) and nurses (r=0.01). Additionally, significant improvement in confidence in caring for T1D students on insulin pump were found for both school physicians (p-value=0.047) and school nurses (p-value=0.018).
Conclusion: Pre-assessment showed the lack of knowledge and low confidence of school healthcare professionals about IPT. Significant improvement in knowledge and confidence in caring for T1D students who are on IPT resulted from the delivery of these workshops, which proved the effective role of diabetes educators to pump the knowledge and skills and enhanced their confidence in providing essential management for students at schools.

Disclosure
Z. Rahme: None. N. Mesbah: None. F. Aljaser: None. E. Saad: None. N.A. Taha: None.
653-P: Changes in Knowledge and Self-Efficacy following a Reproductive Health (RH) Intervention (READY-Guys) in Transition Clinic for Adolescent and Young Adult (AYA) Males with T1D
Authors: FISCHL ANDREA F.R. , CHARRON-PROCHOWNIK DENISE , ABUJARADEH HIBA , SEREIKA SUSAN M. , FINNEY JESSICA , DIAZ ANA M. , CHARACHE NICOLE , LIBMAN INGRID 
Published: June 2019

Background: 50% of males with T1D report RH complications (e.g., erectile dysfunction, decreased libido) starting at age 25 years; precursors to more life-threatening complications and affect family planning. Glycemic control may prevent/delay RH complications. AYA males are vulnerable to poor glycemic control. These issues are rarely discussed during routine clinic visits. Raising RH awareness regarding metabolic control and preventing RH complications starting in this age group is imperative.
Purpose: To examine the changes in knowledge and self-efficacy following a new educational/counseling intervention (READY-Guys) on diabetes and RH among AYA males enrolled in a large tertiary university-based children’s hospital transition clinic.
Methods: Diabetes and RH was a teaching module for AYA patients. Fourteen AYA males (17-22 years) completed quantitative measures on RH knowledge and self-efficacy before and after receiving READY-Guys (Reproductive-health Education & Awareness of Diabetes in Youth for Guys); and open-ended qualitative questions for feedback on the RH intervention. A paired t-test compared pre to post RH knowledge and self-efficacy; content analysis was used for open-ended responses.
Results: Both RH Knowledge (t=6.5, p&lt;.001) and self-efficacy (t=2.7, p=.019) improved significantly after the session. Open-ended themes included “session provided new information,” “it was helpful,” “start RH education in early adolescence.”
Conclusion: Attending the RH session appeared to improve AYA male’s knowledge regarding diabetes and RH and their self-efficacy to initiate discussion with health professionals and to take actions to decrease their risks of RH complications. The new RH information was acceptable and informative. To start during adolescence was confirmed by participants. Group discussion sessions during a transition clinic provided a venue to raise awareness about RH.

Disclosure
A.F.R. Fischl: None. D. Charron-Prochownik: None. H. Abujaradeh: None. S.M. Sereika: None. J. Finney: None. A.M. Diaz: None. N. Charache: None. I. Libman: Consultant; Self; Novo Nordisk Inc.

Funding
David Paul Diabetes Transition Care Research Initiative Fund
656-P: Characteristics Associated with Dropout in the National Diabetes Prevention Program, Montana, 2008-2016
Authors: CARPENEDO DOROTA , BROKAW SARAH M. , TYSK SONJA , FERNANDES JESSIE , HARWELL TODD S. , HELGERSON STEVEN D. , GOHDES DOROTHY M. 
Published: June 2019

Attendance and retention is a concern for the National Diabetes Prevention Programs (National DPP) because participants who complete more sessions benefit the most. This study identified characteristics of the National DPP participants associated with program dropout by comparing participant characteristics stratified by the number of program sessions completed (Table). From 2008 through 2016, 7,584 MT adults enrolled in the National DPP; 81% completed &gt;=11 sessions. Enrollees with high participation rates were more likely to be older, have lower baseline BMI, self-pay to participate, and have a parental history of DM, but less likely to have a history of GDM or to deliver a baby &gt;9lbs compared to enrollees with low participation rates. A logistic regression analysis found characteristics independently associated with early program dropout were aged 45-59 years [AOR 0.45, 95% 0.36-0.56], BMI 35+ [AOR 0.56, 95% 0.45-0.71], and having primary Medicaid/Medicare insurance [AOR 0.52, 95% 0.41-0.66]. Our findings identify participant subgroups that should be targeted to increase the National DPP participation rates in MT and provide benchmark comparison data for the National DPP programs elsewhere.

Disclosure
D. Carpenedo: None. S.M. Brokaw: None. S. Tysk: None. J. Fernandes: None. T.S. Harwell: None. S.D. Helgerson: None. D.M. Gohdes: None.
657-P: Inclusion of the Patient Voice: Aligned HCP and Patient Education in Diabetes
Authors: BEASER RICHARD S. , TURELL WENDY , SEGAL ALISSA R. 
Published: June 2019

Aligned educational programs for patient and health care provider (HCP) audiences were launched live and online in 2018 and were on-demand for 6 months. The patient program, “New Long-acting insulins for the Treatment of type 2 diabetes: Patient Perspectives,” consisted of four, 10-minute segments. The HCP program, “New Long-acting Insulins for the Treatment of type 2 diabetes: Data, Guidelines, and Perspectives on Patient and Provider Barriers,” was a 1-hour CME program. Both incorporated audience polling and question and answer segments. While each program was uniquely tailored to the different audiences, the overall goal was to provide knowledge and explore attitudes and barriers regarding ultra-long insulin therapy, including patient perspectives and exposing providers to the “patient voice” as part of their educational experience. The patient education was hosted on a patient-friendly diabetes education website and distributed through Facebook. Patient program faculty included physicians, a nurse educator, and a patient living with diabetes. The HCP program panel included a physician and a pharmacist CDE. Educational evaluation included pre/post/10-week follow-up online surveys targeting knowledge, competence and self-reported behavior changes. In total, 609 HCPs and 781 patients participated in the educational programs in-platform (on initiative web-sites) and 15,800 participants viewed the patient program via Facebook.
Results: Follow-up results indicated that 70% of patient learners improved HCP-related communication and 57% of improved health-related behaviors since participation. Of HCP learners, 75% reported the activity positively impact patient experience or outcome, and 87% reported the activity positively impacted clinical practice. 176 “themed” qualitative comments further detail the impact. Knowledge and competence questions that aligned with learning objectives consistently yielded improvements, 63% of which were statistically significant.

Disclosure
R.S. Beaser: None. W. Turell: None. A.R. Segal: None.

Funding
Sanofi U.S.
659-P: Family Caregivers' Roles in Supporting Adults' Self-Management of Diabetes
Authors: FIELDS BETH , RODRIGUEZ KERI L. , MAKAROUN LENA K. , ROBINSON CLAIRE H. , FORMAN JANE , ROSLAND ANN-MARIE 
Published: June 2019

Background: Increased social support positively influences self-management of diabetes, but limited data exist documenting the specific roles that family caregivers assume in supporting adults with diabetes. Moreover, explanations for why caregivers take on certain roles has received little attention. Understanding what roles caregivers fill and why is critical to informing and targeting services aimed at improving caregiver competency in promoting diabetes self-management for their loved ones.
Methods: To characterize caregivers’ roles in supporting adults’ self-management of diabetes, as well as reasons for assuming those roles, 31 one-on-one, in-depth, semi-structured telephone interviews were conducted with adults with type 2 diabetes (n=19) and their family caregivers (n=12). Two coders independently reviewed transcripts from interview audio recordings in NVivo 12 Pro using interpretive phenomenological data analysis.
Findings: Adults and their caregivers described three central roles of caregivers in diabetes self-management: care organizer, health motivator, and medication tracker. Caregivers also recognized another prominent role, knowledge seeker. Two explanations for assuming specified roles emerged: changes in health and healthcare expertise. Caregivers reported taking on care roles because their loved one experienced a health problem that required medical or surgical attention. Some adults described turning to caregivers for diabetes management support because their family member had a healthcare background, such as a nurse or paramedic.
Conclusion: These adult and caregiver perspectives shed light on what roles families assume in supporting diabetes self-management and why. Information gleaned from this study may help healthcare providers target support for family roles to enhance caregivers’ ability to help adults with diabetes management.

Disclosure
B. Fields: None. K.L. Rodriguez: None. L.K. Makaroun: None. C.H. Robinson: None. J. Forman: None. A. Rosland: None.

Funding
Ann Arbor VA Center for Clinical Management Research; Michigan Center for Diabetes Translational Research (5P60-DK09292)
66-OR: Remission of Type 2 Diabetes for Two Years Is Associated with Full Recovery of Beta-Cell Functional Mass in the Diabetes Remission Clinical Trial (DiRECT)
Authors: ZHYZHNEUSKAYA SVIATLANA V. , AL-MRABEH AHMAD , BARNES ALISON C. , ARIBISALA BENJAMIN , HOLLINGSWORTH KIEREN G. , PILKINGTON HELEN , SATTAR NAVEED , LEAN MICHAEL E. , TAYLOR ROY 
Published: June 2019

Aims: Observational studies have suggested that beta cell functional mass inevitably decreases over time. We assessed this after 2 years in a geographically defined subgroup of DiRECT who achieved initial remission after diet-induced weight loss.
Methods: A Stepped Insulin Secretion Test with Arginine (SISTA) was used to quantify functional beta cell mass (maximum insulin secretory response during hyperglycemia). Insulin secretion rates were estimated by de-convolution; 40 subjects initially achieved remission (HbA1c&lt;6.5% and FPG &lt;126mg/dl on no antidiabetic drug therapy). At 2 years 20 subjects (13M/7F) remained in remission, 13 gained weight and relapsed, and 7 lost to follow-up. A nondiabetic Comparator (NDC) group, matched for age/gender of DiRECT intervention group participants after weight loss, was studied.
Results: In the responder group, median (IQ range) maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months, 0.94 (0.57 to 1.24) (p=0.017 from baseline) at 12 months, and 0.94(0.64 to 1.44) (p=0.030 from baseline) nmol/min/m2 at 24 months. This was comparable to NDC (1.02(0.86 to 1.51) nmol/min/m2) by 12 (p=0.064) and 24 months (p=0.244).
Median first phase insulin response increased in responders from 0.042 (0.004 to 0.0637) at baseline to 0.108 (0.058 to 0.163) nmol/min/m2 (p&lt;0.0001) at 5 months, to (0.110(0.059 to 0.201) then 0.125(0.066 to 0.166) nmol/min/m2; p&lt;0.0001)] at 12 and 24 months.
Those who failed to maintain remission were characterized by more weight regain 5-24 months (11. 3±1.9 vs. 6.6±1.0 kg, p=0.036). In responders mean HBA1C was 6.0±0.0% at 24 months.
Conclusion: Provided weight regain is minimized, remission of type 2 diabetes is durable over 2 years, with a gradual increase to normal beta cell functional mass.

Disclosure
S.V. Zhyzhneuskaya: None. A. Al-Mrabeh: None. A.C. Barnes: None. B. Aribisala: None. K.G. Hollingsworth: None. H. Pilkington: None. N. Sattar: Advisory Panel; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S. Consultant; Self; NAPP Pharmaceuticals Limited. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Amgen Inc., Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Roche Diagnostics France, Sanofi. M.E. Lean: Consultant; Self; Counterweight Ltd., Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. R. Taylor: Advisory Panel; Self; Wilmington Healthcare. Speaker's Bureau; Self; Lilly Diabetes, Novartis AG.

Funding
Diabetes UK
661-P: Medical Officers (MOs) Training in Diabetes Management by Public Health Foundation of India (PHFI)—A Role Model to Improve Primary Health Care in Chronic Conditions
Authors: KUMAR PUSHKAR , BHALLA SANDEEP , CHANDWANI HARESH , MONGA ANURADHA 
Published: June 2019

Objective: To describe the unique training model of PHFI for training MOs in diabetes and associated comorbidities through state Government collaborations.
Intervention: In PHFI, the training division has been building capacities of physicians to upgrade their knowledge and skills in chronic conditions since 2010. These training initiatives are currently running at 533 centers in 27 States and UTs covering more than 101 cities and have trained 16878 PCPs across the country in diabetes, gestational diabetes, cardio diabetes and diabetic retinopathy programs. An analysis revealed that 30% of the trainees were from Government sector. An innovative collaborative model between PHFI, academic partners and various State Governments was established. MoU was signed with state governments, training of trainers was conducted and MOs were nominated from sub district health facilities. MOs were trained using evidence-based curriculum which included national guidelines. Curriculum was developed by the academic partners and reviewed by national experts. PHFI assured training quality by a robust monitoring and evaluation mechanism.
Result: Initially 2 State governments (Kerala, Kolkata Municipal Corporation) have partnered with PHFI for training their MOs, and every year 2-3 new State Governments have been adopting these diabetes initiatives for increasing knowledge and skills of their physicians. As a result, partnership with 10 States have trained 1156 MOs. State Governments have designated these trained MOs as NCD nodal officers and posted them at Primary health centers. End line evaluation has found increased confidence among MOs in managing diabetes in the primary health setup and decrease in referrals.
Conclusion: Collaboration with governments built capacities of MOs and strengthened primary care in the country. The success of this model in Indian setting implies its use in other LMICs.

Disclosure
P. Kumar: None. S. Bhalla: None. H. Chandwani: None. A. Monga: None.
663-P: Online Diabetes Nutrition Education for American Indian and Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives
Authors: STOTZ SARAH A. , BREGA ANGELA G. , MOORE KELLY R. 
Published: June 2019

Nutrition education is known to promote healthful dietary behaviors and reduce diet-related complications among people with diabetes. American Indians and Alaska Natives (AIAN) have more than double the risk for type 2 diabetes (T2D) and diabetes-related complications than non-Hispanic whites. Despite the high prevalence of T2D in AIAN communities, AIANs often lack access to diabetes-related nutrition education, particularly resources targeted to AIAN audiences. Literature suggests that online nutrition education may effectively serve low-income audiences, but research specific to AIANs is scarce. We employed qualitative focus group and individual interview methods to understand stakeholder perspectives on the feasibility of an online eLearning diabetes nutrition education program for AIAN adults with T2D. We interviewed four types of stakeholders, including: experts in AIAN diabetes nutrition education (n=9); AIAN educators, Native elders, and tribal leaders (n=11); and AIAN adults with T2D (n=29) and their family members (n=22) at 4 geographically distinct urban and reservation sites. Focus groups and interviews were recorded and transcribed verbatim. The constant comparison method guided data coding and thematic analysis and Atlas.ti (Mac Version 8.0) was used to digitalize the analysis. Participants shared that smartphone-based Internet access is common among AIAN adults, except for the very old. Sixty percent of focus group participants indicated that they use the Internet at least daily. Participants reported interest in online education opportunities that are reputable, culturally adapted for AIAN people, and smartphone friendly. Educators and leaders indicated that access to a registered dietitian and food resource management education via online learning would provide Native people with the additional support needed to eat healthfully in communities with high rates of food insecurity and limited access to healthy food.

Disclosure
S.A. Stotz: None. A.G. Brega: None. K.R. Moore: None.

Funding
American Diabetes Association (4-18-SMSC-01 to K.R.M.)
667-P: Effect of the Diabetes BeHaS Program on Diabetes Self-Care, Diabetes Empowerment, and Physical Function in Older Adults with Type 2 Diabetes
Authors: PARK KEUMOK , KU BON JEONG , KIM BOHYUN , JIN SOHYUN , SONG YOUNGSHIN 
Published: June 2019

The Be Happy and Strong (BeHaS) program was developed to improve self-esteem and physical function in 2006. In this study, the contents of BeHaS program was revised to include empowerment strategies (named of Diabetes BeHaS program) to improve diabetes self-care. The purpose of this study was to re-develop the Diabetes BeHaS Program in older adults with type 2 diabetes and its effect on diabetes self-care, diabetes empowerment, and physical function. Participants were recruited from a public healthcare center in S-city of South Korea. A matched subject design was used to allocate the intervention (n=31) and control (n=31) groups based on age, gender and HbA1c. Demographics, and clinical factors were checked via medical record. Researchers measured physical functions (handgrip strength and shoulder flexibility), and main variables were measured using validated instruments. Χ2-test and independent t-test were performed to confirm the homogeneity and the change scores of physical functions, diabetes self-care, and diabetes empowerment. Based on the empowerment theory, the Diabetes BeHaS Program were re-developed consisting of an education [10min/session] + diabetes empowerment strategies [10min/session] + physical activities [40min/session]), which was applied once a week by a trained nurse for two months. The change scores of physical functions (both hands grip strength [p &lt;.001], shoulder flexibilities [p &lt;.001]), diabetes self-care (p &lt;.001) and diabetes empowerment (p &lt;.001) were significantly increased in intervention group when comparing to counter group. The Diabetes BeHaS Program in older adults with type 2 diabetes that focused on empowering self-care might be an effective strategy to improve the diabetes self-care and diabetes empowerment as well as physical functions.

Disclosure
K. Park: None. B. Ku: Research Support; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca, Lilly Diabetes, Sanofi-Aventis. B. Kim: None. S. Jin: None. Y. Song: None.
675-P: Final Outcomes of a Four-Year Effort to Support, Scale, and Sustain the National Diabetes Prevention Program
Authors: MENSA-WILMOT YVONNE , MENSA-KWAO AUGUSTINA , FARRIS KIMBERLY D. , BOWEN SHELLY-ANN , THUMMALAPALLY SHARANYA , MURPHY MONICA D. , RUTLEDGE GIA E. 
Published: June 2019

CDC’s State and Local Public Health Actions 1422 Cooperative Agreement funded 17 states and 4 large cities for four years to develop and sustain the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) by implementing comprehensive environmental, health system, and community-clinical linkage strategies for populations at high-risk for type 2 diabetes.
Objectives: (1) Describe health system and community-clinical linkage strategies implemented; (2) share findings from baseline to year 4, and (3) highlight key facilitators and barriers to scale and sustain the National DPP. Qualitative and quantitative data were analyzed from awardees’ annual performance reports and health impact statements. Performance measure data from baseline to year 4 were analyzed to determine year-to-year percent change. Qualitative data from awardees were analyzed to identify barriers and facilitators to implementing activities, and understand how barriers were overcome. Recipients and sub-awardees worked with partners across key sectors to implement evidence-based strategies and increase coverage and referral policies to promote engagement in CDC-recognized LCPs. Outcomes from baseline to year 4 will be shared on reach of diabetes prevention media campaigns, the number of people in health systems identified as having prediabetes, the number of health systems engaging community health workers, and the total number of people enrolled in CDC-recognized diabetes prevention programs. Barriers and facilitators to implementation of the National DPP will also be shared. Key lessons learned from SLPHA-1422 include the importance of leveraging existing programs and infrastructure (i.e., SPHA-1305 resources) to scale and sustain the National DPP, establishing strong partnerships across sectors, providing on-going training and technical assistance to recipients and prioritizing enrollment of participants in CDC-recognized LCPs.

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