bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving the Recognition and Management of Elevated Blood Pressure among Youth with Type 1 Diabetes
Authors: GANDHI KAJAL , BUCKINGHAM DON A. , HEHMEYER JESSICA , KRAMER ALYSSA M. , OBRYNBA KATHRYN , INDYK JUSTIN A. , KAMBOJ MANMOHAN K. 
Published: June 2018

Background: Studies show that youth with type 1 diabetes (T1D) harbor cardiovascular risk factors and exhibit clinical signs suggestive of cardiovascular disease. ADA and ISPAD guidelines promote regular blood pressure screening to reduce cardiovascular risk, and strategies should involve effective screening and management. The diabetes clinic previously had limited measures in place to manage T1D youth with elevated blood pressure.
Objective: The aim of this quality improvement (QI) project was to increase provider recognition and follow-up of TID patients with elevated blood pressure readings ≥ 95%tile for age/gender/height, from 0% to 50%, by 12/31/17 and sustain through 12/31/2018.
Methods: After the QI team clarified project goals, a Key Driver Diagram (KDD) and elevated blood pressure process map was established. This algorithm aided to clarify the care process to efficiently recognize and manage youth with T1D who presented with elevated blood pressure in the outpatient diabetes clinic. A “Best Practice Alert” (BPA) was created within the electronic medical record, which alerted the diabetes care team of the presence of elevated blood pressure among T1D patients in clinic. This allowed the provider to choose electronically tracked care options in the medical record to manage elevated blood pressure among T1D patients and coordinate care among subspecialties that manage elevated blood pressure. Data reports were compiled to track utilization of the blood pressure BPA from May 2017 (initiation date) to December 2017 with ongoing data collection.
Results: Upon BPA creation, process mean of the utilization and management of elevated blood pressure BPA among T1D youth increased to 73% over a 7 month period.
Conclusions: This project successfully improved screening and management of T1D youth with elevated blood pressure in the outpatient setting. This project builds on comprehensive diabetes care, with the hope of reducing future cardiovascular burden for youth with T1D.

Disclosure
K. Gandhi: None. D.A. Buckingham: None. J. Hehmeyer: None. A.M. Kramer: None. K. Obrynba: None. J.A. Indyk: None. M.K. Kamboj: None.
Incorporating Depression Screening into Diabetes Clinics across the T1DX Learning Collaborative
Authors: MAJIDI SHIDEH , JOLLY MARY C. , ALONSO GUY T. , BUCKINGHAM DON A. , CABRERA ALYSSA B. , CLEMENTS MARK A. , GARRITY ASHLEY , GIBBS KATE A. , GLICK BETHANY , MING HONG K. , KAMBOJ MANMOHAN K. , LAMBERT KATHRYN L. , LEE JOYCE , NADKARNI PRASHANT V. , MCDONOUGH RYAN , OHMER AMY L. , RIOLES NICOLE , STANEK KELLY R. , THOMAS SARAH , WEINSTOCK RUTH S. , CORATHERS SARAH 
Published: June 2018

Objective: Depression contributes to suboptimal health outcomes amongst people with type 1 diabetes (T1D). The ADA standards of care recommend regular psychosocial screening, however these guidelines are not universally implemented.
Aim: Demonstrate feasibility of expanding depression screening across clinics in the national T1D Exchange Learning Collaborative (T1DX-LC) using a quality improvement (QI) approach.
Methods: Six clinics in T1DX-LC participated in bi-monthly calls and three learning sessions for depression screening. Sites shared existing resources and used QI methodology to design iterative plan-do-study-act cycles to develop or refine existing processes and adopt interventions in their respective contexts around the following themes: 1) consistent screening and referral criteria, 2) integration of screening into work flow, 3) acceptance from families and staff, 4) adequate social work and psychology referral resources, and 5) incorporation of health information technology.
Results: Screening increased from baseline of 10% across sites to 60% of eligible patients at all sites over 18 months (Figure).

Discussion: Through the T1DX-LC, a network of centers were successful at completing depression screening in alignment with ADA standards of care. Sites expanded screening to individuals with type 2 diabetes and additional centers are joining the screening intervention.

Disclosure
S. Majidi: None. M.C. Jolly: None. G.T. Alonso: None. D.A. Buckingham: None. A.B. Cabrera: None. M.A. Clements: Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Glooko, Inc.. A. Garrity: None. K.A. Gibbs: None. B. Glick: None. K. Hong: None. M.K. Kamboj: None. K.L. Lambert: None. J. Lee: Consultant; Self; Unitio. P.V. Nadkarni: None. R. McDonough: None. A.L. Ohmer: None. N. Rioles: None. K.R. Stanek: None. S. Thomas: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. S. Corathers: None.
Diabetogenic Potential of Dexamethasone and Effect of Annona Muricata Methanolic Bark Extract as Post-exposure Therapy in Albino Rats
Authors: OLADIPO TUNBOSUN A. , ADEOYE YEMISI D. , OLADIPO OLUWAMAYOWA O. , OLUKUNLE JOHNNY O. 
Published: June 2018

Background: Diabetes mellitus has been identified as the leading cause of death from non-infectious diseases. The use of dexamethasone is on the increase due to wide array of its therapeutic effects. Therefore, the potential of dexamethasone to induce DM and ability of Annona muricata methanolic bark extract (AMMBE) to treat DM were studied.
Methods: The research was carried in Federal College of Animal Health and Production Technology, Ibadan and lasted for twenty eight (28) days. Rats were allotted into four groups. Group B, C and D were induced with Dexamethasone (2mgkg-1) daily for 7 days i.p, while A was positive control group. B was induced without AMMBE administered, C was induced and treated with AMMBE at 400mgkg-1 and D induced and treated with glibenclamide (2.5mgkg-1b/w) for 14 days. Liver, kidney and pancreas were collected for histopathology.
Results: Dexamethasone induced diabetes after 7 days. Average blood sugar in induced groups (B, C and D) were 132.0±4.05a,129.0±1.41aand130.0±2.93a respectively. After administration of AMMBE, average blood sugar for C and D were 91.0±1.72b and 87.0±2.97c respectively. Clinical signs of alopecia, dehydration, paw-licking etc was seen. Massive loss of pancreatic cell mass after induction was seen. Liver lesions ranges from no visible lesion, accentuation and marked vacuolar degeneration of hepatocytes in periportal areas. Kidney degeneration and multifocal coagulation necrosis of tubular epithelium were observed. Blood sugar post exposure to AMMBE and Glibenclamide were drastically reduced.
Conclusions: It could be concluded that prolonged use of dexamethasone has potential of inducing diabetes and AMMBE has antidiabetic effect which could be fully explored.

Disclosure
T.A. Oladipo: None. Y.D. Adeoye: None. O.O. Oladipo: None. J.O. Olukunle: None.
Managing Diabetic Patients with Hypertension Comorbidity by Retail Pharmacists Using a Digital Solution in China
Authors: WANG WEI , LI YINGJIE , WANG ZHEN , LI DONGXING , ZHANG HONGGUANG , LIU KAI , CAO JIUMEI 
Published: June 2018

Objective: To identify the effects of implementing a digital approach at pharmacies to manage the healthcare outcomes of comorbidities of diabetes and hypertension.
Methods: A digital solution that includes a set of blood glucose (BG) and blood pressure (BP) tele-monitors, an App, and a cloud engine with decision support algorithms was implemented in 941 drug stores in 91 cities in China. During Jun 8th 2015 to Dec 26th 2017, a total of 3,468 patients of both uncontrolled BG and BP were recruited to receive the monthly in-store healthcare services of: 1) BG and BP testing with the results synchronized to the cloud, 2) App-assisted lifestyle modification for meal planning, coaching and exercise, and 3) App-guided medication consultation.
Results: The study population had an average age of 65.3 ± 10.1, BMI of 24.6 ± 3.3, and male of 47.2%. Their fasting blood glucose (FBG) and random blood glucose (RBG) were reduced by 0.8 mM (baseline: 9.1 ± 2.2 mM, last time: 8.3 ± 2.3 mM, P&lt;0.001) and 3.1 mM (baseline: 14.4 ± 3.2 mM, last time: 11.3 ± 4.0 mM, P&lt;0.001), respectively. Systolic and diastolic BPs were reduced by 9.1 mm Hg (baseline: 154.3 ± 14.7 mm Hg, last time: 145.2 ± 18.7 mm Hg, P&lt; 0.001) and 4.4 mm Hg (baseline: 86.5 ± 11.1 mm Hg, last time: 82.1 ± 11.8 mm Hg, P&lt;0.001), respectively. The proportion of controlled diabetic and hypertensive patients was 30.0% (n=1,040, P&lt;0.001) and 36.1% (n=1,251, P&lt;0.001) by the time of this analysis. Patients were satisfied with the intervention due to the convenient access to the digital database and the services available. The health outcomes were not associated with geographic differences or economic status of the site.
Conclusion: Mobilizing community pharmacists with new digital technologies presents an effective approach to provide patient-centered care for diabetic patients with comorbidities such as hypertension.

Disclosure
W. Wang: None. Y. Li: None. Z. Wang: None. D. Li: None. H. Zhang: None. K. Liu: None. J. Cao: None.
Comparison of Adult and Pediatric Resources for Type 1 Diabetes Care among T1D Exchange Centers
Authors: AGARWAL SHIVANI , HIRSCHFELD EMILY , GARRITY ASHLEY , SHAH AVNI , CORATHERS SARAH , WEINSTOCK RUTH S. , LAMBERT KATHRYN L. , BOBIK CRAIG , CABRERA ALYSSA B. , RIOLES NICOLE , LEE JOYCE 
Published: June 2018

Background: The American Diabetes Association recommends that patients with type 1 diabetes (T1D) receive care from a multidisciplinary team. We are unaware of studies that have compared staffing resources in pediatric and adult diabetes centers across the United States (U.S.).
Methods: In 2015, we performed an environmental scan of staffing resources for centers in the T1D Exchange. Total number of T1D patients and staff full-time equivalent (FTE) for T1D patients were enumerated. Mean staff FTE-patient ratios were calculated and compared within and between pediatric and adult clinics.
Results: We collected data on 57 diabetes clinics (38 pediatric, 19 adult) of 77 centers, which collectively cared for 45,873 pediatric and 34,287 adult T1D patients. Staffing ratios did not vary significantly within pediatric or adult clinics. However, upon comparison, adult clinics had approximately half as many staff resources as pediatric clinics, despite having similar volumes of patients (Table 1). Psychologists and social workers were available at 42% of adult vs. 87% of pediatric clinics (p&lt;0.001).
Conclusions: Among specialized T1D centers in the U.S., there are stark disparities in staffing in adult vs. pediatric clinics. The relationship of these resources to outcomes is unknown. Benchmarking may be needed to optimize T1D care for pediatric and adult populations with T1D.Table 1. T1D staff FTE to patient ratios of pediatric vs. adult diabetes clinics in the T1D ExchangeStaffPediatricAdultp-valuesMean RatioSDMean RatioSDPhysician1:1711:931:2181:1160.63Nurse Practitioner1:3471:931:6471:192&lt;0.001Certified Diabetes Educator1:581:191:1611:57&lt;0.001Registered Dietician1:3791:1771:7971:133&lt;0.001

Disclosure
S. Agarwal: None. E. Hirschfeld: None. A. Garrity: None. A. Shah: None. S. Corathers: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. K.L. Lambert: None. C. Bobik: None. A.B. Cabrera: None. N. Rioles: None. J. Lee: Consultant; Self; Unitio.
Probabilistic Prognosis of Different Treatment for the Diabetic Kidney Disease Course in Overweight and Obese T2DM Patients with Microalbuminuria
Authors: VELICKIENE DZILDA , MALECKAS ALMANTAS , IESMANTAS TOMAS , ALZBUTAS ROBERTAS 
Published: June 2018

Introduction: Diabetic kidney disease (DKD) is one of the most enabling microvascular complications. Comparison of different treatment is problematic, as there are no clinical trials comparing different managements and patients’ characteristics vary between the studies.
Aim: to create probabilistic model, which allows predict DKD course according to the different treatment.
Methods: A systematic literature review was performed, which allowed to estimate transition probabilities between the states of DKD - normoalbuminuria (NA), microalbuminuria (MA), diabetic nephropathy (NP), end stage renal disease. Due to the high complexity of dependence between transition rates and probabilities, Markov Chain Monte Carlo scheme was applied.
Results: Of 1,812 articles identified after initial search, 95 publications had relevant data to estimate transition probabilities between DKD states. The lowest transition probabilities from MA to NP and the highest probability of remission from MA to NA was found in surgery group, followed by ACEI and ARB medications group (Fig.1).
Conclusions: according to the model data bariatric surgery presents the highest probability of regression to NA state and the lowest probability of progression to NP state among the overweight and obese patients with type 2 diabetes mellitus and MA.

Disclosure
D. Velickiene: None. A. Maleckas: None. T. Iesmantas: None. R. Alzbutas: None.
Implementation Strategy for a Digital Health Tool Influences User Engagement
Authors: SHOMALI MANSUR , PEEPLES MALINDA 
Published: June 2018

Background and Aims: Digital health tools not only should be effective in clinical trials, but should be implemented into the healthcare ecosystem without adding undue burden for patient and the care team. We hypothesized that different modes of implementation may be associated with differences in engagement.
Method: In the first model, users received a prescription for a FDA-cleared digital tool from their healthcare providers. In the second model, certified diabetes educators provided the digital tool to their patients. In the third model, the digital tool was distributed via a direct-to-patient email from a large, national health plan for Medicare enrollees. The user data was collected electronically and de-identified according to data policies.
Results: 3,141 users were identified as part of the provider prescription model. Of note, 30.7% of users did not enter their diabetes medications into the system. 136 users were identified in the educator-driven model. Again, a significant minority (25.3%) did not enter their diabetes medications. In the health plan model, of the 11,000 enrollees who were invited to participate by email, 161 individuals activated accounts. Interestingly 67% of these users engaged with the digital tool via the web, not on mobile devices.
Conclusions: In the provider prescription and the educator models, individuals were provided the digital tool during a face-to-face visits. Though overall engagement with the system was good, a significant minority of users still did not enter their medications into the system. In the health plan driven model, only a small proportion of recipients of the emails activated their accounts. Surprisingly, those users were more likely to use the web portal vs. the mobile app. These insights can be used to guide the effective integration of digital tools into clinical practice.

Disclosure
M. Shomali: Consultant; Self; WellDoc, Inc. M. Peeples: Employee; Self; WellDoc, Inc..
Development of a Clinical Screening Tool for Undiagnosed Diabetes in a Hospital Observation Unit
Authors: NOONAN REBECCA M. , CASTILLO WILFRIDO J. , SAFFRAN GABRIEL M. , MONTGOMERY COLLIN B. , PHAYAL GANESH , SEEMANGAL RONALD H. , KOHN NINA , TIBERIO ALLISON , WOLFF ELISSA , SCHULMAN RIFKA , SILVERMAN ROBERT 
Published: June 2018

Background: While diabetes mellitus (DM) is typically diagnosed in the outpatient setting, 30% of patients in the U.S.A remain undiagnosed, prompting novel approaches to screening. There are 2 million Observation Unit (OU) stays annually in the U.S.A. The OU allows prolonged care for Emergency Department (ED) patients who are not sick enough to be hospitalized. A previous study found 9% of OU patients have undiagnosed DM and therefore our OU practice is to obtain HbA1c on patients without a history of DM. A typical OU stay is 24 hours, allowing adequate time for screening, education and initiation of treatment if warranted. To conserve resources, we developed a screening tool to allow selective HbA1c testing in the OU.
Methods: We reviewed OU admissions at a tertiary hospital and included patients with no known history of DM and who had HbA1c assessed during their OU stay. Those with HbA1c ≥ 6.5 were categorized as newly diagnosed DM. Previously validated clinical variables were tested in the model; also included were clinical variables readily available in the OU. A model was developed on 2/3 of the cohort and validated on the remaining 1/3.
Results: A total of 2425 patients met inclusion criteria. The final model included: BMI, race, family history of DM, age, serum sodium and potassium, glucose on ED arrival and initial systolic blood pressure. Predictive assessment of the model was strong with a C-statistic of 0.823. The model was validated and findings remained strong with a C-statistic of 0.788. Performance at the optimal cut-point yielded a sensitivity of 0.750 and specificity of 0.771.
Conclusions: This screening tool identifies 75% of previously undiagnosed DM patients, while excluding 77% of nondiabetic patients from testing. The model can be used at the bedside or embedded in the electronic medical record to selectively screen for DM. There is potential to identify large numbers of previously undiagnosed DM in the OU and the typical 24-hour stay allows time for education and treatment to be initiated.

Disclosure
R.M. Noonan: None. W.J. Castillo: None. G.M. Saffran: None. C.B. Montgomery: None. G. Phayal: None. R.H. Seemangal: None. N. Kohn: None. A. Tiberio: None. E. Wolff: None. R. Schulman: None. R. Silverman: None.
Complement and Cardiometabolic Risk in Adolescents
Authors: HOFFMAN ROBERT P. , COPENHAVER MELANIE M. , YU CHACK-YUNG 
Published: June 2018

Background: Adipocytes produce complement C3 and respond to activation products of the complement cascade. Increased complement levels in adults predict future cardiometabolic disease such as type 2 diabetes and myocardial infarction. Since these diseases have their origins in childhood we studied the relationships of complement components, C3 and C4, to cardiometabolic risk factors in healthy, nonHispanic white adolescents.
Methods: C3 and C4 levels, endothelial function (reactive hyperemia (RH), venous occlusion plethysmography), arterial stiffness (augmentation index (AI), arterial tonometry), lipids, interleukin-6 (IL-6), c-reactive protein, plasminogen activator inhibitor 1 (PAI1) insulin sensitivity and secretion (oral glucose tolerance test) were measured in 59 subjects (29 female, age=15.3±1.7 years, BMI=22.4.1±5.9 kg/m2, mean±SD). BMI percentile, waist circumference and percent body fat (air displacement) were measured to assess adiposity.
Results: C3 correlated with multiple cardiometabolic risk factors including reactive hyperemia (r=0.41, p=0.002), LDL (r=0.34 p=0.012), triglycerides (r=0.56, p&lt;0.001), PAI1 (r=0.30, p=0.023) insulin sensitivity (r=-0.31, p=0.024). C3 tended to correlated with AIX (r=0.25, p=0.074) and insulin secretion (r=0.24, p=0.079). C4 levels correlated with RH (r=0.28, p=0.043), AI (r=0.26, p=0.074) and IL-6 (r=0.41, p=0.003). Stepwise regression found that C3 levels predicted LDL independent of measures of adiposity and triglycerides in conjunction with waist circumference while C4 levels in conjunction with BMI%tile predicted AI, and IL-6 in conjunction with waist circumference. Adiposity measures alone predicted RH, HDL, PAI1 and insulin secretion and sensitivity.
Conclusions: These results indicate that obesity induced increases in C3 are likely to play a significant role in the development of adverse lipids with increased plasma triglyceride and LDL levels while C4 plays a role in the development of increased arterial stiffness and inflammation.

Disclosure
R.P. Hoffman: None. M.M. Copenhaver: None. C. Yu: None.
Effectiveness and Applicability of Self-Management Peer Coaching in the Continuity of Diabetes Care
Authors: MCGOWAN PATRICK 
Published: June 2018

The goal of this 2-year research project was to investigate the feasibility and effectiveness of telephone peer coaching for persons with type 2 diabetes. It involved a partnership between a university and 11 diabetes centers. One hundred nine persons with type 2 diabetes or who were familiar with type 2 diabetes (e.g., family members) were trained as coaches and learned how to use self-management behavioral change strategies and to navigate the healthcare system. Diabetes educators recruited 115 adults with type 2 diabetes who were experiencing difficulty managing.
Coaches and subjects were paired, and over a 6-month period, coaches telephoned subjects once each week and engaged in a 30 minute conversation focusing on managing their condition, their medications and on their family and work life. Both coaches and subjects completed questionnaires at baseline, and at 6 and 12 months. A one-way repeated-measures analysis of variance was used to investigate change with 14 measures. To investigate the peer coaching process, a grounded theory qualitative analysis was conducted to obtain information on the coaching process.
The analysis showed statistically significant improvements between baseline and 12 months, namely: A1c (-9%), patient activation (+15%), depression (-24%), self-efficacy (+23%), communication with health care professionals (+23%), and diabetes empowerment (+10%). Further analysis found that these results were not influenced by covariates of age, gender, number of chronic health conditions and education level. The main themes found in the qualitative study which contributed to participant improvements were: learning self-management skills, personal accountability, encouragement, finding resources, and the boundary between the coach and participant.
This pilot “pragmatic” study demonstrated that peer coaches are acceptable to clinicians and clients and have an important role in the continuity of care for persons experiencing diabetes.

Disclosure
P. McGowan: None.