bluuebunny/crossref_metadata_2025_split huggingface dataset:
831-P: Comparing Experience and Satisfaction of Adults with Type 1 Diabetes Participating in Interventions to Reduce Diabetes Distress
Authors: BOWYER VICKY , FISHER LAWRENCE , HESSLER DANIELLE M. , POLONSKY WILLIAM , MASHARANI UMESH , PARRA JOSÉ , DEDHIA MANSI 
Published: June 2019

Diabetes distress (DD) refers to the emotional burdens that arise from living with a demanding chronic disease like diabetes. T1REDEEM was a randomized-controlled trial comparing two group interventions to reduce DD among adults with type 1 diabetes (T1D): KnowIt (KI), a comprehensive education program, and OnTrack (OT), a program focused on identifying and addressing diabetes-related emotions. Both programs included a group workshop and 4 online group meetings over 3 months. Both programs were equally effective in reducing high DD. The aim of this report is to compare participant satisfaction between programs, and to identify key themes related to participation. 267 of 293 (91.1%) participants completed surveys following the 3-month intervention program to rate satisfaction and experience. T-tests compared group mean scores. A thematic analysis of open-ended survey questions identified overarching experiential themes. Participants in OT were significantly more satisfied than those in KI on multiple measures: they rated OT as more helpful (3.62 (1.1) vs. 3.13 (1.1)), had a more positive group workshop experience (4.22 (.9) vs. 3.68 (1.1)), and reported profiting more from group discussion (3.98 (1.0) vs. 3.58 (1.1)) and group support (3.72 (1.2) vs. 3.19 (1.3), all p&lt;.05). Main themes related to satisfaction and experience differed by group. KI participants reported higher levels of disappointment, especially concerning lack of novelty of program content. OT participants reported greater exploration of new health behaviors, gaining a new perspective on their diabetes, and finding the experience of meeting other adults with T1D to be more assuring. Feeling support from and connection with other group participants was a more common theme in OT than KI. Findings suggest that high DD T1D adults participating in an emotion-focused intervention were more satisfied than those attending an education-focused program to address high DD.

Disclosure
V. Bowyer: None. L. Fisher: Consultant; Self; Abbott, Eli Lilly and Company. D.M. Hessler: Consultant; Self; Eli Lilly and Company. W. Polonsky: Consultant; Self; Abbott, Bigfoot Biomedical, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Johnson & Johnson Diabetes Institute, Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Servier. U. Masharani: Research Support; Self; Clementia Pharmaceuticals. J. Parra: Employee; Self; Behavioral Diabetes Institute. M. Dedhia: None.

Funding
National Institutes of Health
841-P: Clinically Elevated T1D Distress and Depression in Parents of Kids with New-Onset Type 1 Diabetes (T1D)
Authors: NOSER AMY E. , CLEMENTS MARK A. , MONZON ALEXANDRA , MAJIDI SHIDEH , PATTON SUSANA R. 
Published: June 2019

We applied existing clinical cut-points for T1D distress to examine cross-sectional and prospective relations between distress and depression in 127 parents of 5-9-year-olds with new-onset T1D. Parents completed the Problem Areas in Diabetes Survey- Parent Revised (PAID-PR) and the Center for Epidemiologic Studies-Depression Scale-Revised (CESD-R) at baseline, 6, 12, 18, and 24 months post-baseline. We used clinical cut-points &gt;3.11 (item mean) and &gt;16 (total score) for the PAID-PR and CESD-R, respectively, to identify parents with elevated scores. We used unadjusted odds ratios to explore cross-sectional and prospective relations between parents’ scores. At baseline, kids were 7.5±1.3 years-old and 4.7±3.2 months from diagnosis. 68% of parents had PAID-PR scores &gt;3.11 at baseline, dropping to 25-38% of parents later. 21-28% of parents had CESD-R scores &gt;16 across all visits. Compared to parents without elevated PAID-PR scores at 6 months, parents with elevated PAID-PR scores were more likely to have elevated CESD-R scores at 6, 12, 18, and 24 months (ORs: 3.5-7.8, p’s ≤ .05) and these relations persisted. While elevated T1D distress may be common for parents shortly after their child’s diagnosis, our data suggest persistent elevated T1D distress is a risk factor for current and subsequent parental depression. Thus, we need interventions to treat T1D distress in parents of kids with new-onset T1D.

Disclosure
A.E. Noser: None. M.A. Clements: Advisory Panel; Self; Glooko, Inc. Consultant; Self; Eli Lilly and Company. Speaker's Bureau; Self; Medtronic. A. Monzon: None. S. Majidi: None. S.R. Patton: None.

Funding
National Institutes of Health
849-P: Comparative Effectiveness of In-Person and Conference Call Group Lifestyle Interventions in Primary Care—The Real Health Diabetes Randomized Clinical Trial (RCT)
Authors: DELAHANTY LINDA M. , CHANG YUCHIAO , PORNEALA BIANCA C. , MCCARTHY JEANNA , GOLDMAN VALERIE M. , LEVY DOUGLAS E. , WEXLER DEBORAH J. 
Published: June 2019

Background: Lifestyle interventions (LI) to treat obesity and type 2 diabetes improve medical outcomes but are not currently available in usual care.
Objective: To compare the effectiveness of 2 LI programs: in-person group (IP) and telephone conference call (TCC) to medical nutrition therapy (MNT), on weight loss at 1 year in a practice-based RCT. The LI programs are adapted from Look AHEAD’s LI program and delivered in 3 community health centers and one hospital-based practice.
Methods: Patients with type 2 diabetes, HbA1c 6.5-11.5, BMI &gt; 25 (&gt; 23 in Asians) kg/m2 (n=211) were randomly assigned to IP (n=70), TCC (n=72), or MNT (n=69). Trained registered dietitians delivered 25 lifestyle sessions in the first year. MNT participants had facilitated referral for outpatient dietitian visits (usual care).
Results: Participants were 62 ± 10 years, 45% male, 77% white, with BMI 35 ± 6 kg/m2, diabetes duration 10 ± 8 years and HbA1c 7.7 ± 1.2%; 66% of IP and 72% of TCC attended &gt;18/25 sessions. Mean percent weight change at 6 and 12 months was -5.6 ± 4.9 and -4.6 ± 6.1 in IP, -4.6 ± 5.8 and -4.8 ± 6.1 in TCC, and -1.1 ± 3.7 and -2.0 ± 4.1 in MNT, with statistically significant differences between both LI arms and MNT (P&lt;0.01 at both timepoints), but not between the two LI arms at 6 and 12 months. HbA1c improved in all participants with no statistically significant differences among study arms. At 6 and 12 months, 42 and 45% of IP participants had stopped or reduced a glucose-lowering medication, compared to 23% of MNT participants at both timepoints (P=0.03 and 0.01, respectively). No significant difference in medication reduction was observed between TCC participants (33 and 36% at 6 and 12 months) and the other two groups.
Conclusions: IP and TCC lifestyle interventions can achieve equivalent outcomes in terms of clinically significant weight loss, improvement in glycemic control, and participant engagement. The TCC delivery format may extend program reach.

Disclosure
L.M. Delahanty: Advisory Panel; Self; Jana Care Inc., Omada Health, Inc., Weight Watchers International, Inc. Y. Chang: None. B.C. Porneala: None. J. McCarthy: None. V.M. Goldman: None. D.E. Levy: None. D.J. Wexler: Other Relationship; Spouse/Partner; APOLO1BIO.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
862-P: Association of Parent Executive Function and Child Glycemic Control in Type 1 Diabetes
Authors: TULLY CARRIE , BENTO SAMANTHA P. , HAMBURGER SAMANTHA , ROSE MEREDITH , STREISAND RANDI 
Published: June 2019

Executive functions (EF) are a collection of effortful self-regulation abilities that control intentional behavior and promote regulation of thoughts and emotion. Parents of children with type 1 diabetes (T1D) are charged with organizing management of child behavior while simultaneously engaging in beneficial health behaviors, all of which involve key EF tasks (e.g., attention, self-regulation, working memory, and problem solving). As such, individual parent EF abilities likely play a significant role in children’s diabetes management and health outcomes. This study examined the relation between parent EF and glycemic control in children with T1D. Fifty-two parents of children age 2-10 (M parent age = 37.4 years, 53.8% African American, M child age = 8.0, M diabetes duration = 3.7 years) with T1D were enrolled in the cross-sectional study at a pediatric diabetes clinic. Parents completed the Working Memory Index (Arithmetic and Digit Span) of the Wechsler Adult Intellectual Scale - Fourth Edition, Behavior Rating Inventory of Executive Function, Self-Care Inventory-Parent, Center for Epidemiologic Scale - Depression and medical, psychiatric, and demographic history. Medical chart reviews were conducted to extract child glycemic control, diabetes health, and complications. Results from objective measures of EF demonstrated a positive association between Digit Span and A1C (r=-.25, p =.03), though not for Arithmetic and A1c (r = -0.14, p = 0.34). Linear regression was calculated to examine the relation between self-reported EF and adherence. Controlling for parent depressive symptoms, higher overall executive functioning was associated with higher adherence F(1, 51) = 7.78, p = .008, R2 = 0.13). There is an association between parent executive function and child glycemic control, which may be explained through differences in adherence behaviors. Future research should focus on parent EF screening in pediatric diabetes clinics and adapting cognitive interventions for this population.

Disclosure
C. Tully: None. S.P. Bento: None. S. Hamburger: None. M. Rose: None. R. Streisand: None.
866-P: Lifestyle Change Program Session Completion and Cardiometabolic Outcomes in Real-World Clinical Practice
Authors: HUANG HISAO-CHING , AZAR KRISTEN M. , SUDAT SYLVIA , PRESSMAN ALICE , ROMANELLI ROBERT 
Published: June 2019

Background: Translational diabetes prevention lifestyle change programs can promote weight loss and reduce cardiometabolic risk factors in those at high risk for diabetes. Few studies have examined completion of such programs in the real world or the relationship between program completion and cardiometabolic outcomes.
Methods: In this retrospective study, we identified program participants, ≥18 years of age, in the electronic health records (2010-2017) of a large, community-based healthcare system. We examined the number of classes completed during the 12-week intensive core phase of the program (12 sessions max) and the total number of sessions completed during the full 12-month curriculum (26 session max). We further examined the relationship between total session completion and changes in weight, systolic/diastolic blood pressure (SBP/DBP), and total cholesterol (TC) at 12 months (±3 months) follow-up, using linear regression with adjustment for baseline characteristics.
Results: We identified 1,116 program participants meeting eligibility criteria. At baseline, mean weight = 99 kg, SBP/DBP = 126/76 mmHg, and TC = 192 mg/dL. Participants attended a mean of 9 of 12 sessions (median=11) during the intensive core phase, and 60% completed ≥10 sessions. Participants attended a mean of 14 sessions (median=15) over the full 12-month program. Each session completed was statistically significantly associated with, on average, a -0.39 kg change in weight (P&lt;0.001) and a -0.13 mmHg change in DBP (P=0.01). There was a non-significant trend for each session completed and mean change in SBP (-0.13 mmHg; P=0.196) and TC (-0.11 mg/dL P=0.390).
Conclusion: In real-world clinical practice, lifestyle change program completion is suboptimal, yet evidence suggests that greater class attendance is associated with better outcomes. Strategies to promote program retention can have an important impact on cardiometabolic risk reduction.

Disclosure
H. Huang: None. K.M. Azar: None. S. Sudat: None. A. Pressman: None. R. Romanelli: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
867-P: The Impact of Diabetes on Daily Life: Highlights from People with T1D and Their Caregivers
Authors: BISPHAM JEOFFREY , HUGHES ALLYSON , PEREZ-NIEVES MAGALY , FAN LUDI , MCAULIFFE-FOGARTY ALICIA 
Published: June 2019

People with type 1 diabetes (T1D) and caregivers of minors with T1D experience significant impact to many aspects of daily life. The impact of diabetes is not limited to monetary costs assessed by healthcare and economic data, but also includes the “cost” of sacrifices, such as sleep disruption and time lost. Limited research exists regarding daily disruptions and missed opportunities due to T1D. This study aimed to identify other aspects that are impacted by T1D in patients and caregivers living in the U.S. Six focus groups were conducted based on previously identified themes regarding finances, missed opportunities, and disruptions in daily activities from patients, caregivers and health care provider interviews. The current study conducted focus groups with people with T1D, ages 23-72 (n=17) and caregivers ages 34-55 (n=14), of minors with T1D. Five focus groups were conducted online and one was conducted in-person (San Diego, CA) with a total of 31 participants. All participants were recruited from T1D Exchange Glu (www.myglu.org), an online community for individuals living with T1D. Focus groups were audio-recorded, transcribed, and thematically analyzed. Participants reported issues with sleep, finance, health insurance (including obtaining supplies), and disruptions in work and school as most impacted by T1D. Overall, the majority of participants reported that their sleep was most impacted. Patients and caregivers experienced substantial amounts of sleep loss due to device alarms and night time blood glucose excursions as well as taking preventative actions to avoid excursions. People with T1D reported time dedicated to managing diabetes had a greater impact on life, while caregivers reported financial and employment sacrifices had the most impact. This study provides insight into the real-world impact of diabetes beyond the more commonly studied healthcare costs.

Disclosure
J. Bispham: None. A. Hughes: None. M. Perez-Nieves: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. L. Fan: Employee; Self; Lilly Diabetes. Stock/Shareholder; Self; Lilly Diabetes. A. McAuliffe-Fogarty: None.
872-P: Impact of Psychosocial Factors and Nutrition Using a 12-Week Course on Diabetes Management for Veterans
Authors: FARRELL NANCY 
Published: June 2019

U.S veterans are at considerable risk for complications from diabetes. It affects nearly 25 percent of VA's population. Many veterans report suffering from psychosocial complications particularly lack of management success and symptoms of depression. The Diabetes Empowerment Group (DEG), a 12-week interdisciplinary group for diabetes management. Curriculum includes values assessment, goal setting, biofeedback, problem solving, mindful eating, and other management skills. A registered dietician provides nutritional education and coaching each session. Based on feedback, program changes are implemented to each new group cycle for quality improvement (QI) purposes.
Methods: Hemoglobin A1c levels for veterans were measured via on-site laboratory services. They completed Diabetes Empowerment Scale - Short Form and Patient Health Questionnaires-9 at the beginning and end of their respective group session cycles. Scores were used to determine whether group content impacted veterans' HbA1c, depressive symptoms and empowerment in managing their diabetes. Paired sample t-tests were utilized to compare pre- and post-session cycle values. Fifty-nine veterans completed lab work and QI measures. Mean HbA1c levels (t(58) = 2.55, p&lt;0.01) and depressive symptoms scores (t(54) = 3.11, p&lt;0.001) decreased from the beginning (M = 8.11, SD = 3.60; M = 11.31, SD = 43.55) of the group to the end (M = 7.74, SD = 1.97; M = 9.22, SD = 38.77). Mean empowerment scores increased (t(55) = -3.08, p&lt;0.001 from the beginning (M = 3.56, SD = 0.58) of the group to the end (M = 4.02, SD = 1.24). These findings demonstrate the efficacy of DEG in helping veterans manage diabetes. We expect successive improvements toward a more integrative, standardized curriculum will result in increased empowerment and reduced HbA1c levels and depressive symptomatology. Future directions for QI include increasing access to care by initiating access by starting a new cycle of DEG every six weeks.

Disclosure
N. Farrell: None.
879-P: Using Telehealth to Enhance Engagement and Reduce Patient Burden in the Management of Gestational Diabetes: A Randomized Trial in a Diverse Community Setting
Authors: SINGH HARSIMRAN , SENDEJAS MICHELLE , PALLIVATHUCAL LIA B. , GONZALEZ MEGHAN , DECKER STEPHANIE , PIMENTEL ANA R. , MILLS MARLIN D. , AHN DAVID T. , BILLIMEK JOHN 
Published: June 2019

Optimal management of gestational diabetes (GDM) is critical to ensure successful maternal and fetal birth outcomes, yet various factors limit uptake of GDM management education interventions. We developed a psychoeducational intervention for GDM management using a video telehealth platform (TH) as an alternative to routine in-person (RC) sessions to improve patient access and engagement. Both groups were guided by the same providers and received similar educational materials. However, all RC visits were held in-person while all TC visits (except for pre and post assessment) were held virtually. Clinical and psychosocial indicators including out of range blood glucose (BG), birth outcomes, BG monitoring behavior, and patient satisfaction were assessed. Between group comparisons were performed using independent samples t-tests and Fisher’s exact test. Sixty ethnically diverse women with GDM were randomized to TH (n=30) or to RC (n=30). At post assessment, GDM knowledge improved significantly and similarly in both groups (p=0.009), but no group differences were observed on the clinical (including out of range BGs) and psychosocial variables assessed. In late pregnancy, BG monitoring was significantly better in TH (84%) vs. RC (68.4%) (p&lt;0.05). Similarly, attendance at all intervention visits was higher in TH (63.3%) vs. RC (36.7%). Total interaction time for participants completing all intervention visits was significantly shorter in TC (202 min) than in RC (255 min, p&lt;0.001). Although, satisfaction was high in both groups, all but one participant indicated preference for TH for future GDM education. The impact of TH was found to be equivalent to RC on various clinical and psychosocial indicators, but superior in terms of patient engagement, BG monitoring adherence, and patient burden.

Disclosure
H. Singh: None. M. Sendejas: None. L.B. Pallivathucal: None. M. Gonzalez: None. S. Decker: Advisory Panel; Self; Sanofi-Aventis. A.R. Pimentel: None. M.D. Mills: None. D.T. Ahn: Advisory Panel; Self; Ascensia Diabetes Care, MannKind Corporation. J. Billimek: None.

Funding
Hoag Hospital Foundation
886-P: Smoking and Cessation Patterns of People with Diabetes
Authors: OZCAN SEYDA , GORURGOZ FERIDE , CARKOGLU ASLı , AKBULUT ZELIHA , NICHTER MIMI , NICHTER MARK 
Published: June 2019

Turkey has the highest prevalence of diabetes and smoking in Europe (diabetes 13.7%; smoking 44% of men and 18% of women). Smokers with diabetes have a heightened risk of morbidity and mortality. The routine assessment of tobacco use as an essential to prevent smoking or encourage cessation.(ADA,2018) At present, little is known about the cessation services provided by diabetes professionals to their patients in Turkey. A nationwide survey was conducted to gather data on this topic. Utilizing a point prevalence methodology, data was collected from 24 provinces around Turkey. Diabetes nurses from 172 diabetes centers were invited to complete a survey (response rate 28.4%). The survey included 11 questions; patient demographics, type and duration of diabetes, patient smoking status, smoking and cessation behaviors after diabetes diagnosis, cessation recommendation from HCP. The survey with instruction + video about how to complete the survey were sent via e-mail and phone messages to the nurses. Surveys were completed on one clinic day between December 3-7,2018 to all diabetes patients. (Ethics 2018.229.IRB3.162) of patients (n=779), 59,4% is women; 86,3% has type 2 diabetes. Mean duration of diabetes 10,39 years; mean age is 54,97 years. Smoking prevalence is 26,8%. The highest smoking prevalence is 40,4% in men, while 19,0% in women. Of patients,19,3% smokes 10 cigarettes or more in a day; 26,2% is quitter while 10,7% of them quit after diabetes diagnosis; 80,1% believes any amount of smoking is harmful. As opposed to, 7.4% of patients believes 1-2 cigarettes in a day is not harmful, 6,0% believes that there is no relation between smoking and diabetes. Only 11,8% of smokers has quitting advice from HCP relating the risk of smoking for diabetes control. This nation-wide survey reveals the first data on smoking and cessation in Turkish people with diabetes. Findings shows that patients are not aware of the harm of tobacco. Behavior-based smoking cessation trainings will be applied for diabetes professionals in the light of these early data.

Disclosure
S. Ozcan: None. F. Gorurgoz: None. A. Carkoglu: None. Z. Akbulut: None. M. Nichter: None. M. Nichter: None.
89-OR: Type 1 Interferons Inhibition of Interleukin-10 Signaling in T Cells in Type 1 Diabetes Development
Authors: LOZANO MARCOS IGLESIAS , CHICCO MARIA , BIBICHEFF DARREL A. , BRANDACHER GERALD , RAIMONDI GIORGIO 
Published: June 2019

Type 1 diabetes (T1D) is an autoimmune disease caused by T cell-mediated destruction of insulin-producing beta cells of the pancreas. The “fertile field” hypothesis of T1D proposes that, in a genetically predisposed individual, an inflamed environment prompts the organ towards autoimmunity. In this context, the protective role of the regulatory cytokine IL-10 remains unclear and somewhat controversial. In this study, we tested whether chronic and localized accumulation of type-I interferons (TI-IFNs) creates a “fertile field” that releases diabetogenic T cells from IL-10 mediated regulation and prompts T1D development. In vitro incubation of mouse T cells with IFN-β induces a dramatic defect in the production of phospho-STAT3 in response to IL-10 (but not in response to IL-6, that shares the same signaling pathway). This resulted in prevention of upregulation of IL-10 induced genes. This altered signaling was NOT caused by reduction of IL-10 receptor expression, nor by induction of SOCS-1 or 3. Instead, microarray analysis suggested a novel role for the transcription factor STAT1. IFN-β increases STAT1 levels causing a reversal of the STAT1/STAT3 protein ratio in T cells, ultimately favoring a competitive role of STAT1. In agreement, STAT1-KO T cells exposed to IFN-β did not show any defect in IL-10 signaling. In diabetes-prone NOD mice we discovered a persistent reduction of IL-10 signaling in T cells of pancreatic and mesenteric lymph nodes (but not in T cells of other lymphoid tissues), correlating with the reported aberrant and localized accumulation of TI-IFNs in these mice. Early treatment of NOD mice with an IFNRA blocking antibody (that delays the onset and reduces the incidence of T1D) showed a clear restoration of IL-10 signaling. Overall, these data reveal a previously unknown molecular interplay between IL-10 and TI-IFNs that, if thoroughly elucidated, could reveal a novel target of intervention to enhance the efficacy of T1D immunotherapies.

Disclosure
M. Iglesias Lozano: None. M. Chicco: None. D.A. Bibicheff: None. G. Brandacher: None. G. Raimondi: None.