bluuebunny/crossref_metadata_2025_split huggingface dataset:
233-LB: Depressive Symptom Trajectories among Youth and Young Adults with Type 1 Diabetes
Authors: SUTHERLAND MELANIE W. , LOHMAN MATTHEW , REBOUSSIN BETH A. , FLORY KATE , BROWN MONIQUE J. , CORATHERS SARAH , BELLATORRE ANNA , LAWRENCE JEAN M. , YI-FRAZIER JOYCE , PIHOKER CATHERINE , LIESE ANGELA D. 
Published: June 2019

Purpose: To characterize the burden of depressive symptoms over time in youth and young adults (YYA) with type 1 diabetes (T1D) by identifying subgroups that have similar trajectories of depressive symptoms and assessing baseline demographic predictors of these trajectories.
Methods: YYA diagnosed with T1D between 2002-2005, ages 10.0 to 20.6 years, who were enrolled in the SEARCH for Diabetes in Youth Study baseline were included (n = 879, 47.6% female, 76.3% non-Hispanic white). Participants provided a baseline and at least one follow-up measure of depressive symptoms using the Center for Epidemiologic Studies - Depression (CES-D) scale over a five-year period. Group-based trajectory modeling was used to assign individuals to the most likely depressive symptom trajectory class, and multinomial logistic regression was used to assess predictors of trajectories. Depressive symptoms were interpreted based on established CES-D cut-offs for adolescents: minimal (0-15), mild (16-23), and moderate/severe (24-60).
Results: Five depressive symptom trajectory classes were identified: little to no symptoms (63.2%), persistent minimal (22.2%), increasing from mild to moderate (4.6%), decreasing from mild to minimal (6.7%), and chronic moderate (3.3%). There were no significant differences in age at baseline among the groups. Significant demographic predictors of trajectories included sex, race/ethnicity, parental education, family income, and health insurance status. For example, the increasing mild to moderate trajectory had a greater proportion of Hispanic participants, public health insurance, and lower parental education compared to the little to no symptoms trajectory.
Conclusion: Among YYA with T1D, unique trajectories of depressive symptoms show meaningful differences in demographic characteristics. These results provide insight into the identification of high-risk groups and potential target populations for prevention of chronic depressive symptoms.

Disclosure
M.W. Sutherland: None. M. Lohman: None. B.A. Reboussin: None. K. Flory: None. M.J. Brown: None. S. Corathers: None. A. Bellatorre: None. J.M. Lawrence: None. J. Yi-Frazier: None. C. Pihoker: None. A.D. Liese: None.

Funding
University of South Carolina
2340-PUB: Success of Online CME at Improving the Clinical Knowledge and Confidence in Using SGLT1/SGLT2 Inhibitors in T1D Management
Authors: LARKIN AMY , LACOUTURE MICHAEL , LE ANNE 
Published: June 2019

Introduction: New data continue to emerge related to safety and efficacy of emerging SGLT1 and 2 inhibitors. We sought to assess the effect of online education designed to improve the knowledge and confidence of primary care physicians (PCPs), diabetologists and endocrinologists (D/Es), and nurses/nurse practitioners (NPs) in emerging therapies for diabetes management.
Methods: The education consisted of a 30-minute continuing medical education (CME)-certified roundtable discussion among 3 expert faculty. A 3-question knowledge and 1-question confidence linked pre-/post-assessment study design with McNemar’s chi-squared test (5% significance level, P &lt;.05) assessed educational effect. The activity launched September 26, 2018 and data collected through October 5, 2018.
Results: Improvements were demonstrated by all specialties (PCP N=324, D/E N=104, nurse/NP N=1519): 24% more PCPs (P&lt;.0001), 20% more D/Es (P=.0032), and 4% more nurses/NPs (P=.0251) correctly identified the mechanism of action of dual SGLT1/SGLT2 inhibitors. 38% of PCPs, 27% of D/Es, and 28% of NPs reported increased confidence in the treatment of type 1 diabetes with non-insulin therapies, specifically SGLT type 1 and SGLT type 2 inhibition. Continued knowledge gaps were identified for all specialties: 72% of PCPs, 65% of D/Es, and 66% of nurses/NPs failed to recognize safety and efficacy data for an emerging dual SGLT1/SGLT2 inhibitors. 40% of PCPs, 17% of D/Es, and 55% of nurses/NPs incorrectly identified a candidate for dual SGLT1/SGLT2 therapy 45% of PCPs, 32% of D/Es, and 69% of nurses/NPs failed to recognize the mechanism of action of dual SGLT1/SGLT2 inhibitors.
Conclusion: This study demonstrates the success of an online CME-certified roundtable discussion on improving clinical knowledge and confidence of PCPs, D/Es, and nurses/NPs related to dual SGLT1/SGLT2 inhibitors when treating patients with T1D. Continued knowledge gaps were identified for future education.

Disclosure
A. Larkin: None. M. LaCouture: None. A. Le: None.

Funding
Sanofi U.S.; Lexicon Pharmaceuticals
235-OR: Sphingosine Kinase 2-Mediated Pyroptosis of Renal Tubular Epithelial Cells Contributes to the Progression of Diabetic Nephropathy
Authors: YAN SISHAN , LIANG LANMEI , LIU WENWEN , CHEUNG WAI WILSON , DING WEI , LAN TIAN 
Published: June 2019

Pyroptosis of renal tubular epithelial cells and deposition of interstitial matrix proteins leads to chronic diabetic nephropathy. Recent data suggest that deficiency of sphingosine kinase 2 (SphK2) attenuates acute kidney injury and renal fibrosis. We aim to investigate the role of SphK2 signaling in the pathogenesis of diabetic nephropathy. The protein expression of SphK2 in kidney, especially in renal tubular, was significantly increased in STZ-induced diabetic mice and Leprdb/db mice, compared with control mice. Renal injury and fibrosis, as demonstrated by albumin-to-creatinine ratio, histology and fibronectin deposition, were significantly ameliorated in STZ-induced SphK2-/- or Leprdb/dbSphK2-/- double KO mice relative to control mice. Moreover, administration of ABC294640, the specific inhibitor of SphK2, significantly prevented renal injury and fibrosis in STZ-induced diabetic mice. SphK2 siRNA significantly downregulated fibronectin in renal tubular epithelial cells (NRK52E) cultured by high glucose. Furthermore, the activation of NLRP3 inflammasome and caspase 1, as well as subsequent pyroptosis were significantly inhibited in NRK52E cells transfected with SphK2 siRNA under high glucose condition.
In conclusion, SphK2 deficiency attenuates diabetic nephropathy by preventing pyroptosis in renal tubular epithelial cells.

Disclosure
L. Liang: None. W. Liu: None. W. Cheung: None. W. Ding: None. T. Lan: None.

Funding
National Natural Science Foundation of China (81870420); Science and Technology Planning Project of Guangdong Province (2017A020211007)
2356-PUB: The Relationship between Hypoglycaemia, Weight, and Quality of Life among Patients with Type 1 Diabetes: Observations from the DEPICT-2 Trial
Authors: GORDON JASON , BERESFORD-HULME LEE M. , BENNETT HAYLEY , TANK AMARJEET , EDMONDS CHRISTOPHER , MCEWAN PHILIP 
Published: June 2019

Insulin-treatment in type 1 diabetes mellitus (T1DM) is associated with elevated risk of hypoglycaemia and weight gain, which may act as a barrier to achieving optimal glycaemic control. For patients inadequately controlled by insulin alone, adjunct dapagliflozin can reduce body weight and improve glycaemic control without increased risk of hypoglycaemia. This study aimed to empirically quantify the inter-relationships between hypoglycaemia, body mass index (BMI) and quality of life using DEPICT-2 trial data. A two-stage linear regression framework evaluated (1) the relationship between hypoglycaemic fear score (HFS) and the occurrence of severe hypoglycaemia, the number of documented symptomatic events and patient age, and (2) the relationship between health-related utility (EQ-5D) and prognostic factors for utility, including HFS and BMI. Model selection was based on clinically-relevant factors. A linked evidence approach correlated the relationship between treatment, hypoglycaemia incidence and HbA1c over 52-weeks, to the relationships captured within the regression models. HFS increased as a function of incidence of severe hypoglycaemia (coefficient estimate (CE): 14.62, p=0.004) and frequency of symptomatic events (log transposed, CE: 1.32, p=0.0026). In turn, increased HFS and increased BMI were both independently associated with a significant reduction in utility (CE 0.0024, p&lt;0.001 and 0.0026, p=0.0016 respectively). In DAPA-treated patients, attainment of target glycaemic control was not associated with an increased rate of hypoglycaemic events. This study demonstrates that fear of hypoglycaemia, driven by increased incidence of hypoglycaemia, and BMI are significant determinants of quality of life for people with T1DM. These findings support the role of dapagliflozin in T1DM management, which was associated with achievement of glycaemic control targets and weight loss, without increased hypoglycaemia.

Disclosure
J. Gordon: Research Support; Self; AstraZeneca, Bristol-Myers Squibb Company, GlaxoSmithKline plc., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Takeda Canada, Takeda Pharmaceutical Company Limited. L.M. Beresford-Hulme: None. H. Bennett: Consultant; Self; AstraZeneca. Employee; Self; Health Economics and Outcomes Research Ltd. A. Tank: Employee; Self; AstraZeneca. C. Edmonds: Employee; Self; AstraZeneca. P. McEwan: Consultant; Self; AstraZeneca. Employee; Self; Health Economics and Outcomes Research Ltd.
237-OR: Beneficial Impact of Intensified Multifactorial Intervention on Stroke—The Steno-2 Study
Authors: GÆDE PETER , OELLGAARD JENS , KRUUSE CHRISTINA , ROSSING PETER , PARVING HANS-HENRIK D. , PEDERSEN OLUF 
Published: June 2019

Epidemiological studies have shown that diabetes is a well-established independent but modifiable risk factor for stroke. In the Steno-2 Study 160 patients with T2DM and microalbuminuria were randomised to intensified or conventional multiple risk factor intervention targeting classical CVD risk factors for a mean of 7.8 years and then followed for up to 21.9 years. The primary endpoint in this post hoc analysis was time to first stroke (Cox regression adjusted for age and sex). Baseline predictors were examined using backwards regression elimination (threshold of α = 0.10) of the following variables: age, sex, known diabetes duration, smoking status, left ventricular ejection fraction, heart rate variability, atrial fibrillation, BMI, systolic BP, GFR, retinopathy, HbA1c, proBNP and total cholesterol, and urinary albumin excretion rate. During follow-up 30 participants experienced a total of 39 strokes. More patients randomised to conventional therapy experienced a stroke with 21 participants (26%) with 29 strokes in the conventional-therapy group vs. 9 participants (11%) with a total of 10 strokes in the intensive therapy group. Baseline systolic BP and GFR were significant risk factors for stroke.
In conclusion, intensified multiple risk factor intervention in patients with type 2 diabetes and microalbuminuria reduces the risk for strokes as well as the number of recurrent cerebrovascular events.

Disclosure
P. Gæde: None. J. Oellgaard: Employee; Self; Novo Nordisk A/S. C. Kruuse: Speaker's Bureau; Self; Novo Nordisk A/S. P. Rossing: Advisory Panel; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp. Other Relationship; Self; Novartis AG, Novo Nordisk A/S. H.D. Parving: None. O. Pedersen: None.
2371-PUB: Addition of a GLP-1 Agonist to Safety Net Hospital System Formulary to Improve Glycemic Control
Authors: GUNASEKARAN UMA 
Published: June 2019

Parkland Health and Hospital System (PHHS) is one of the largest safety net health systems in the United States serving the indigent population of Dallas County. The majority of patients with diabetes seen in the PHHS Primary Care clinics receive their medications through PHHS pharmacies which offer subsidized prices for medications on the PHHS formulary. The GLP-1 agonist, liraglutide, was added to the formulary at the end of 2016. To improve glycemic control in the primary care clinics, bi-monthly webinars providing diabetes education, in conjunction with e-consultations between primary care providers and diabetes specialists, were begun in early 2017 with an emphasis on using GLP-1 agonists. GLP-1 agonist prescriptions in the PHHS primary care clinics increased 435% (34 to 148) between 2016-2017 and 168% (148 to 248) from 2017-2018, an overall increase in prescribing of 729%. Of the 469 patients who were prescribed GLP-1 agonists from 2015-2018, 316 patients had baseline and post-prescription Hba1c values available. The average baseline Hba1c at time of prescription was 9.0% with an average final Hba1c value of 8.4% (p=0.0005). This data shows how an institutional formulary can be used as an agent of change to improve glycemic control. Of note, 90% of prescriptions were written for liraglutide with the other 10% including other GLP-1 agonists such as exenatide, albiglutide, and dulaglutide, showing the effect of diabetes education in prescribing practices.

Disclosure
U. Gunasekaran: None.
2374-PUB: Early Diabetes Intervention for High-Risk Cardiology Inpatients
Authors: FOURLANOS SPIROS , MINGOS NICHOLAS D. , ROWAN LOIS M. , BARMANRAY RAHUL , KYI MERVYN 
Published: June 2019

Adverse glycaemia in hospital is associated with worse clinical outcomes. Given the high prevalence of diabetes in the cardiology wards, we introduced an early intervention model of diabetes care in high-risk inpatients aiming to decrease adverse glycaemia. A prospective pre- and post-intervention study was conducted in a tertiary referral hospital cardiology ward. It consisted of an initial 6-month baseline phase of standard care (a ‘reactive’ referral-based diabetes consultation service), followed by an 9-month intervention phase, comprising a ‘proactive’ multidisciplinary inpatient diabetes team (IDT) assisted by networked blood glucose (BG) meter technology. The proactive IDT performed electronic surveillance of capillary BG measurements and provided an early consultation service (within 24 hours of admission), without waiting for referral from the parent team. Consecutive inpatients admitted to the cardiology ward (length of stay &gt;48 hours) at high risk of adverse glycaemia (insulin treatment prior to hospital; or BG &lt;4, &gt;15 or two BG &gt;10 mmol/L in the first 48 hours) were recruited. BG data from day 2 until discharge, along with demographic and clinical features, was collected. The primary outcome was the incidence of adverse glycaemic days (AGD) (rate per 1000 patient-days with any capillary BG measure &lt;4 or &gt;15 mmol/L). Overall, we observed 332 patients (1320patient-days and 4887 BG measurements). Compared to usual care, the incidence of AGD decreased from 405 to 320 per 1000 patient-days (21% decrease, p=0.002) which remained significant after MVA adjustment. During the intervention phase, there was decreased mean (±SD) patient-day BG (10.8 ±3.3 vs. 10.1 ±2.8, p&lt;0.001), decreased patient-days with hyperglycaemia (BG &gt;15 mmol/L) (10.4% vs. 6.1%, p=0.044) with no significant difference in patient-days with hypoglycaemia. Analysis of clinical outcomes is pending. An early intervention model of diabetes care decreased adverse glycaemia in cardiology in patients with diabetes.

Disclosure
S. Fourlanos: None. N.D. Mingos: None. L.M. Rowan: None. R. Barmanray: None. M. Kyi: None.
2381-PUB: Shared Medical Appointments: An Academic-Community Partnership to Improve Metabolic Outcomes among People with Type 2 Diabetes in the Central Valley of California
Authors: NOYA CAROLINA E. , GATEWOOD ELIZABETH , ALKON ABBEY , CASTILLO ELIZABETH , KUO ANGEL C. 
Published: June 2019

Diabetes has reached epidemic proportions in the United States. Shared medical appointments are an increasingly popular model to provide access to DSMES and primary care services.
The purpose of the study was to evaluate the effectiveness of a Shared Medical Appointment (SMA) intervention, compared to usual primary care (UPC), for the treatment of adults with type 2 diabetes over a 6-month period in two rural Federally Qualified Health Centers (FQHC) in the central valley of California.
This study was a quasi-experimental design with a non-randomized matched control group that followed participants prospectively for 6 months. All adults living with type 2 diabetes receiving primary care at 2 FQHC clinics were eligible for inclusion. Participants in the control group were matched retrospectively on baseline A1C and age.
To test the effect of group membership on A1C change, differences in change scores were compared between the ALDEA SMA intervention group and the UPC control group. Linear regression analysis was computed to assess if mean A1C change at 6 months post-intervention was greater among SMA intervention group participants compared to the UPC control group participants.
The reductions in A1C were greater in the intervention group relative to the control group at 6 months. Results of the linear regression analysis revealed a net reduction A1C difference of -1.12% from baseline to 6 months (p≤0.05) in FQHC #1, and -1.06% from baseline to 6 months (p≤0.05) in FQHC #2.
This study demonstrated that patients in the ALDEA program were able to achieve a significant reduction in A1C compared to those who received UPC. Despite its limitations, the ALDEA SMA program was successful in empowering patients and improving glycemic control.

Disclosure
C.E. Noya: None. E. Gatewood: None. A. Alkon: None. E. Castillo: None. A.C. Kuo: None.

Funding
Health Resources and Services Administration
2382-PUB: Socioeconomic Disparities in the Management of Glycemic Control among Adults with Type 2 Diabetes in the United States
Authors: PAWASKAR MANJIRI , NGUYEN JENNIFER , HUYNH STEPHANIE , HASKELL TOM , LEE LULU , RAJPATHAK SWAPNIL 
Published: June 2019

Optimal management of glycemic control is important to delay and prevent the onset of long-term complications in patients with type 2 diabetes (T2D). While health disparities in diabetes burden and complications are well-documented, limited data exist on socioeconomic status (SES) as a determinant of glycemic control. We conducted a study linking the National Health and Wellness Survey (NHWS), a nationally-representative, self-administered annual internet survey of about 75,000 adults (≥18), and two electronic health record (EHR) systems: Veradigm, which contains data for 46+ million unique patients, and Healthverity, a nationally-representative database with 60+ million unique patients. The study population consisted of T2D adults who responded to the NHWS between 2015-2018 and had clinical measurements in the EHR database for at least 6 months from NHWS response (i.e., at least 6 months of follow-up). Glycemic control was treated as a binary variable (HbA1c &lt;7% or ≥7%) and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated adjusting for age and gender. Of 2,380 total T2D patients [mean age = 61.5 (standard deviation = 12.0), 54% males, 85% White, 32% employed, 84% living in an urban area], 501 (21%) had at least one HbA1c test taken within 6 months of NHWS participation. Of these 501 patients, 197 (39%) had uncontrolled HbA1c (≥7%). Black/African American patients were significantly more likely to have uncontrolled HbA1c compared with White patients (OR = 2.0; 95% CI: 1.02, 3.92; p = 0.04). Further, Medicaid and uninsured patients were significantly more likely to have uncontrolled HbA1c compared to those with commercial health insurance (OR = 2.81; 95% CI: 1.46, 5.4; p &lt; 0.005). There were no differences by geographic regions. The observed associations of glycemic control with race and health insurance may possibly be related to disparity in diabetes management. Future studies are needed further investigating the role of SES in diabetes management.

Disclosure
M. Pawaskar: Employee; Self; Merck & Co., Inc. Stock/Shareholder; Self; Merck & Co., Inc. J. Nguyen: Other Relationship; Self; Merck & Co., Inc. S. Huynh: Other Relationship; Self; Merck & Co., Inc. T. Haskell: Other Relationship; Self; Merck & Co., Inc. L. Lee: Other Relationship; Self; Merck & Co., Inc. S. Rajpathak: None.
2384-PUB: Implementation of Interdisciplinary Panel Management (PM) Teams in Urban Primary Care Settings to Improve Care for High-Risk Patients with T2DM
Authors: WITTMAN DEBORAH , ABIA CASELY-HAYFORD SOPHIA NAA , YOUNG EDWIN , ALBU JEANINE 
Published: June 2019

Purpose: Mount Sinai St. Luke’s Hospital located in NYC, received a DSRIP (Delivery System Reform Incentive Program) grant to improve population health in the Medicaid population. Divisions of Endocrine and General Medicine collaborated to improve care for high-risk patients with T2DM in three urban primary care practices by implementing PM to reduce percentage (%) of patients with HbA1c &gt;9.
Methods: A team of six CDEs was formed; two CDEs were embedded in the practices and each CDE was assigned to a PCP(s). Teams received quarterly reports of patients (HbA1c &gt;9) and met monthly to discuss care management (PM). Eligibility criteria: HbA1c &gt;9 taken within 12 months. Patients were excluded if receiving care by a CDE/endocrinologist. We calculated % of patients who reached HbA1c &lt;9 using the first HbA1c from time of PM until their last repeated HbA1c over one year. We also evaluated % of patients who reached HbA1c &lt;9 based on visits with: PCP only, CDE-PCP, CDE-endocrine or endocrine only. Lastly, we calculated % of patients seen by a CDE who attained HbA1c &lt;9 with or without PM.
Results: A total of 549 patients were identified; 257 patients were eligible and received PM where 34% (n=87) improved, achieving HbA1c &lt;9. Out of the 87 patients, 10.5%, 12.5%, 8.2% and 2.7% showed improvement, based on visits with: PCP only, CDE-PCP, CDE-endocrine or endocrine only, respectively. A total of 292 patients did not receive PM; 153 patients were eligible where 44% (n=67) improved, achieving HbA1c&lt;9. Overall improvement in HBA1c &lt;9 was found in 45% of patients seen by a CDE vs. in 35% of those not seen by a CDE, regardless of PM or endocrine involvement.
Conclusion: While use of PM for patients with T2DM identified as high-risk (HbA1c &gt;9) was not impactful, visits with CDEs had the greatest impact on improving HbA1c to &lt;9, regardless whether the patient was part of PM or not. We therefore recommend all patients with T2DM identified as high-risk (HbA1c &gt;9) receive CDE support services.

Disclosure
D. Wittman: None. S.N. Casely-Hayford: None. E. Young: None. J. Albu: None.