bluuebunny/crossref_metadata_2025_split huggingface dataset:
801-P: Group Appointments (GA) via Home Telehealth (HT) for Young Adults (YA) with Type 1 Diabetes (T1D) May Improve Psychosocial Functioning
Authors: BISNO DANIEL I. , REID MARK W. , BERGET CARI , CAIN CINDY L. , KLINGENSMITH GEORGEANNA J. , RAYMOND JENNIFER 
Published: June 2019

Background: Participation in GA via HT is associated with improved attendance, satisfaction, and psychosocial functioning in YA with T1D. The effects of long-term participation are unknown.
Objective: Evaluate whether exposure to GA via HT improves psychosocial functioning in YA with T1D receiving care via HT.
Methods: Patients in the Colorado Young Adults with T1D (CoYoT1) prospective study of GA via HT self-selected into an initial year-long study phase comparing GA to usual care. Next, 58 new and returning patients were randomized to receive HT with or without GA for one year. Overall, 19 patients were exposed to HT alone for one year (GA0), 29 were exposed to HT with GA for one year (GA1), and 10 were exposed to HT with GA for two years (GA2). They completed the EQ-5D, Diabetes Distress Scale (DDS), Center for Epidemiologic Studies Depression (CES-D), Self-Efficacy in Diabetes (SED), and Self-Management of Type 1 Diabetes in Adolescence (SMOD-A) measures.
Results: YA patients were 67% female, 86% white, and 11% Latinx. Regardless of attendance, greater exposure to GA was associated with greater communication and self-efficacy; and reduced pain, depressive symptoms, and distress at study end (See Figure 1). Overall, GA1 and GA2 reported better psychosocial functioning than GA0.
Conclusions: Greater exposure to GA via HT may improve psychosocial functioning in YA with T1D.

Disclosure
D.I. Bisno: None. M.W. Reid: None. C. Berget: Consultant; Self; Insulet Corporation, Medtronic. C.L. Cain: None. G.J. Klingensmith: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Company Limited. Research Support; Self; Novo Nordisk Foundation. Stock/Shareholder; Spouse/Partner; Dexcom, Inc. J. Raymond: Other Relationship; Self; Insulet Corporation.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
803-P: Modifiable Diabetes-Specific Factors and Glycemic Control in Economically Vulnerable and Racial/Ethnic Minority Young Adults with Type 1 Diabetes
Authors: AGARWAL SHIVANI , KANAPKA LAUREN , RAYMOND JENNIFER , WALKER ASHBY F. , GONZALEZ ANDREA GERARD , KRUGER DAVIDA F. , REDONDO MARIA JOSE , RICKELS MICHAEL R. , SHAH VIRAL N. , BUTLER ASHLEY , MILLER VICTORIA , VERDEJO ALANDRA , GAL ROBIN L. , WILLI STEVEN M. , LONG JUDITH A. 
Published: June 2019

Minority and socioeconomic disparity in glycemic control exists in young adults (YA) with type 1 diabetes (T1D). The contribution of social determinants of health versus diabetes-specific clinical care factors to these disparities remains unclear. We administered a survey on demographics, clinical factors, self-management, and social determinants to non-Hispanic black (NHB), Hispanic, and non-Hispanic white (NHW) YA from 6 centers in the T1D Exchange. We examined bivariate associations of variables with A1c and added significant factors to a linear regression model in sequential groups. A1c disparity was the outcome. We adjusted models for race-ethnicity, age, gender, and T1D duration. We recruited 300 YA (97 NHB, 103 Hispanic, 100 NHW) with mean age of 21±2 years and T1D duration of 11±5 years. NHB but not Hispanic YA had higher A1c vs. NHW (p&lt;0.001) (NHB 10.5%, Hispanic 8.6%, NHW 8.1%). Only lower education attainment, lower pump use, receiving care in an adult system, and worse self-management were associated with A1c in the final model (Table 1), explaining 31% of the variance in A1c. Few social determinants were associated with A1c once examined with diabetes care factors. While social factors should be considered in the care of vulnerable YA, clinicians should continue to emphasize diabetes self-management and technology treatment options.

Disclosure
S. Agarwal: None. L. Kanapka: None. J. Raymond: Other Relationship; Self; Insulet Corporation. A.F. Walker: None. A. Gerard Gonzalez: None. D.F. Kruger: Advisory Panel; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Insulet Corporation. Consultant; Self; CeQur Corporation, Hygieia. Speaker's Bureau; Self; AstraZeneca, Dexcom, Inc., Eli Lilly and Company. Stock/Shareholder; Self; Dexcom, Inc. Other Relationship; Self; Novo Nordisk Inc. M.J. Redondo: None. M.R. Rickels: None. V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. A. Butler: None. V. Miller: None. A. Verdejo: None. R.L. Gal: None. S.M. Willi: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Roche Diagnostic USA. Research Support; Self; Jaeb Center for Health Research, National Institute of Allergy and Infectious Diseases, Sanofi-Aventis. Other Relationship; Self; National Institute of Diabetes and Digestive and Kidney Diseases. J.A. Long: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust; National Institute of Diabetes and Digestive and Kidney Diseases
807-P: The Diabetes-Related Emotional and Attitude Distress (DREAD) Scale
Authors: GROOT MARY DE , CRAVEN MICHAEL , VRANY ELIZABETH A. , SIMONS ZACHARY 
Published: June 2019

Diabetes-related distress (DD) is defined as the emotional and regimen-specific burdens of managing diabetes and affects 38%-45% of patients. It is associated with poorer medical outcomes. Health care providers (HCPs) are on the frontline of diabetes care, but no known research has assessed DD in HCPs. This study developed a measure of DD from the perspective of HCPs.
Items (N=69) were based on interviews and focus groups with HCPs who treat people with diabetes and rated on a 5-point Likert scale. The DREAD scale was completed by 135 HCPs. Mean age was 48.9 years, 90.8% female, 79.6% white, and 67.6% married. 49.3% were nurses/nurse practitioners, 16.9% endocrinologists and 16.2% dieticians. 56.3% identified as Certified Diabetes Educators.
Evaluation of item distribution characteristics, Cronbach’s α, factor analysis and scree plot analysis indicated a 1-factor solution with 43 items. Cronbach’s α item to total was 0.92. A principal axis factor analysis was conducted; the Kaiser-Meyer-Olkin test supported sampling adequacy (KMO = .80, p &lt; .001). The eigenvalue for the single factor was 9.11. Factor loadings ranged from 0.63 to 0.31.
To test convergent validity, the DREAD total score was correlated with the Maslach Burnout Inventory Human Services Survey for Medical Personnel (r = 0.56, p&lt; .001 for emotional exhaustion; r = 0.39, p &lt; .001 for depersonalization; and r = 0.40, p &lt; .001 for personal accomplishment) and the Marlow-Crowne Social Desirability Scale (r = 0.32, p &lt; .001). Test-retest reliability (n = 93) was conducted &gt;2-4 weeks after the first survey: coefficient r = 0.78 (p &lt; .001).
Diabetes-related distress is part of the caregiving experience among HCPs who treat diabetes. The DREAD scale demonstrated acceptable levels of validity and reliability in a diverse sample of HCPs. These results suggest that the DREAD scale measures a related, yet distinct, construct from general physician burnout. This measure may be used to evaluate the psychological impact of treating diabetes among HCPs in future samples.

Disclosure
M. de Groot: Consultant; Self; Eli Lilly and Company, Johnson & Johnson Diabetes Institute. M. Craven: None. E.A. Vrany: None. Z. Simons: None.
815-P: Eating Behaviors, Personality Traits, and Diabetes Fatalism: Predictors of HbA1c in Type 2 Diabetes
Authors: FARRAN NATALI , SUKKARIEH-HARATY OLA ALI , BAKHOUR DALAL AL , BASSIL MAYA 
Published: June 2019

The effect of eating behavior and personality on glycemic outcomes in type 2 diabetes (T2DM) has received little attention. Diabetes fatalism has furthermore been associated with uncontrolled glycemia. The aim of the present study is to explore the interrelationship of these constructs, which might uncover new insights for diabetes management. A total of 333 Lebanese patients (Age: 59 ± 13 years, 50.2% M) with T2DM were recruited. Eating behaviours (Dutch Eating Behaviour Questionnaire), personality traits (NEO Five-Factor Inventory-3), and diabetes related fatalistic attitudes (Diabetes Fatalism Scale) were assessed. Regression analyses showed that neuroticism, restrained eating, and external eating predicted A1C. Total diabetes fatalism and its ‘despair’ subscale also predicted HbA1C. Multiple regression analysis showed that neuroticism, restrained eating, and fatalism subscale ‘despair’ predicted HbA1C levels and explained 5.4% of the variance (F(3,302) = 5.77, p = .001). A moderated moderation was run and revealed that the effect of conscientiousness on restrained eating was moderated by powerlessness (fatalism subscale) and neuroticism. At low neuroticism levels and with any powerlessness levels, conscientiousness did not exert a significant effect on restrained eating. However, at high levels of neuroticism with low or moderate levels of powerlessness, conscientiousness exerted significant effect on restrained eating (low powerlessness: B = .07, t = 4.39, p &lt; .001; medium powerlessness: B = .04, t = 3.24, p &lt; .01). On the other hand, when powerlessness was high, conscientiousness did not exert a significant effect on restrained eating.
In summary, the impact of conscientiousness on restrained eating, which in turn predicts HbA1C levels, is moderated by the belief of powerlessness and neuroticism in T2DM. These factors should be taken into account in the clinical practice. Further exploring similar constructs in T2DM to improve the quality of health care is warranted.

Disclosure
N. Farran: None. O.A. Sukkarieh-Haraty: None. D. Al Bakhour: None. M. Bassil: None.
819-P: Personalized Texts Improve Adherence and A1c over 6 Months among High-Risk Adults with Type 2 Diabetes
Authors: MAYBERRY LINDSAY S. , NELSON LYNDSAY A. , GREEVY ROBERT A. , WALLSTON KENNETH , KRIPALANI SUNIL , OSBORN CHANDRA Y. , BERGNER ERIN M. , LESTOURGEON LAUREN , WILLIAMSON SARAH E. , SPIEKER ANDREW J. , GENTRY CHAD , BROWN ANNE W. , GREGORY BECKY P. , ACUFF S. WILL , ELASY TOM 
Published: June 2019

Medication nonadherence and suboptimal glycemia are common among adults with T2D, particularly minorities and people with low SES. Text messaging is used ubiquitously without disparities. REACH (Rapid Education/Encouragement And Communications for Health) is a theory-based text messaging intervention that iteratively personalizes content to participants’ diabetes medicines and barriers to adherence.
All participants have completed 6-month follow-up of a 15-month pragmatic RCT evaluating REACH. Adults (N=512) with T2D were recruited from community health centers and medical center primary care clinics. All participants received educational newsletters, completed A1c tests (venipuncture or mail-in kit) and surveys every 3 months; those assigned to REACH received daily texts. Surveys included a barriers assessment and the Summary of Diabetes Self-Care Activities medications subscale. Regression models examined change in barriers, adherence, and A1c (adjusted for test type) relative to controls.
Participants were predominantly non-white (53%) and low SES (56% annual incomes &lt;$35K; 49% underinsured; 42% &lt;high school degree; 11% homeless/unstably housed), with an average age 56.0±9.5 years; 54% female; 49% on insulin; and baseline A1c 8.6±1.8%. At 6 months, retention was 90% and average response rate to daily interactive texts was mean 84% [IQR 79-90]. The 6-month overall REACH effect on A1c was -0.3% (p&lt;.05), but reductions were greater among participants with higher baseline A1c (interaction term p&lt;.05) - demonstrating A1c reductions ≥1.0% among participants with baseline A1c≥12.5% and ≥0.5% among participants with baseline A1c≥8.0% (both p&lt;.05). Relative to controls, REACH also reduced adherence barriers (p&lt;.05) and improved adherence (.53 days per week, p&lt;.001).
REACH engaged a diverse and high-risk group with daily texts, reduced barriers to adherence, improved adherence, and substantively improved A1c among patients with elevated glycemia at baseline.

Disclosure
L.S. Mayberry: None. L.A. Nelson: None. R.A. Greevy: None. K. Wallston: None. S. Kripalani: None. C.Y. Osborn: Employee; Self; One Drop. E.M. Bergner: None. L. LeStourgeon: None. S.E. Williamson: None. A.J. Spieker: None. C. Gentry: None. A.W. Brown: None. B.P. Gregory: None. S. Acuff: None. T. Elasy: None.

Funding
National Institutes of Health (R01DK100694)
829-P: The Choice Should Be Yours: Diabetes-Related Distress by Insulin Delivery Method for Patients with Type 1 Diabetes
Authors: WARDIAN JANA L. , TRUE MARK W. , COLBURN JEFFREY A. , FOLARON IRENE , TATE JOSHUA M. , BECKMAN DARRICK 
Published: June 2019

The ADA recommends psychosocial assessment as an integrated part of care for people with diabetes, which includes diabetes-related distress. Elevated diabetes-related distress is associated with poor self-management, lower medication adherence, and poorer quality of life. Intensive insulin delivery is achieved with a combination of basal and bolus dosing, which attempts to mimic normal pancreatic function. Delivery methods can be either multiple daily injections (MDI) via a syringe or pen or through continuous subcutaneous insulin injection (CSII). CSII is recommended for patients with type 1 diabetes (T1DM) who prefer pump therapy over MDI. Thus, we explored the relationship of insulin delivery method (MDI versus CSII) to diabetes-related distress in patients with T1DM.
The Diabetes Center of Excellence (DCOE), a specialty clinic for military health system beneficiaries, administered the 17-item Diabetes-related Distress Scale (DDS-17) from June 2015 through August 2016 as standard care. Adults with T1DM receiving diabetes care at the DCOE were included in this study.
There were 203 patients with T1DM who completed the DDS-17 during the time period. Patients were categorized as CSII (57.6%) or MDI (42.4%). There were no significant differences in diabetes-related distress by insulin delivery method. Furthermore, no significant differences were found in HbA1c between CSII (7.85%) and MDI (8.10%) users. In addition, no significant differences in BMI between patients using CSII (M=28.33 kg/m2) and MDI (28.49 kg/m2) users.
Our study demonstrated that there were no differences in diabetes distress scores, HbA1c, or BMI between CSII and MDI. As we move toward more patient-centered care, patients with T1DM may benefit from choosing the method of delivery that will enable them to achieve individual goals without increased diabetes-related distress.

Disclosure
J.L. Wardian: None. M.W. True: None. J.A. Colburn: None. I. Folaron: None. J.M. Tate: None. D. Beckman: None.
842-P: Damage Control (Group) for Youth with T1D: Capturing the True Value of NICH
Authors: WAGNER DAVID V. , JENISCH CELESTE , KOSKELA-STAPLES NATALIE C. , GUTTMANN-BAUMAN INES , LARSEN CHRISTOPHER E. , TEPLITSKY LENA , HARRIS MICHAEL A. 
Published: June 2019

Objective: Novel Interventions in Children’s Healthcare (NICH) is an ecologically valid intervention for youth with T1D who experience avoidable acute complications. While NICH has been associated with reductions in DKA events, the true impact of NICH is unclear without a control group. This study compares NICH youth utilization over time to youth referred to but denied NICH by insurance (i.e., unserved).
Methods: Medical providers referred youth with T1D who experienced avoidable utilization to NICH (n=110). Unserved youth (n=50) were more likely than NICH youth (n=60) to have commercial insurance and less accessible medical records. There were no demographic differences between the groups (M age=14.0 years; 58% were female; 79% were non-Hispanic white). Medical record review included 1 year prior to and 2 years following NICH.
Results: NICH youth had more documented hospital admissions and ED visits in the year prior to services (p&lt;.05) than unserved youth. Compared to unserved youth, NICH youth experienced a greater reduction in days admitted during the 1st year and in DKA events in the 2nd year post-initiation (p&lt;.05).
Conclusions: This study was the first to compare NICH to a control group. NICH youth demonstrated greater reductions in acute complications following treatment; however, findings indicate that these groups were different in important ways, likely under capturing control group utilization following referral.

Disclosure
D.V. Wagner: None. C. Jenisch: None. N.C. Koskela-Staples: None. I. Guttmann-Bauman: None. C.E. Larsen: None. L. Teplitsky: None. M.A. Harris: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
843-P: Hypoglycemia Unawareness Is Associated with Attachment and Reflective Functioning in People with Type 1 Diabetes
Authors: THOMAKOS PETROS , GRIVA FAY , KEPAPTSOGLOU OLGA , MITRAKOU ASIMINA , VASLAMATZIS GRIGORIS , ZOUPAS CHRISTOS 
Published: June 2019

The importance of attachment has been studied extensively as a frame for understanding the self-care behaviours of people with diabetes and their relations with practitioners. A component of attachment is the ability to reflect upon one’s mental state and understand what one is feeling and why.
Aim of the study was to investigate attachment patterns and their relation with the reflective function of people with type 1 diabetes. 102 people (age 38.6±10 years, 63% females, diabetes duration 21.3±13 years, HbA1c 7.5±1.2%, Gold Score 2.2±1.5) completed measures of attachment (ECR-R) and reflective functioning (RFQ). Results suggested that there were differences in the attachment styles (χ2= 9.04, p= 0.02) between individuals who were able to detect hypoglycemia symptoms quickly enough to avoid progression to a severe hypoglycemic episode and those with hypoglycemia unawareness. 63.6% (p&lt; 0.001) of participants with hypoglycemia unawareness were characterized as fearfully attached, a pattern associated with emotional dysregulation and problems in interpersonal relationships. People with impaired reflective functioning were more likely to report hypoglycemia unawareness (t= 2.74, p= 0.007) suggesting that impairments in identifying and expressing emotional states are associated with the ability to recognize hypoglycemic symptoms. Mediation analysis revealed significant indirect effects with a point estimate of b= 0.128 (SE= 0.055), excluding zero (95% CI= 0.033, 0.248) for anxiety and b= 0.109 (SE= 0.052), excluding zero (95% CI = 0.019, 0.226) for avoidance, indicating that attachment insecurities indirectly influence hypoglycemia awareness via the capacity to recognize and understand one’s own and other’s psychological state. Overall, the results indicate that impaired reflective processes may be involved in the recognition of hypoglycemia. Therapeutic interventions designed to enhance reflective functioning could improve hypoglycemia awareness.

Disclosure
P. Thomakos: None. F. Griva: None. O. Kepaptsoglou: None. A. Mitrakou: None. G. Vaslamatzis: None. C. Zoupas: None.
855-P: The Relationship between Primary Care Providers’ Perceptions of Patient Motivation and Their Referral Practices for the National Diabetes Prevention Program Lifestyle Change Program
Authors: ZHANG XUANPING , CANNON MICHAEL , LANZA ANDREW , KHAN TAMKEEN , JACKSON MATTHEW C. , NHIM KUNTHEA 
Published: June 2019

Previous studies indicate that primary care providers’ (PCP) clinical decision making is affected by their perceptions of patient motivation. However, it is unclear how these perceptions affect PCP’s decisions to refer patients to community-based programs, such as the National Diabetes Prevention Program lifestyle change program (National DPP LCP), a structured, evidence-based, year-long lifestyle change program to prevent or delay onset of type 2 diabetes in adults with prediabetes or at risk of developing type 2 diabetes. Using data from the DocStyles 2018 web-based cross-sectional survey, we examined the relationship between PCP perceptions and referral practices. The following questions were asked to ascertain PCP perceptions and referral practices respectively: 1) “I need to make sure that my patients are motivated and ready to succeed in the National DPP LCP”; and 2) “Have you referred your patients with prediabetes to the in-person or online National DPP LCP to prevent or delay type 2 diabetes?” We analyzed the data using logistic regression analysis, with the final adjusted model controlling for PCP’s age, gender, practice years, PCP practitioner type, practice setting, and region. Our study sample included 1253 PCPs (46.3% female), with a mean age of 48.4 years and a mean practice duration of 17.4 years. We found that PCPs who realized the importance of patient motivation and readiness for their referral decision were more likely to refer their patients to the National DPP LCP, in both unadjusted (odds ratio [OR]=2.59, 95% confidence interval [CI]=1.85, 3.65) and adjusted (OR=2.58, 95% CI= 1.83, 3.64) models. Our findings highlight the importance of PCPs’ perceptions of patient motivation in their referral practices, suggesting that patient motivation and their PCP’s awareness of this motivation may need to be addressed to increase referrals to and enrollment in the National DPP LCP.

Disclosure
X. Zhang: None. M. Cannon: None. A. Lanza: None. T. Khan: None. M.C. Jackson: None. K. Nhim: None.
86-LB: Elevated First-Trimester Neutrophil Count Is Associated with the Development of Gestational Diabetes Mellitus in Pregnant Women
Authors: SUN TIANGE , MENG FANHUA , ZHANG RUI , YU ZHIYAN , ZANG SHUFEI , LIU JUN , YANG MIN 
Published: June 2019

Aims: Chronic low-grade inflammation is an important cause of systemic insulin resistance and play a central role in the pathophysiology of gestational diabetes mellitus (GDM). This study aimed to investigate the correlation between neutrophil(N) in first-trimester pregnancy and the development of GDM.
Methods: 258 women with GDM and 1412 women without GDM were included in this retrospective study. Demographic, pregnancy variables, white blood cell(WBC), neutrophil(N) counts, Neutrophil-to-Lymphocyte Ratio(NLR), clinical biochemical characteristics, delivery information were got from all subjects. Logistic regression analysis with forward stepwise selection were used to determine the independent risk factors for the development of GDM.
Result: GDM patients had much higher level of blood glucose(BG), triglyceride(TG), fetal birth weight, WBC, N counts and NLR than women without GDM. There were significant positive association between N counts and 1-hour BG, 2 hour BG, glycosylated hemoglobin(HbA1c), pregnancy body mass index(BMI), and homeostasis model assessment for insulin resistance(HOMA-IR). Additionally, there were significant negative association between N and quantitative insulin sensitivity check index (QUICKI) and low-density lipoprotein(LDL) cholesterol. After adjusting confounding variables, we found N counts was an independent factor for the development of GDM (OR = 1.35; 95% confidence interval, 1.08 to 1.69), regardless the history of GDM (OR = 1.32 for without GDM history).
Conclusion: N counts in first-trimester pregnancy is closely associated with the development of GDM in pregnant women.

Disclosure
T. Sun: None. F. Meng: None. R. Zhang: None. Z. Yu: None. S. Zang: None. J. Liu: None. M. Yang: None.

Funding
Shanghai Fifth People’s Hospital Research Project Plan; Minhang District Natural Science Research