bluuebunny/crossref_metadata_2025_split huggingface dataset:
60-LB: Evaluating the Efficacy of a Novel Insulin Dosing Regimen to Prevent Lows at High-Intensity Diabetes Sports Camp
Authors: TERRY AMANDA M. , BOLLEPALLI SUREKA , SMITH LAURA , RODRIGUEZ HENRY 
Published: June 2019

Objectives: To determine the efficacy of reductions in long acting and basal insulin to prevent lows in T1D sports campers. The Sam Fuld’s T1D Sports Camp is a camp for children with T1D taking place each February. It involves high-intensity exercise for up to six hours in a day. We began adjusting our insulin dosing recommendation in 2017 to prevent incidence of hypoglycemia and ensure more campers are able to fully participate.
Methods: We compared incidence of hypo and hyperglycemic events at camp from 2016-2019. Using bg data recorded for all T1D campers. Starting in 2017, we recommended MDI campers decrease long acting insulin by 30% the night before camp and pump users decrease basal rates by 30% beginning at breakfast prior to camp. In 2019, meal boluses for lunch were also cut by 50%.
Results: From 2016 to 2018 there was a 40% decrease in campers with low bgs, and an expected increase in hyperglycemic values. In 2019, we saw an increase in lows compared with 2018 with lower overall prevalence than seen in prior years and fewer hyperglycemic events than in 2018.
Of those campers who followed the recommendations, in 2017, no incidents of hypo or hypoglycemia occurred, in 2018 there were just three incidents of hyperglycemia and in 2019, one bg value &lt; 50 mg/dL and 8 bg values &gt; 250 mg/dL (mostly in the morning).
Conclusion: More research is needed to determine the best dosing guidelines for intense exercise in children with T1D.

Disclosure
A.M. Terry: None. S. Bollepalli: None. L. Smith: None. H. Rodriguez: Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Daiichi Pharm Corp, MannKind Corporation, Medtronic MiniMed, Inc. Research Support; Spouse/Partner; Medtronic MiniMed, Inc. Research Support; Self; Takeda Pharmaceutical Company Limited. Other Relationship; Self; Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc.
604-P: Automated Diabetic Retinopathy Screening in the Primary Care Setting Improves Compliance with Follow-Up Ophthalmic Care
Authors: LIU JAMES C. , RAMCHAL SHAWN , GIBSON ELLA , KUO JESSICA , SOLANKI KAUSHAL , BHASKARANAND MALAVIKA , FONDAHN EMILY , RAJAGOPAL RITHWICK 
Published: June 2019

Purpose: Diabetic retinopathy (DR) is a leading cause of blindness, yet a majority of adults with diabetes are noncompliant with annual ophthalmic screening recommendations. We hypothesized that point-of-care automated DR could increase the rate of compliance with recommended retinal surveillance in patients with diabetes when administered during primary care visits.
Methods: We performed a prospective cohort study of adults ages 18 or older with diabetes seen at a primary care clinic from 3/1/18 to 8/31/18. A retrospective chart review of adults with diabetes from the same clinic was also conducted and served as a historical control. Participants were screened using non-mydriatic fundus photography and automated DR screening software (Eyenuk Inc.). Those with positive or inconclusive screening results were referred to ophthalmology for comprehensive evaluation. Rates of compliance with referral recommendations were compared between the study participants and historical control.
Results: One hundred and sixty-five adults with diabetes were included in the prospective study cohort. Twelve (7.3%) screened positive for referable DR, 23 (13.9%) screened positive for vision threatening DR, and 47 (28.4%) had an inconclusive screening result. Those that screened negative (83 participants) were all confirmed not to have DR by independent review from a retina specialist. The rate of compliance with follow-up eye care in referred participants was 54.9% compared to a historical rate of 18.7% (p&lt;0.0001, chi-squared).
Conclusions: The use of automated DR screening at our institution's primary care clinic reduced referrals for those with no retinopathy and increased the rate of compliance with follow-up eye care in those with positive or inconclusive screening results. These findings suggest that implementation of automated screening could effectively increase compliance with ophthalmic care among those with referable DR.

Disclosure
J.C. Liu: None. S. Ramchal: None. E. Gibson: None. K. Solanki: Employee; Self; Eyenuk Inc. Stock/Shareholder; Self; Eyenuk Inc. M. Bhaskaranand: Employee; Self; Eyenuk Inc. E. Fondahn: Consultant; Self; Greeley Company. R. Rajagopal: None.
64-LB: Aerobic Exercise Decreases Hepatic Glucose Production via Asprosin Pathway in Diabetic Rats
Authors: KO JEONGRIM , KIM TAE NYUN , SEO DAE YUN , HAN JIN 
Published: June 2019

The asprosin, a novel protein hormone released from white adipose tissue, plays an important role in the regulation of glucose metabolism for diabetes prevention. Aerobic exercise has been shown to improve type 1 diabetes (T1DM); however, exercise-induced asprosin production and its role in physiological regulation of metabolic pathways are still unclear. The aims of this study investigation were 1) to determine whether aerobic exercise could decrease asprosin levels in the liver of streptozotocin (STZ)-induced diabetic rats 2) to assess whether exercise-induced asprosin levels could contribute to asprosin-dependent downstream pathways for diabetes prevention. Five-weeks-old male Sprague-Dawley rats (n = 18) were randomly divided into control (CON), STZ-induced diabetes (STZ), and STZ with aerobic exercise (STZ-Ex) groups (n = 6 each). T1DM was induced by a single dose of STZ (65 mg/kg i.p.). The exercise group ran on treadmill for 60 min at a speed 20 m/min (4 times per week for 8 weeks). Following the 8-week experiment, the levels of asprosin, protein kinase A (PKA), 5’ adenosine monophosphate-activated protein kinase (AMPK), protein kinase B (Akt), peroxisome proliferator-activated receptor gamma coactivator-1α, β (PGC-1α, β), fibronectin type III domain-containing protein 5 (FNDC5), and uncoupling protein 3 (UCP3) were analyzed in liver. Protein expression of asprosin and PKA were significantly lower but AMPK, Akt, PGC-1β, and SOD2 were significantly higher in STZ-Ex group compared with STZ group. These findings suggest that aerobic exercise might serve as a potential physiological treatment for type 1 diabetes by decreasing asprosin and PKA levels in the liver.

Disclosure
J. Ko: None. T. Kim: None. D. Seo: None. J. Han: None.

Funding
Korean Ministry of Education (2010-0020224, 2018R1D1A1B07040370); Korean Ministry of Science, ICT and Future Planning (2018R1A2A3074998)
73-OR: Development of SteadiFlow Technology, an Advanced Insulin Delivery Cannula Featuring Extended Duration of Use, More Reliable Insulin Delivery, and Reduced Inflammatory Tissue Response
Authors: JOSEPH JEFFREY I. , TORJMAN MARC C. , LOEUM CHANNY , EISLER GABRIELLA J. , STRASMA PAUL J. , KHALF ABDURIZZAGH 
Published: June 2019

There is great clinical need for an insulin infusion set that produces reliable and consistent insulin absorption (PK) from dose to dose and functions reliably for 7 or more days. Capillary Biomedical, Inc. is developing SteadiFlow technology which features a soft yet kink-proof cannula with 1 distal orifice and 3 additional orifices distributed over the final 6 mm of the distal end of the cannula. We compared the performance of the SteadiSet to commercial insulin infusion sets with a Teflon cannula in large ambulatory swine.
Investigational infusion sets featuring SteadiFlow technology and commercial Teflon infusion set were inserted into the subcutaneous tissue of swine’s abdomen every other day for 14 days. Insulin lispro (U-5) was infused through the catheters using the same basal/bolus pattern. On day # 14, a 70 ul bolus of insulin/x-ray contrast agent was infused through each CSII catheter. The tissue surrounding each CSII was excised 5 minutes later, frozen, and imaged using a high-resolution micro-CT scanner. The tissue was then processed and stained to produce high-resolution histology images.
Histology images revealed a significantly thinner and smaller area of inflammatory tissue around the SteadiSet cannulas compared with the commercial Teflon cannulas. Micro-CT images revealed a significantly larger surface area of insulin/x-ray contrast agent delivered into the adjacent tissue when infused through the SteadiSet infusion sets compared with the commercial infusion sets with a Teflon cannula. A glucose clamp PK/PD study performed in swine using SteadiSet infusion sets implanted for 6 days showed reliable performance and relatively consistent insulin absorption into the circulation. Human clinical trials are planned for early 2019 to evaluate SteadiFlow technology for reliability, glucose control performance, and PK/PD metrics in patients with type 1 diabetes.

Disclosure
J.I. Joseph: Advisory Panel; Self; CapillaryBiomedical, Inc., Thermalin Diabetes, Inc. Research Support; Self; Capillary Biomedical, inc., Thermalin Diabetes, Inc. Stock/Shareholder; Self; Capillary Biomedical, Inc. M.C. Torjman: Other Relationship; Self; Capillary Biomedical, Inc. C. Loeum: Stock/Shareholder; Self; Capillary Biomedical, Inc. G.J. Eisler: None. P.J. Strasma: Employee; Self; Capillary Biomedical, Inc. A. Khalf: None.

Funding
JDRF; Capillary Biomedical, Inc.
765-P: Effects of an Advanced Carbohydrate Counting Course on Diet Composition in Insulin-Treated Type 2 Diabetes
Authors: CHRISTENSEN MERETE B. , HALLDORSSON THORHALLUR I. , GOTFREDSEN ANDERS , HOMMEL EVA , GÆDE PETER , OLSEN SJURDUR F. , NØRGAARD KIRSTEN 
Published: June 2019

Background and Aim: Training in advanced carbohydrate counting improves glycemic control in type 1 diabetes and type 2 diabetes. We aimed to investigate, whether a course in advanced carbohydrate counting reduced intake of carbohydrates and glycemic index of carbohydrates in persons with basal-bolus insulin treated type 2 diabetes.
Material and Methods: We conducted a 24-week open-label, randomized controlled study in 79 participants with basal-bolus insulin treated type 2 diabetes. Participants were randomized 1:1 into two groups. ABC group received 6-hour training in advanced carbohydrate counting and use of an automated bolus calculator. MC group also received 6-hour training in advanced carbohydrate counting but was trained in manual calculation of insulin bolus. Diet composition and intake of macronutrients were assessed at baseline, week 12 and week 24 using a validated electronic food frequencies questionnaire.
Results: Baseline characteristics were similar between groups (mean age 62.5 ± 9.6 years, mean HbA1C 72 ± 11 mmol/mol, mean diabetes duration 18.7 ± 7.6 years, mean BMI 33 ± 6 kg/m2). Mean energy intake was significantly reduced in the ABC group from baseline to week 24 (P=0.03), primarily due to significantly reduced intake of carbohydrates in form of cereals (P=0.005). No significant changes in energy intake were seen in the MC group (P=0.62). Further, glycemic index of ingested carbohydrates was reduced significantly in the ABC group (P=0.03), but not in the MC group (P=0.09). As previously reported HbA1c had decreased significantly by 9.0 mmol/mol in both groups at week 24. There were no significant changes in BMI throughout the study.
Conclusion: Advanced carbohydrate counting with the use of an automated bolus calculator may help to reduce energy intake and glycemic index of ingested carbohydrates in basal-bolus insulin treated type 2 diabetes.

Disclosure
M.B. Christensen: None. T.I. Halldorsson: None. A. Gotfredsen: None. E. Hommel: None. P. Gæde: None. S.F. Olsen: None. K. Nørgaard: Advisory Panel; Self; Abbott, Medtronic, Novo Nordisk A/S. Speaker's Bureau; Self; Bayer US, Medtronic, Roche Diabetes Care, Rubin Medical, Sanofi, Zealand Pharma A/S. Stock/Shareholder; Self; Novo Nordisk A/S.

Funding
Roche A/S
791-P: Patient Preferences for Medical Nutrition Therapy
Authors: CLERC PHILIP G. , WARDIAN JANA L. 
Published: June 2019

Introduction: Medical nutrition therapy (MNT) can have a profound impact on diabetes prevention and treatment. However, most patients with diabetes do not receive MNT interventions. The aim of this survey was to identify current and desired usage of MNT interventions.
Methods: Surveys were distributed to adults at San Antonio Military Medical Center and Wilford Hall Medical Center in the fall of 2018. Data included self-reported comorbidities, a validated dietary assessment, current and desired usage of MNT interventions, and current and desired nutrition recommendations from primary care providers.
Results: 446 surveys were collected. Self-reported prevalence of diabetes and prediabetes were 23% and 5% respectively. Most respondents (79%) stated they need to eat healthier. Only 41% of respondents ate home-cooked meals at least once daily. Current and desired MNT utilization ranged from 3-15% and 10-26% respectively. The largest gaps between current and desired MNT utilization were nutritional cooking classes (19.3%) and grocery store tours (9.9%). Most respondents (69%) desired an online nutritional cooking class. Most respondents (58%) stated they would cook at home more often if they knew how to cook quick, healthy, inexpensive meals. Frequency of nutrition recommendations by primary care providers ranged from 0.4-6.1%. Results were similar among those with the least and most healthy diets, and when only including patients with diabetes and prediabetes.
Conclusion: Most surveyed patients recognize the need to eat healthier. Desired MNT utilization is relatively low, but higher than current MNT utilization. Primary care provider nutrition recommendations are rare. Online nutritional cooking classes may provide a novel and highly desired form of nutrition therapy. Our institution is currently developing an online nutritional cooking class.
Disclaimer: The views expressed are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components.

Disclosure
P.G. Clerc: None. J.L. Wardian: None.
827-P: Prevalence and Clinical Characteristics of Sleep Disorders in Japanese Patients with Type 2 Diabetes: A Case-Control Study
Authors: MURAKAMI HIROSHI , DAIMON MAKOTO , MIZUSHIRI SATORU 
Published: June 2019

Background: Sleep disorders are associated with type 2 diabetes, and result in a low quality of life. However, there are few reports on the prevalence and correlates of sleep disorders in diabetics. This study investigated the prevalence and factors, including personality traits, associated with sleep disorders in type 2 diabetics.
Research Design and Methods: A case-control study was performed in patients with type 2 diabetes mellitus (223 males, 208 females; age 60.8 ± 12.8-years-old; HbA1c, 7.2 ± 0.9%) compared with age-/sex-matched healthy controls (219 males, 217 females; age 60.8 ± 13.0-years-old; HbA1c, 5.6 ± 0.3%). Participants used self-administered questionnaires on sleep attitude (Pittsburgh Sleep Quality Index; PSQI), quality of life (SF-36), depression (CES-D), and personality (Ten Item Personality Inventory).
Results: The number of subjects with sleep disorders (PSQI &gt; 5) was higher in diabetic patients (26.9%) than control subjects (17.4%) (p &lt; 0.01). Sleep latency was longer in diabetic patients (20.2 ± 0.8 minutes) than control subjects (13.7 ± 0.5 minutes) (p &lt; 0.01). Among diabetic patients, patients with sleep disorders were significantly younger (p = 0.04) and showed higher body mass index (p=0.04), higher percentages of females (p = 0.03), depression (p &lt; 0.01), overactive bladder (p = 0.01), and benign prostatic hyperplasia (p &lt; 0.01). Diabetic patients with sleep disorders scored higher neuroticism (p &lt; 0.01), lower agreeableness (p = 0.01) and lower conscientiousness (p &lt; 0.01) scale than patients without sleep disorders. All SF-36 scores were lower in patients with sleep disorders. No differences were found in HbA1c, stage of diabetic retinopathy and nephropathy between patients with the presence or absence of sleep disorders.
Conclusions: The prevalence of sleep disorders was high in patients with type 2 diabetes, and their quality of life was impaired. Therefore, clinicians should monitor sleep disorders among these patients.

Disclosure
H. Murakami: None. M. Daimon: None. S. Mizushiri: None.

Funding
Japan Society for the Promotion of Research
839-P: Outcomes of Systematic User Involvement and User Research in a National Patient-Reported Outcomes Diabetes Initiative
Authors: SKOVLUND SOREN E. , NØRGAARD LISE MELLERGAARD , STEFANSEN SIMON , DE LICHTENBERG TRINE HONNENS , TROELSEN LISE , PIETRASZEK ANNA , KJÆR PERNILLE H. , LARSEN HANNE RAVN , JAKOBSEN POUL ERIK O. , EJSKJAER NIELS 
Published: June 2019

Background: Involvement of People With Diabetes (PWD) is important for diabetes research and care, yet there is a lack of evidence-based and systematic methodologies.
Aim: To evaluate the quality and value of a novel User Involvement (UI) process for people with diabetes (PWD) and caregivers in a national project to develop a new Patient Reported Outcomes (PRO) questionnaire for routine diabetes care.
Methodology: 56 PWD (type 1 and 2) and 9 caregivers were recruited for individual and group UI activities with consideration of age, gender, diabetes type, duration, complications, treatment, geographic region and patient advocacy experience. Analyses were done on qualitative data from interviews, focus groups and workshops over 1 year. 7 UI quality criteria were used for planning and evaluation: 1) Shared purpose, 2) Respect and Accessibility, 3) Representativeness, 4) Roles, 5) Capacity and Capability, 6) Transparency and Documentation, 7) Continuity.
Results: UI generated multiple insights which impacted A) Aims and focus for PRO, B) PRO content and C) PRO implementation. Key insights included: A) PWD priority aims for use of PRO: To enable PWD to take more active role (incl. vulnerable groups), ensure all priority topics (incl e.g., sexual dysfunction) are covered consistently in visits, focus on what matters most to each PWD (use care resources where they add most value). B) PWD preferences for items: Simple, brief, relevant (individualized), supportive of autonomy, non-stigmatizing, non-paternalistic and not overly negative, C) PWD insights for implementation: PWD and care providers to be able to act on all PRO outputs (e.g., web tool and training). Stakeholders found the 7 quality criteria relevant for UI planning and evaluation.
Conclusions: Systematic UI led to major new insights that impacted outcomes of a national PRO diabetes program. The systematic diabetes UI process is recommended for further use in diabetes research and care improvement.

Disclosure
S.E. Skovlund: Stock/Shareholder; Self; Novo Nordisk A/S. L. Nørgaard: None. S. Stefansen: None. T. Honnens de Lichtenberg: None. L. Troelsen: None. A. Pietraszek: None. P.H. Kjær: None. H. Ravn Larsen: None. P.O. Jakobsen: None. N. Ejskjaer: None.

Funding
National Health Data Authority Region, Northern Denmark
911-P: Are New Metrics for Glucose Management Needed in Older Adults?
Authors: TOSCHI ELENA , SLYNE CHRISTINE , ATAKOV-CASTILLO ASTRID , GREENBERG JORDAN , SIFRE KAYLA , CARL SAM , DUFOUR ALYSSA B. , MUNSHI MEDHA 
Published: June 2019

With the increasing use of continuous glucose monitoring (CGM), it is now known that A1c derived from venous blood often poorly correlates with estimated A1c derived from CGM. Recently, a new formula was developed, termed Glucose Management Indicator (GMI), for connecting CGM metrics to venous A1c. However, there is no data on this new measure in older population with type 1 diabetes (T1D).
Methods: We analyzed data from older adults (age ≥65 years) with T1D with stable health and medications within past 3 months. We used A1c value from venous blood, and CGM data over a 14-day period performed concurrently. We calculated GMI based on the published data by Bergenstal et al (Diabetes Care 2018) and showed the degree to which GMI and A1C agree in our older cohort versus their historical cohort.
Results: We evaluated 76 participants mean age of 71 years. As shown in the Table, in both the historical and older cohort, GMI and A1c values are identical in 19% and 17% of the time, respectively. However, the percentage of absolute values between GMI and A1c differ by ≥0.6% in 19% of the historical cohort and 33% of the older cohort. These values differ by an entire 1% in only 3% of the historical cohort while 16% of the older cohort.
Conclusions: Compared to the historical cohort, greater difference between A1C and GMI values might be more common in older adults with T1D. Larger studies are needed to understand the use of new metrics in the older population.

Disclosure
E. Toschi: Advisory Panel; Self; Lexicon Pharmaceuticals, Inc. C. Slyne: None. A. Atakov-Castillo: None. J. Greenberg: None. K. Sifre: None. S. Carl: None. A.B. Dufour: None. M. Munshi: Consultant; Self; Lilly Diabetes, Sanofi.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
915-P: Characteristics Associated with Improved Blood Glucose Control for a Large Diabetes Population Using a Connected Blood Glucose Meter with CDE Support
Authors: LU WEI , WHALEY CHRISTOPHER , PAINTER STEFANIE L. , BOLLYKY JENNIFER 
Published: June 2019

Background: Managing blood glucose (BG) values within target range (80-180 mg/dL) decreases the risk for acute and chronic complications of diabetes. The Livongo for diabetes Program provides a connected blood glucose meter, unlimited glucose test supplies, digital one-to-one coaching from CDEs.
Methods: Medical claims, pharmacy claims, Livongo program use and demographic data for members who had been in the Livongo program for &gt; 3 months with continuous health benefits eligibility 1 year before and after launches of the Livongo program through large self-insured employers (N=1480) were obtained. Hemoglobin A1c was estimated (eA1c) based on BG values captured over 90 days for each member at 3, 6, 9 and 12 months after program activation and compared with HbA1c self-reported at baseline. Associations between eA1c improvements and BG checking patterns, coach interactions, medication adherence, medical spending and demographic characteristics at various time points were assessed using logistic regression models.
Results: The odds of improvement in eA1c was significantly higher for people who are older (OR=1.02, p&lt;0.01, CI(1.01-1.03)), have higher self-reported A1c value (OR=1.31, p&lt;0.01, CI(1.22-1.40)), are African American (OR=1.81, p&lt;0.01, CI(1.24-2.64)) and not on medication (OR=1.67, p&lt;0.05, CI(1.005-2.77)). With other characteristics controlled, having more coaching sessions and BG alert contact with coaches was associated with improved eA1c (OR=1.62, p&lt;0.1, CI (0.95-2.76)) and future low BG alerts (OR=1.21, p&lt;0.05, CI(1.04-1.41)) at 12 months.
Conclusions: Clinical impact of the Livongo for diabetes program varies based on demographics, clinical and program feature usage. Understanding these associations can improve personalization, member experience and clinical outcomes. These results suggest that real-time technology solutions can improve health for patients.

Disclosure
W. Lu: None. C. Whaley: Consultant; Self; Livongo Health. S.L. Painter: Employee; Self; Livongo Health. J. Bollyky: Employee; Self; Livongo Health. Stock/Shareholder; Self; Livongo Health.