bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors Affecting Long-Term Healthy Behaviors and Posttraumatic Growth in Type 2 Diabetes Patients
Authors: KAYANO AYAKO , YAMAZAKI MASAHIRO , TAKU KANAKO , SAKAI RYOSUKE , HIGO NAOKO , ASANO MAI , HOSOKAWA TOYOSHI , KAWASE MASATOSHI , FUKUI MICHIAKI 
Published: June 2018

Background/Purpose: Constant self-management is important for type 2 diabetes patients to improve or maintain their quality of life, however it can become difficult and burdensome. The purpose of the current study is to qualitatively investigate the mechanisms of psychological adaption to a type 2 diabetes diagnosis and the factors affecting long-term healthy behaviors by referring to a theoretical framework of Posttraumatic Growth (PTG), that is, personal growth resulting from struggle with trauma.
Methods: A series of semi-structured interviews were conducted with adult patients (N = 10) who were diagnosed with type 2 diabetes over two years prior, maintaining an HbA1c of under 8% stable over 6-months, and showed a relatively higher level of PTG in a screening test using the extended version of the PTG Inventory.
Results: Interviews were analyzed by the Grounded Theory Approach. Three main mechanisms were identified. (1) Some were able to continue healthy behaviors because they experienced PTG as a result of single major life event that occurred prior to diagnosis. (2) Some were able to continue healthy behaviors because they experienced PTG as a result of a number of minor but stressful life events that occurred in succession prior to diagnosis. (3) Others were able to continue healthy behaviors because they experienced PTG directly as a result of the diagnosis of diabetes. Overall, patients included in the current analyses were not overly conscious of their diagnosis or treatment in their daily lives, and did not seem to struggle with identity conflicts relating to their diagnosis.
Conclusion: Current study identified three paths leading to healthy behaviors. Regardless of the triggering events, PTG experiences seem to transform cognitive processes and increase stress tolerance, resiliency, and perhaps purpose in life and a sense of identity, and thus enable them to maintain healthy behaviors. Future study should explore the paths among patients who have not experienced PTG.

Disclosure
A. Kayano: None. M. Yamazaki: None. K. Taku: None. R. Sakai: None. N. Higo: None. M. Asano: None. T. Hosokawa: None. M. Kawase: None. M. Fukui: Research Support; Self; Grant-in-Aid for Scientific Research (C), Ono Pharmaceutical Co., Ltd., AstraZeneca, Astellas Pharma US, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kyowa Hakko Kirin Co., Ltd., Kissei Pharmaceutical Co., Ltd., MSD K.K., Novo Nordisk Foundation.
The Influence of Daily Stress on Glycemic Control and Mortality in Adults with Diabetes
Authors: WALKER REBEKAH J. , GARACCI EMMA , CAMPBELL JENNIFER A. , EGEDE LEONARD E. 
Published: June 2018

Background: Daily stress may compound the burden of diabetes. This analysis investigated whether frequency or severity of stress had an influence on glycemic control (HbA1c) and mortality in adults with diabetes.
Methods: Data from the second and third wave of the national longitudinal survey of Midlife Development in the United States (MIDUS), conducted between 1995 and 2014, was used. A total of 141 adults with diagnosed and undiagnosed diabetes, based on HbA1c and self-report of diagnosis, completed the national study of daily experiences (NSDE) project during which questions were asked about daily stress type, frequency, and impact for eight consecutive nights. General linear models investigated the relationship between stress and HbA1c. Cox proportional hazard models estimated hazard ratios using national death index information linked to MIDUS data.
Results: On average, this population of adults with diabetes reported 3.1 days with a stressor and 3.9 stressors in an 8-day period. While 21.9% reported only one stressor type, 72.3% reported more than one stressor type. No significant relationships existed between number of days with stressor, average number of stressors, or number of stressor types. Average physical symptom severity reported in relationship to stressful events was negatively associated with HbA1c (-0.20, p=0.04). The average stressor severity and average stressor negative affect were both significantly associated with mortality (HR=0.45, p=0.04 and HR=0.17, p=0.03, respectively).
Conclusions: Daily stress may influence outcomes for adults with diabetes; in particular, severity of stressors experienced, severity of physical symptoms related to stressors, and negative affect (negative emotions and poor self-image) related to stressors. Interventions addressing psychosocial factors, such as daily stress, in individuals with diabetes may need to focus on helping individuals mitigate the impact of stress rather than decrease the amount of stress in their lives.

Disclosure
R.J. Walker: None. E. Garacci: None. J.A. Campbell: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..
Psychological Distress Mediates the Association between Poor Sleep Quality and Prediabetes
Authors: LI LI 
Published: June 2018

Background: Evidence indicates that poor sleep quality increases risk for prediabetes. Psychological distress may be a potential mechanism through which poor sleep quality affects glucose metabolism. Sleep, prediabetes, and distress are linked to type 2 diabetes. We examined the relations between poor sleep quality and prediabetes, and tested whether psychological distress mediates their relation in a cross-sectional study.
Methods: Subjects were 133 men (n=49) and women (n=84) aged 37.9±12.5 years with body mass index (BMI) between 30.3±6.9kg/m2. Subjective sleep quality was determined by the Pittsburg Sleep Questionnaire Index (PSQI). Subjects were stratified based on PSQI score into normal (NSQ; PSQI≤5, n=68) vs. poor sleep quality (PSQ; PSQI&gt;5, n=65). Two hour-oral glucose tolerance test (OGTT) was conducted in each subject, and prediabetes was diagnosed using the ADA diagnostic criteria. Psychological distress was assessed using the Childhood Trauma Questionnaire, and depression was self-evaluated using Beck Depression Inventory. PROCESS Macros method was used to assess the direct relation between sleep quality and prediabetes, and the potential mediating effects of psychological distress on that relation. All data analysis was adjusted for age, gender, race, education, employment status, depression and BMI.
Results: Experiencing poor sleep quality was associated with higher fasting glucose levels (95.9±7.6 vs. 98.0±10.2, p&lt;0.01) and 2h-post prandial glucose levels (102.8±24.7 vs. 108.7±30.5, p&lt;0.01) compared to NSQ group. PSQ group also had greater OGTT-derived QUICKI (p&lt;0.05). Psychological distress mediated the relation between poor sleep quality and prediabetes with adjustment for co-variables.
Conclusions: Poor sleep quality is associated with prediabetes through psychological distress. Efforts to improve sleep quality and decrease psychological distress may yield lower type 2 diabetes rate in this high-risk prediabetic population.

Disclosure
L. Li: None.
Building Infrastructure for Diabetes Self-Management Support in Church-Based Settings—Results of a 15-Month Cluster-Randomized Controlled Trial
Authors: KOSCIELNIAK NIKOLAS J. , FUNNELL MARTHA , PIATT GRETCHEN 
Published: June 2018

Diabetes self-management support (DSMS) is not a covered benefit in the U.S. health system, and little is known about the infrastructure needed to provide effective DSMS in organizations without existing diabetes self-management education (DSME) programs. The Praise study is a 15-month cluster-randomized controlled trial in 9 African American (AA) churches in metro-Detroit, as a conduit to build infrastructure for DSMS in low-resource communities. From 2013-2015, Praise examined the effects of peer-led DSMS on A1C and diabetes distress (DD) at 3, 9, and 15 months. CDEs trained peer leaders (PL) (n=12) and parish nurses (PN) (n=3) on goal setting, skills development, and group facilitation. Following professionally-delivered DSME, 6 monthly DSMS groups were independently planned and facilitated by 12 PL (mean age: 61.9 years, 100% AA, 25% male), followed by an additional 6 months of ongoing support to assess the logistical feasibility of sustaining DSMS efforts. Churches (and their participants, n=94) were randomized to 3 parallel groups: 1) PL only DSMS (n= 28), 2) PN + PL DSMS (n= 36), or 3) enhanced usual care (n= 30). Over time, a significant increase in A1C (p=.03) was observed across groups overall, but not within study groups. After adjusting for multiple factors, younger age (β=-.04; p=.004) and lower levels of DD (p=.04) were associated with improvements in A1C over time, while insulin use (p= .032) was associated with increases in A1C. A marked improvement in DD was observed (p=.04) overall. PL only (p= .003), PL+PN (p=.01), and A1C (p=.02) were significantly associated with improvements in DD. Results suggest DD is a significant indicator of improvement in A1C levels. DD levels also improved following a faith community-based DSME intervention and were sustained by using the PL and PN DSMS infrastructure of the church. Opportunities to expand the DSMS infrastructure beyond churches and into other community organizations is needed.

Disclosure
N.J. Koscielniak: None. M. Funnell: Advisory Panel; Self; Sanofi US, Intarcia Therapeutics, Inc.. G. Piatt: None.
The Emotional Side of Diabetes and Glycemic Control in a Brazilian Sample of Adults with Type 1 Diabetes
Authors: SILVEIRA MÔNICA S.V..M. , PARISI MARIA C. , RUPPERT KRISTINE , ARNALDO MOURA NETO , SIMINERIO LINDA M. , SPOSITO ANDREI C. , FUNNELL MARTHA , PAVIN ELIZABETH J. , FISHER LAWRENCE 
Published: June 2018

Adults with type 1 diabetes (T1D) have a higher risk of developing depression symptoms during their lives and new research shows that over 40% of T1Ds experience elevated diabetes-related distress (DD). Psychosocial assessment is recommended as a critical part of patient-centered care in order to promote better diabetes outcomes and psychosocial well-being. The goals of this study were to document the prevalence of and relationships among Major Depressive Disorder (MDD), depression symptoms and DD, and to determine the linkage each of these measures with glycemic control in a Brazilian sample of adults with T1D at The State University of Campinas, Brazil. In a cross-sectional study, 70 T1D adults were evaluated. Inclusion criteria were age ≥18 and diagnosis of T1D ≥ 6 months. Exclusion criteria were cognitive impairment, history of major psychiatric disorders (e.g., schizophrenia, drug addiction, dementia), and severe diabetes-related complications (blindness, need for hemodialysis, limb amputations, stroke). Diagnoses of MDD was made using DSM-5 criteria. Depression symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression scale (HAD-D). The Diabetes Distress Scale (DDS) assessed DD. Metabolic control was evaluated by HbA1c. The latest lipid panel results were recorded and BMI was calculated. Number of complications was obtained from medical records. Forty percent of T1Ds were male, mean age 31(±8,8), mean number of complications was 1 (± 1.2), and mean HbA1c was 10.0%(±2). Frequency of MDD was 30,0% and 35,7% reported high depression symptoms. Fifty-two percent reported high DD. Only DD and depression symptoms were each significantly and positively associated with HbA1C (p &lt; .05). This study shows that several measures that reflect the emotional side of diabetes are related to glycemic control. They emphasize the need to incorporate the emotional side of diabetes into strategies of care for adults with T1D.

Disclosure
M.S.M. Silveira: None. M.C. Parisi: None. K. Ruppert: None. A. Moura Neto: None. L.M. Siminerio: None. A.C. Sposito: None. M. Funnell: Advisory Panel; Self; Sanofi US, Intarcia Therapeutics, Inc.. E.J. Pavin: None. L. Fisher: Consultant; Self; Eli Lilly and Company, Abbott, Merck & Co., Inc..
Clinical Practice Factors That Define Insulin Pump Readiness
Authors: PUCKETT CASSIDY , WONG JENISE C. 
Published: June 2018

The American Association of Clinical Endocrinologists/American College of Endocrinology and Endocrine Society guidelines on insulin pump use emphasize patient assessment to determine pump readiness for patients with type 1 diabetes (T1D). While guidelines mention the importance of the clinical practice context, such as the presence of a comprehensive pump management program and prescribing provider expertise in pump therapy, primary emphasis is placed on the measurement of patient knowledge of diabetes management, their mental and psychological status, and adherence to self-care. But how clinics define and assess “pump readiness” is not standardized, and the extent to which this process is linked to systematic differences in the allocation of healthcare technologies by race and class is unclear. In this comparative qualitative study, we describe how two ADA recognized pediatric endocrinology centers with different prevalences of patient pump use (32% vs. 77% of patients with T1D) also differ in how they determine pump readiness. In the clinic with higher overall pump use, there are no differences in frequency of pump use between non-Hispanic white and ethnic minority patients, and differences by insurance status are small. In contrast, in the clinic with lower overall pump use, there are large differences in pump use by race and insurance status. To explore these trends, we conducted over 400 hours of observations of clinical encounters and decision-making processes and fifteen 30-minute interviews with pediatric endocrinologists, nurses, certified diabetes educators, and other staff and coded the data using Atlas.ti. Findings suggest pump allocation is shaped by how: 1) providers respond to patient “cultural capital” or interaction styles, 2) clinics frame and engage with medical technologies (e.g., “pro-tech” practices such as ongoing provider and patient education to support new devices), and 3) clinics organize provider care and decision making processes (e.g., professional opinion vs. use of metrics).

Disclosure
C. Puckett: None. J.C. Wong: Research Support; Self; Dexcom, Inc.. Other Relationship; Self; Tidepool Project.
Gender Differences in Contributions of Mutable and Immutable Factors on Quality of Life in Adults with Type 2 Diabetes
Authors: WILLIAMS JONI S. , EGEDE LEONARD E. 
Published: June 2018

Background: The aim of this study was to assess contributions of mutable and immutable factors on quality of life (QoL) in men and women with type 2 diabetes.
Methods: Cross-sectional study of 615 adults from two clinics in the southeastern U.S. Hierarchical models were performed for the full sample, women, and men using the physical component score (PCS) and mental component score (MCS) of QoL as dependent variables, adjusting for sociodemographic, socioeconomic, psychosocial, built environment, clinical, and self-care factors and diabetes knowledge.
Results: For women, significant associations were found between PCS QoL and neighborhood aesthetics (β=0.09; p=0.009) and exercise environment (β=-0.03; p=0.010), accounting for 25% of the variance and MCS QoL and serious psychological distress (SPD) (β=-0.12; p=0.001), perceived health status, (β=-0.54; p=0.040) and diabetes knowledge (β=0.11; p=0.046), accounting for 36% of the variance. For men, significant associations were seen between PCS QoL and SPD (β=0.02; p=0.031), neighborhood crime (β=-0.17; p=0.041), neighborhood comparison (β=0.17; p=0.012), and kidney problems (β=0.25; p=0.045), accounting for 12% of the variance and MCS QoL and depression (β=-0.08; p=0.004), SPD (β=-0.07; p=0.002), perceived stress (β=-0.14; p=0.001) diabetes duration (β=0.03; p=0.015), comorbidity (β=-0.15; p=0.014), and perceived health status (β=-0.28; p=0.045), accounting for 51% of the variance.
Conclusions: Significant associations were observed between QoL and mutable factors, suggesting areas amenable to health interventions. For women, interventions should focus on improving the built environment, decreasing SPD, and improving diabetes knowledge. For men, interventions should focus on the built environment, mental health, and comorbid conditions.

Disclosure
J.S. Williams: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..
Timely Initiation of Human Insulins—Interim Analysis on Knowledge and Attitude from Indian Human Insulin Registry (INHIRIT)
Authors: PAWAR DILIP , BOSE SAPTARSHI , JABEEN SARAH , SANDEEP S. , KARADI VEERANNA 
Published: June 2018

INHIRIT, India’s one of the largest human insulin registries encompassing 300 Health Care Professionals(HCPs) and 9000 patients with an objective to identify the factors for timely insulin initiation in T2DM patients. A Multicentric, open label, cross sectional survey in assessing the knowledge and attitude among 112 HCPs through e-questionnaire, validated by a panel of experts. The primary objective is to understand the knowledge, attitude and practice of timely insulin initiation whereas adherence and treatment satisfaction are being assessed as secondary objectives.
Results: Key factors identified for timely insulin initiation were patients uncontrolled on existing therapy (OHA) (91.96%), diabetes duration (66.07%) and presence of comorbidities (57.14%). The comorbidities influencing HCPs to initiate timely insulins are CKD (59.71%), foot ulcer (58.93%), and CAD (52.68%). Affordability and similar efficacy were two important reasons for HCPs to prefer human insulins [median (IQR): 70% (60-75)] over to analogues [30% (25-40)] in day to day practice. HCPs opined to initiate insulin as second and third line therapy in 42.5% of their patients. While intensifying from basal supported oral therapy, 91.49% clinicians preferred premixed human insulins over basal-bolus therapy. Major aspects that deter insulin initiation were patient’s factors (86.61%), newer antidiabetic drugs (58.93%), and physician’s inertia (41.96%). Patient support programs such as insulin injection techniques (34.58%), counselling (33.64%) and educational materials (15.89%) etc. were preferred by HCPs while initiating insulins.
Conclusion: Primary analysis of INHIRIT study provides key insights on timely insulin initiation i.e., patients uncontrolled on OADs, duration of diabetes and comorbid conditions. Similarly patient support programs help HCPs to set individualized glycaemic strategy which helps in better health and economic outcomes in their patients.

Disclosure
D. Pawar: Employee; Self; Biocon. S. Bose: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. S.: Employee; Self; Biocon.V. Karadi: None.
Insulin Pump Therapy with Simple Scheme in Insufficiently Controlled Patients with Type 2 Diabetes on Intensive Injection Therapy—A Real-Life Study
Authors: DE VALK HAROLD W. 
Published: June 2018

Background and Aims: Many patients with type 2 diabetes mellitus on intensive insulin injection therapy (MDI) do not reach adequate glycemic control. A randomized controlled trial has shown that continuous subcutaneous insulin infusion (CSII) using a simple scheme with one basal rate, improves glycemic control (Lancet 2014; 384: 1265-72). We studied effectiveness of this scheme in a real life setting.
Materials and Methods: Patients with type 2 diabetes with HbA1c ≥ 64 mmol/mol on MDI with insulin requirement between 0.7 and 2.2 U/day were eligible. Hourly basal rate was 50% of the total daily dose (TDD) divided by 24; 50% of TDD was divided equally between three meals. Trial duration 6 months.
Results: Sixty-seven patients participated. Mean age: 61.3±0.9 years, 42% female; duration of disease: 16.0±7.6 years; weight: 10.7.4±21.9 kg; BMI: 35.8±6.9 kg/m2, baseline TDD: 135.5±62.3 U/day. Mean HbA1c fell from 80.1 ± 15.2 to 62.4 ±10.0 mmol/mol (p&lt;0.001); mean change in HbA1c -17.7±2.1 mmol/mol. After exclusion 3 outliers (ΔHbA1c &gt;-50 mmol/mol), the results were comparable: HbA1c fell from 78.0±11.8 to 63.0 ±9.7 mmol/mol (p&lt;0.001); mean change -15.0±1.5 mmol/mol. Total cholesterol decreased slightly (4.33±0.13 to 4.21±0.13 mmol/l, p&lt;0.05); no changes in other lipid parameters or blood pressure. Body weight increased from 106.2±19.5 to 109.3±20.61 kg (p&lt;0.001).
Conclusion: This real-life study shows that introducing CSII with simple insulin schema in patients with insufficiently-controlled type 2 diabetes on MDI, leads to major improvement of glycemic control, at the expense of some weight gain. This approach provides a worthwhile alternative in patient with poorly-controlled DM2 and considerable insulin resistance. Nutritional counselling deserves attention to diminish weight gain.

Disclosure
H.W. de Valk: None.
A Real-World Evidence in Understanding the Barriers and Behaviours of Insulin Therapy among Indian Type 2 Diabetes Mellitus (T2DM) Patients
Authors: RAJ PRAVEEN , PAWAR DILIP , JABEEN SARAH , VS SHIVARAM 
Published: June 2018

Introduction: American Diabetes Association categorizes barriers to adherence as either patient barriers, medication factors, or system factors. The aim of the study is to understand the barriers and behaviors of insulin therapy among T2DM patients in India from a real world setting.
Methods: The data is collected from an ongoing patient support program called as iTAP (Insulin Therapy Assistance Program) designed by Biocon in patients with T2DM receiving insulin. It’s an open label, multicentric, real world data depicting 10426 T2DM patients, of which 3192 (30.61%) patients have moved on to various therapies observed over 9 months. Data of these 3192 patients were analyzed to understand the reasons for shift in therapy.
Results: The prime behavioral change is from insulin to oral hypoglycaemic drugs (64.35%) and others are, short term insulin therapy (12.81%), and change/shift from an ampoule to vial dosage (6.11%). The primary barriers in insulin therapies were hypoglycaemic episodes (25.9%), stress (17.1%), fear of injection (10.3%) and cost (7.4%).
Conclusion: There is an underwhelming amount of data on interventions to addressing those barriers or even aimed at improving insulin adherence in general. Education and empowerment (stress, fear of injection and cost) through shared decision-making allow patients’ preferences to be presented and considered and subsequently generate the best individualized treatment plan for each patients.

Disclosure
P. Raj: Employee; Self; Biocon. D. Pawar: Employee; Self; Biocon. S. Jabeen: Employee; Self; Biocon. S. Vs: Employee; Self; Biocon.