bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poor Adherence in Adolescents with Type 1 Diabetes Associated with Distress, Fear of Hypoglycemia, and Executive Functioning
Authors: WESTEN SARAH C. , WARNICK JENNIFER , ENTESSARI MINA , ALBANESE-O'NEILL ANASTASIA , SCHATZ DESMOND , HALLER MICHAEL J. , JANICKE DAVID M. 
Published: June 2018

Introduction: T1D poses unique challenges to adherence-related behavior due to complex treatment regimens. This study aimed to determine prevalence rates of adherence in adolescents on multiple daily injections (MDI) or subcutaneous insulin infusion (CSII). Additional aims included determination of whether adherence correlated to HbA1c and whether psychological factors predicted adherence.
Methods: Self-monitoring of blood glucose (SMBG) and insulin delivery data were downloaded for the previous 30 days. Distress was measured using the Problem Areas in Diabetes-Teen Version, the Blood Glucose Monitoring Communication Questionnaire, and the Barriers to Diabetes Adherence survey. The Hypoglycemia Fear Survey and Behavior Rating of Executive Function were administered. Bivariate correlations and hierarchical regressions were used to determine how adherence related to HbA1c and the predictive value of psychological factors. Continuous glucose monitor (CGM) use was considered as a covariate.
Results: Adolescents (N=81; 41 on MDI and 40 on CSII; 32 on CGM) aged 11 to 17 years completed the study. The mean HbA1c was 8.74% (SD=1.74%). Daily, &lt;7% of participants engaged in SMBG ≥4 times; &lt;7% engaged in carbohydrate entry ≥3 times, and &lt;20% engaged in bolus delivery ≥3 times. Hyperglycemia readings were followed by a correction bolus in 58% of cases. HbA1c was negatively correlated with several adherence domains: frequency of SMBG (r=-0.465, p&lt;.01), carbohydrate entry (r=-0.511, p&lt;.01), and bolus insulin delivery (r=-0.522, p&lt;.01). Distress and fear of hypoglycemia predicted adherence to correction bolusing for hyperglycemia (R2=.237, p&lt;.05) in a model with child age, gender, and executive functioning.
Conclusions: Findings suggest adolescents do not adequately adhere to treatment for T1D. The use of diabetes treatment technology is helpful to measure specific domains of adherence and clarify relationships with psychological factors.

Disclosure
S.C. Westen: None. J. Warnick: None. M. Entessari: None. A. Albanese-O'Neill: None. D. Schatz: None. M.J. Haller: None. D.M. Janicke: None.
Correlates of Perceived Stress in Parents of Teens with Type 1 Diabetes
Authors: WHITTEMORE ROBIN , DELVY ROBERTA , COLEMAN JULIA L. , KATO BERNET , AMBROSOLI JAMES A. , MAURAO MICHAEL P. , ZINCAVAGE REBEKAH , MARCEAU LISA 
Published: June 2018

Parents of teens with type 1 diabetes (T1D) are responsible for a labor-intensive and complicated daily regimen that has been described as overwhelming and requiring constant vigilance. Parents report high levels of stress, particularly during the adolescent transition. The primary aim of this study was to identify demographic (parent/child age, gender, race/ethnicity, income, marital status), clinical (T1D duration, pump use, CGM use, episodes of hypoglycemia, other health diagnoses) and psychosocial factors (depressive symptoms, family conflict, childhood-illness parenting stress, teen autonomy) associated with perceived stress in parents of teens with T1D. This was a secondary analysis of baseline data from parents (n=162) of teens with T1D (11-16 years) who were enrolled in a study to evaluate a web-based tool to help with the transition of diabetes care. Bivariate correlates of perceived stress were included in a multivariate model analysis. Parents were 45.6 (±5.3) years of age, 98% female, 91% white, 91% married/partnered, 51% high income, 36% with elevated depressive symptoms, and 40% with elevated anxiety symptoms. Teens had a mean A1C of 7.9 (±1.2), 5.(±3.62) years duration of diabetes, with 75% using an insulin pump, 69% using a CGM, and 39% reporting 20 or more episodes of hypoglycemia in the previous 3 months. Significant bivariate demographic, clinical, and psychosocial correlates were included in the model, in a stepwise procedure. Multivariate correlates of perceived stress were parent age, teen T1D duration, other teen health diagnosis (R2=0.13, p&lt;.01), family conflict and childhood-illness parenting stress (R2 change=.30, p&lt;.01), and parent depression (R2 change=.18, p&lt;.01), explaining 62% of the variance. Parents of teens with T1D experience high stress and may need additional support to prevent and/or decrease family conflict, childhood-illness parenting stress, and depressive symptoms. Parent stress has health implications not only for parents, but also teens with T1D.

Disclosure
R. Whittemore: None. R. Delvy: None. J.L. Coleman: None. B. Kato: None. J.A. Ambrosoli: None. M.P. Maurao: None. R. Zincavage: None. L. Marceau: None.
Effects of Mindfulness-Based Stress Reduction on Insulin-Treated Diabetes
Authors: REIN RAQUEL , SEARL MEGHAN , BHANDARI SHREYA , COTE KATHRYN E. , HASHMI ISRA , DEL VALLE KAYLA L. , MCDONNELL MARIE E. 
Published: June 2018

Patients with type 1 (T1D) and type 2 diabetes (T2D) on insulin experience significant diabetes related distress (DD) which is known to negatively impact overall health and ability to self-manage the disease. Mindfulness Based Stress Reduction (MBSR) is an 8-week in-person group-taught program that has been shown to be effective in improving outcomes in chronic diseases. However, MBSR research in diabetes has been limited and has not included complex diabetes. We hypothesized that MBSR would lower DD and improve glycemic control in patients with uncontrolled insulin-treated diabetes. We conducted a nonrandomized pilot feasibility study of MBSR in insulin-treated patients with A1c above goal. Subjects completed the Diabetes Distress Scale (DDS) and Problem Areas in Diabetes (PAID) surveys at baseline, 3 months, and 6 months post intervention. Of 335 patients screened, 10 were enrolled. Patient characteristics included mean age 50.8 years; 60% female; 100% white non-Hispanic; mean baseline A1c= 8.6% +/-0.8. Duration of diabetes was 14 years +/-9; 30% T1D, 70% T2D; 100% on insulin; 70% injected insulin at least 3 times per day. Subjects attended 26 hours of in-class contact. Nine subjects completed the study; one was excluded due to interim pregnancy. All had decreased total DDS scores. There were statistically significant reductions in two DDS domains: emotional (-1.2, p=0.01) and regimen-related distress (-1.2, p=0.004). At 6 months, the mean A1c reduction was -0.4% +/- 0.9. The reduction in PAID score correlated with A1c reduction (r= 0.5).
In conclusion, uncontrolled insulin treated diabetes patients who participated in MBSR experienced a sustainable improvement in emotional and regimen-related distress which was accompanied by lower A1c. Results suggest the need for a large clinical trial designed to optimize accessibility to a broader population of patients and to test the cost-effectiveness of this nonpharmacologic intervention.

Disclosure
R. Rein: None. M. Searl: None. S. Bhandari: None. K.E. Cote: None. I. Hashmi: None. K.L. Del Valle: None. M.E. McDonnell: None.
Pancreatic Islets in Short Duration Type 2 Diabetes (T2D) Show Macrophage Infiltration and Increased Inflammatory Signaling
Authors: WALKER JOHN T. , SHRESTHA SHRISTI , PRASAD NRIPESH , RICHARDSON TIFFANY , ARAMANDLA RADHIKA , POFFENBERGER GREG , BOTTINO RITA , BRISSOVA MARCELA , POWERS ALVIN C. 
Published: June 2018

T2D is characterized by progressive pancreatic islet dysfunction; however, dissecting causes of this dysfunction in humans is challenging due to disease heterogeneity and the difficulty of obtaining relevant pancreatic samples. To address these challenges, we used an integrated approach to functionally and molecularly study the native pancreas and isolated islets from the same human T2D cadaveric donor. Using associated donor clinical information, we focused on donors with short disease duration (n=10, age 47-66 years, 2-7-year duration, oral medications). Compared to age-matched control islets, T2D islets had dysfunctional insulin (decreased) and glucagon (increased) secretion despite similar insulin and glucagon content. Tissue-section analysis of T2D pancreata showed no difference in relative endocrine (α, β and δ) cell composition. To assess for changes in the islet microenvironment, we analyzed macrophages by staining with Iba1 and endothelial cells with Caveolin-1 and found a 2-fold increase in intraislet macrophages (T2D vs. control: 3.01% vs. 1.45% by area) but no change in intraislet endothelial cell area (T2D vs. control: 8.97% vs. 8.21% by area). Interestingly, costaining with Iba1 and thioflavin S demonstrated that T2D islets with amyloid did not have increased macrophage infiltration compared to T2D islets without amyloid although a close spatial association of macrophages and amyloid deposits was noted. RNA-sequencing analysis of FACS-purified α and β cells from T2D islets showed increased inflammatory signaling pathways in both cell types. Specifically, transcripts for cytokine receptors such as IL6R, IL1R1, and IFNGR1 as well as downstream regulators including NFKB1 and NFKB2 were elevated in T2D α and/or β cells. Together, these data suggest that early in the course of T2D, increased macrophages in the islet microenvironment may lead to elevated α and β cell inflammatory signaling and contribute to human α and β cell dysfunction.

Disclosure
J.T. Walker: None. S. Shrestha: None. N. Prasad: None. T. Richardson: None. R. Aramandla: None. G. Poffenberger: None. R. Bottino: None. M. Brissova: None. A.C. Powers: None.
Dispelling Misperceptions—Family Satisfaction with Behavioral Health Screening
Authors: DUKE DANNY C. , NAGRA HARPREET , MELINDA JONES , BOLEN MORGAN , HARRIS MICHAEL A. 
Published: June 2018

Objectives: The ADA has recommended routine behavioral health screening of youth with T1D given the associations among psychological factors (e.g., depression and anxiety), the skills necessary to manage diabetes (executive functioning), and adherence and health outcomes. Anecdotally, concerns of healthcare providers and staff have included stigma, inconvenience, time, and/or unacceptable burden. However, family acceptance of behavioral health screening has not been systematically assessed.
Methods: After administering a screening protocol for youth with T1D, we administered a brief patient satisfaction questionnaire. The screening protocol included the PHQ-9, GAD-7, DREFS-SF, and the DSMP-SF. During this pilot, 57 youth (11-18 years), and 84 parents completed the screenings. Youth and parents completed the brief quality improvement survey after completing the behavioral health screening. Youth and parents responded to questions using a five-point scale from “strongly agree” to “strongly disagree.”
Results:QuestionsParentChild1.Completing questionnaires was an inconvenience4.8%1.8%2.The Information from questionnaires is important for diabetes care providers98.8%94.6%3.Completing the questionnaire was a burden to me or my family6.1%7.1%4.The questionnaires were too long2.4%1.8%5.The questionnaire about how well diabetes has been managed was helpful98.8%96.4%
Conclusions: Concerns regarding family satisfaction with behavioral health screening of youth with T1D were unfounded. Behavioral health screening was very acceptable to the vast majority of youth and parents with no indication that there was stigma associated with behavioral health issues.

Disclosure
D.C. Duke: None. H. Nagra: None. M. Jones: None. M. Bolen: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.
Predicting MDD with a Semistructured Depression Symptom Severity Interview in Type 2 Diabetes
Authors: SHAPIRA AMIT , ZEMON VANCE , SAFREN STEVEN , GONZALEZ JEFFREY S. 
Published: June 2018

Few studies in T2D have examined the accuracy of clinician-rated depression severity interviews, the gold-standard assessment. We assessed the factor structure and item-performance of the Montgomery-Åsberg Depression Rating Scale (MADRS) in a sample of adults with T2D.
Patients from primary and specialty care clinics of an urban academic medical center (N= 213, M (SD) A1c 8.2 (1.6), age 56 (9.5); 55% male) were screened for a trial of cognitive behavioral therapy for adherence and depression. Assessments included the MADRS and a structured interview (MINI) for diagnosis of MDD. Principal Component Analysis (PCA) with oblique rotation evaluated the number and character of MADRS components. Sensitivity, specificity, and area under the curve (AUC) of determined subscales and MADRS total score in predicting an MDD were calculated. Fifty-four percent (n=118) had current MDD and the mean MADRS score (M=21.2, SD=10.5) indicated moderate severity. PCA with extraction based on an eigenvalue &gt; 1 yielded a single component, supporting use of the MADRS total score. However, in forced multi-component solutions, each of the somatic items (reduced appetite and sleep) loaded as distinct factors, and “concentration difficulties” failed to load highly onto any factor. AUC was 89.2% [95% CI: 84.9-93.5%] when excluding the three problematic items, and 88.9% [95% CI: 84.7-93.2%] for the total MADRS, demonstrating similar performance. Appetite and sleep yielded the smallest AUCs (.59 and .71, respectively). Sensitivity and specificity of the MADRS total score were 81.2% and 80.2%, respectively, with a cutoff score of 20.5.
The MADRS is a strong instrument in predicting MDD and possibly provides a more accurate alternative to self-report measures. Results indicate that 7 of the 10 items could be administrated to T2D adults with depressive symptoms, shortening administration time.

Disclosure
A. Shapira: None. V. Zemon: None. S. Safren: None. J.S. Gonzalez: None.
Which Relationships Really Matter for Blood Glucose Control?
Authors: ROBERSON PATRICIA N.E. , MILLER MELANIE , RASPOVIC KATHERINE M. , LA FONTAINE JAVIER , FINCHAM FRANK , WUKICH DANE 
Published: June 2018

Diabetes patients’ perceived social support is consistently linked to their ability to manage blood glucose (HgA1c). However, little is known about which social relationships are linked to HgA1c. We use linear regression to examine how family, marital, and friendship support/strain predict HgA1c for diabetes patients. For the marital models we included only married participants (N = 121); For the family and friend models we included all participants (N = 160).
Results (Table 1) indicate that family and friend support/strain were not linked to HgA1c. However, marital strain/support were linked to HgA1c (higher strain indicated higher HgA1c and higher support indicated lower HgA1c).
Broad measures of social support are typically examined to understand and improve diabetes outcomes. But, our results suggest a need to focus on the marital relationship in order to improve HgA1c control. As the quality of marital relationship are mutable and brief couple interventions are cost-efficient, standard care could expand to include a marital relationship evaluation and/or a list of referral resources.
Further, the null findings for family and friend strain/support highlights the gap in our knowledge for aging single adults. The number of single adults is growing in the U.S. In the absence of marital support for these adults, we must understand if and to what extent their social environment is linked to HgA1c.
Table 1.Results of the univariate linear regression models for each measure of social support. In this table we present: Unstandardized coefficients with standard error (B(SE)), 95% confidence interval (95% CI), Standardized coefficients (Beta), probability value (p-value), variance explained (R2), and effect size (Cohen’s d).VariableB(SE)95% CIBetap-valueR2Cohen’s dModel 1: Family Support.16(.19)-.22, .54.06.41.004.06Model 2: Family Strain.10(.20)-.38, .40.004.96.000.04Model 3: Friend Support.13(.19)-.25, .51.06.49.003.05Model 4: Friend Strain.07(.24)-.41, .54.02.24.000.02Model 5: Spousal Support-.57(.26)-1.06, -.07-.20.03.04.17Model 6: Spousal Strain.51(.23).06, .96.20.03.04.20

Disclosure
P.N.E. Roberson: None. M. Miller: Employee; Self; Amputee Coalition. K.M. Raspovic: None. J. La Fontaine: None. F. Fincham: None. D. Wukich: None.
Family, Marital, and Friend Relationships and Diabetics Psychological Quality of Life
Authors: ROBERSON PATRICIA N.E. , MILLER MELANIE , RASPOVIC KATHERINE M. , LA FONTAINE JAVIER , FINCHAM FRANK , WUKICH DANE 
Published: June 2018

For diabetics, the mental health facets of quality of life are often comorbid with the development and progression of the disease. Compared to the general population, depressive and anxiety symptoms (D/A) are higher among diabetics. Further, several factors associated with higher D/A (e.g., obesity-promoting behaviors and neuroendocrine and inflammatory responses) cause the development of diabetes, progression of the disease, and insulin resistance. In the general population, social relationship quality is consistently linked to D/A with lower quality linked to more D/A. However, among diabetics, little is known about how social relationships are linked to D/A. In the present study, we test how diabetic patients’ marital (n = 121), family, and friendship relationship quality (n = 160) are linked to their self-reported depressive and anxiety symptoms using a series of univariate and multivariate regression models (Table 1).
Findings indicate a consistent link across relationships and A/D but especially marital and family relationships in multivariate models. These relationships are linked to patient‗s quality of life and potentially subsequent physiological and behavioral factors associated with blood glucose regulation. Therefore, as practitioners alter standard care practices to improve patient‗s quality of life, they should consider assessing social factors in addition to individual factors.Table 1.Unstandardized parameter estimates (standard errors), 95% confidence intervals, and p-values for the univariate and multivariate regression models testing marital, family, and friendship quality influence on two outcome variables: (1) depressive and (2) anxiety symptoms.Depressive Symptoms ModelsModel 1Model 2Model 3Model 4VariableB(SE)95% CIp-valueB(SE)95% CIp-valueB(SE)95% CIp-valueB(SE)95% CIp-valueMarital Quality1.75(.89).00,3.51.05------------.70(.91)-1.11, 2.513.44Family Quality------3.07(.68)1.72,4.42&lt; .001------2.32(.97).40, 4.25.02Friendship Quality------------2.89(.87)1.18,4.61.0011.40(1.19)-.96, 3.76.24Anxiety Symptom ModelsModel 5Model 6Model 7Model 8VariableB(SE)95% CIp-valueB(SE)95% CIp-valueB(SE)95% CIp-valueB(SE)95% CIp-valueMarital Quality1.88(.56).76, 3.00.001------------1.19(.58).04, 2.34.04Family Quality------2.17(.47)1.24, 3.10&lt;.001------1.37(.62).15, 2.59.03Friendship Quality------------2.48(.59)1.31, 3.65&lt;.0011.16(.76)-.34, 2.66.13

Disclosure
P.N.E. Roberson: None. M. Miller: Employee; Self; Amputee Coalition. K.M. Raspovic: None. J. La Fontaine: None. F. Fincham: None. D. Wukich: None.
A Reimbursable Counseling Intervention Improves Physical Activity and Function for Primary Care Patients with Type 2 Diabetes
Authors: HUEBSCHMANN AMY G. , LEAVITT IAN M. , GLASGOW RUSSELL , REGENSTEINER JUDITH G. , DUNN ANDREA L. 
Published: June 2018

Physical activity (PA) is a cornerstone of treatment for type 2 diabetes mellitus (T2D). Among other benefits, regular PA improves physical function which can prevent institutionalization. However, effective PA interventions are not widely adopted in primary care. Our recent systematic review identified an effective PA intervention for adults with T2D that was nearly pragmatic enough for use in primary care. However, it still required adaptation to fit clinic work flows and to be reimbursed by insurance. After adapting the intervention (Be ACTIVE) to address these issues, we hypothesized Be ACTIVE would improve PA and physical function relative to randomized controls. This pragmatic pilot trial randomized adults with T2D to 12 weeks of Be ACTIVE (6 telephone behavioral counseling sessions + PA tracking (FitBit©); 3 primary care visits to teach strength exercises + monitor safety) vs. enhanced usual care (3 self-management mailings). At baseline and post-intervention, we assessed PA with Actigraph© accelerometers (steps/week) and physical function by a timed 400-meter walk (sec) and the Short Physical Performance Battery (SPPB, 0-12 scale). To date, we have completed assessments for 15 participants (n=8 Be ACTIVE, n=7 controls). Pre-post PA increased by 19.8% in the Be ACTIVE group (+5122 ± 10steps/week; data shown as mean ± SE) and decreased by 15.9% in controls (-3122 ± 1233 steps/week). SPPB scores increased by a clinically important &gt;1-point difference in the Be ACTIVE group (+1.1 ± 0.2), and were stable in controls (+0.3 ± 0.1). The 400-meter walk time improved by 10.3% in Be ACTIVE participants (-38.3 ± 6.6 sec) and declined by 5.4% in controls (+17.3 ± 6.4 sec). Be ACTIVE is a reimbursable intervention delivered by primary care staff. Strong pilot data support that Be ACTIVE improves PA/physical function. If our data remain promising at trial completion, the next step towards broader dissemination will be to test Be ACTIVE in multiple clinical settings.

Disclosure
A.G. Huebschmann: Research Support; Self; Merck &Co., Inc..I.M. Leavitt: None.R. Glasgow: None.J.G. Regensteiner: None.A.L. Dunn: None.
Performance of Cleared Blood Glucose Monitor Systems
Authors: KING FRAYA G. , AHN DAVID T. , HSIAO VICTORIA , PORCO TRAVIS , KLONOFF DAVID C. 
Published: June 2018

Many blood glucose monitor systems (BGMs) do not pass international standards of accuracy, even when they have been previously cleared by the FDA. Patients rely on BGM data to make treatment decisions, and inaccuracy can lead to reduced glycemic control and insulin dosing errors. In order to assess the accuracy of these BGMs and identify trends that might explain these results, we performed a literature review of publications between 2010 and 2017 that present data about the accuracy of BGMs using ISO 15197 2003 and/or ISO 15197 2013 as target standards. We found 58 publications describing the performance of 143 unique BGM systems, 59 of which were FDA-cleared. When compared with non-FDA cleared BGMs, FDA-cleared BGMs were significantly more likely to pass both the ISO 15197 2003 (OR= 2.39, CI: 1.45-3.92, p&lt;0.01) and ISO 15197 2013 standards (OR= 2.20, CI: 1.51-3.27, p&lt;0.01). We also found that newer meters were more likely to pass each ISO standard for both ISO 15197 2003 (OR: 1.06, CI: 1.06-1.07, p&lt;0.001, odds ratio reported for a one-year period) and ISO 15197 2013 standards (OR=1.06, CI: 1.03-1.06, p&lt;0.01, odds ratio reported for a one year period). Newer meters tend to favor using the test strip enzyme glucose dehydrogenase (GDH) compared to glucose oxidase (GOX), which correlates to an increased likelihood of passing ISO 15197 2003 (OR=0.23, CI: 0.13-0.38, p&lt;0.001) and ISO 15197 2013 (OR=0.24, CI: 0.15-0.35, p&lt;0.001). We note that many of these studies were supported by BGM manufacturers, and when compared with independent studies, an FDA-cleared BGM was significantly more likely to pass in a manufacturer-supported study for both ISO 15197 2003 (OR=22.4, CI: 8.73-21.57, p &lt; 0.001) and ISO 15197 2013 (OR=23.08, CI: 10.16-60.03, p &lt; 0.001). We conclude that BGM accuracy should be assessed independently, both prior to FDA clearance and again during additional surveillance studies, to ensure accurate performance over time in real-world settings. Failure to do so can result in deleterious clinical and economic effects.

Disclosure
F.G. King: None. D.T. Ahn: None. V. Hsiao: None. T. Porco: None. D.C. Klonoff: Consultant; Self; Ascensia Diabetes Care, Lifecare, Intarcia Therapeutics, Inc., Voluntis USA, Novo Nordisk Inc., Onduo, Trividia Health, Inc., American Diabetes Association, The Endocrine Society, American Association of Diabetes Educators.