bluuebunny/crossref_metadata_2025_split huggingface dataset:
642-P: Diagnosing Peripheral Neuropathy with a Remote Temperature Monitoring Mat
Authors: PETERSEN BRIAN J. , ZHOU MIN , BLOOM JONATHAN D. , ROTHENBERG GARY M. , ARMSTRONG DAVID 
Published: June 2019

The aim of this study was to derive and validate a model to identify peripheral sensory neuropathy using remote temperature monitoring (RTM). We used data from a recent longitudinal study of a once-daily in-home RTM mat. Neurological status was assessed via 10g monofilament. We trained and cross-validated (repeated k-fold sampler) machine learning classifiers (support vector machine with radial basis function kernels). Accuracy was defined as the area under the receiver operator curve (AUC). We report on three final models that assess neuropathic status: (1) foot temperatures at the six plantar locations commonly used for RTM; (2) high-resolution foot temperature maps (thermograms); (3) high-resolution foot shape without associated temperatures. A total of 154 feet were included, of which 30 were insensate (19.5%). The AUCs of these three models were 0.78±0.13 (good), 0.92±0.07 (excellent), and 0.54±0.16 (poor), respectively. The results suggest the diagnostic usefulness of thermograms, which is supported by the fact that analysis feature importance of model 2 shows high diagnostic value for temperatures in the medial midfoot and distal toes. The latter is possibly due to vasodilation of the medial plantar artery, while the former can be explained by the progressive nature of neuropathy from distal to proximal. That model 3 had nearly no predictive value suggests that foot deformity secondary to motor neuropathy is not contributing diagnostic value. Interestingly, 22 feet showed neuropathic progression over the 34-week study. Results from model 1 reflected these changes when assessed at enrollment and at study completion for these feet. These results suggest the RTM mat may be useful for assessing peripheral neurological function and progression in patients with diabetes. These diagnostic models may also inform improved RTM standard and machine learning algorithms for predicting diabetic foot complications secondary to neuropathy.

Disclosure
B.J. Petersen: Employee; Self; Podimetrics. Stock/Shareholder; Self; Podimetrics. M. Zhou: None. J.D. Bloom: Employee; Self; Podimetrics. Stock/Shareholder; Self; Podimetrics. G.M. Rothenberg: Consultant; Self; Podimetrics. D. Armstrong: None.
65-OR: Effects of Treatment with Metformin and/or Sitagliptin on Beta-Cell Function and Insulin Resistance in Prediabetic Women with Previous Gestational Diabetes
Authors: BARONE SARA , DARDANO ANGELA , TURA ANDREA , KURUMTHODATHU JANCY J. , BERTOLOTTO ALESSANDRA , BIANCHI CRISTINA , GIUSTI LAURA , LACARIA EMILIA , ROMANO MATILDE , MICCOLI ROBERTO , PENNO GIUSEPPE , PRATO STEFANO DEL , DANIELE GIUSEPPE 
Published: June 2019

Gestational diabetes (GDM) enhances the risk of type 2 diabetes (T2D) with 20-50% of women progressing to T2D within 10-years after pregnancy. Preventative strategies, including use of pharmacologic agents, are worth considering. We assessed, in a randomized double-blind study, the effect of 16-week therapy with sitagliptin (SITA, 100 mg qd), metformin (MET, 850 mg bid), and SITA+MET (50+850 mg bid) on beta-cell function and insulin sensitivity in women (n=40, age 30-49 y) with recent GDM and impaired glucose regulation (IGR: IFG and/or IGT). A 75gr OGTT and +125 mg/dl hyperglycemic clamp followed by 5 gr i.v. L-arginine were performed at baseline and study-end. Baseline characteristics were comparable in the 3 groups. At week 16, BMI declined in all groups (-1.2±0.2 Kg/m2; p&lt;0.05). First phase(2-10 min) insulin secretion and arginine-stimulated C-peptide response increased with SITA+MET (1.0±0.2 to 1.3±0.3 ng/ml/min and 3.2±0.6 to 4.8±1.0 pmol/min, respectively, both p&lt;0.05) while no changes occurred with MET and SITA. SITA+MET increased OGTT-based glucose sensitivity (55.7±11.3 to 108±56.2 pmol x min-1m-2 x mM-1; p=0.04) but no changes occurred with MET and SITA. No change occurred for rate sensitivity and potentiation factor in any group. SITA+MET increased insulin sensitivity (M/I: 2.2±0.5 to 4.6±1.3 mg/kg/min÷μIU/min/ml; p=0.04; OGIS: 351.9±11.4 to 375.7±9.6 ml x min-1m-2; p=0.08) but it was not affected by MET or SITA. Disposition Index increased with SITA+MET (10.8±1.1 to 13.6±1.6 μIU/ml/min÷mg/dl/min) and SITA (8.6±1.0 to 10.6±1.3; both p&lt;0.05). Among SITA+MET women, 33% reverted to NGT compared to 14% with MET and 7% with SITA (p&lt;0.05). This proof of concept study shows that SITA+MET is superior to SITA and MET monotherapy on beta-cell function and insulin sensitivity improvement in IGR women with previous GDM. It may offer a potential pharmacologic intervention to reduce risk of T2D in this high-risk population.

Disclosure
S. Barone: None. A. Dardano: None. A. Tura: None. J.J. Kurumthodathu: None. A. Bertolotto: Speaker's Bureau; Self; Abbott, Lilly Diabetes. C. Bianchi: None. L. Giusti: None. E. Lacaria: None. M. Romano: None. R. Miccoli: None. G. Penno: None. S. Del Prato: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, GlaxoSmithKline plc., Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk A/S, Sanofi, Servier, Takeda Pharmaceutical Company Limited. Board Member; Self; AstraZeneca. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Takeda Pharmaceutical Company Limited. G. Daniele: None.
652-P: A Group-Based Food Monopoly-Style Game Improved Blood Glucose Control in Newly Diagnosed Type 2 Diabetes
Authors: WU YUEH CHU , WANG YU-MING , KORNELIUS EDY , HUANG CHIEN NING 
Published: June 2019

Objective: The aim of this study was to compare the effectiveness of a Food Monopoly-style Game (FMG) on glycemic control in type 2 diabetes (T2DM), compared with usual care.
Methods: Newly diagnosed T2DM patients were randomly assigned to the FMG group (using a group interaction model of patient education) and a usual care group (using a traditional teaching model). Glycemic outcomes and behavior questionnaires were evaluated at 3 months.
Results: A total of 65 patients were enrolled (FMG group, n=32; usual care group, n=33) with a mean age of 52.9±11.2 years, diabetes duration of 0.7±0.4 years, and HbA1c level of 9.2±1.9%. FMG group patients had significantly greater HbA1c reduction at 3 months than that of usual care patients (-2.3 vs. -0.6%), respectively; p&lt;0.001. SMBG (times/week) (+5.8±3.1) and physical activity (minutes/week) (+42.5 ±24.4) were higher in the FMG group, compared with the usual care group (p&lt;0.001). The FMG group had a significantly greater percentage of patients who achieved HbA1c&lt;7% at 3 months compared with the usual care group (62.5 vs. 0%, p&lt;0.001).
Conclusions: Our data suggest that the FMG approach provided more effective education in poorly controlled T2DM compared with conventional patient education. Education tools, such as FMG, can be used to adjust patients' self-management behavior and enhance diabetes-related psychosocial self-efficacy.

Disclosure
Y. Wu: None. Y. Wang: None. E. Kornelius: None. C. Huang: None.
658-P: Influence of Patient Health Literacy (HL) on Supporter Roles in Diabetes Self-Management
Authors: FIELDS BETH , LEE AARON A. , PIETTE JOHN , TRIVEDI RANAK B. , OBROSKY D. SCOTT , MOR MARIA K. , HEISLER MICHELE , ROSLAND ANN-MARIE 
Published: June 2019

Background: It is unknown whether family members or friends (‘supporters’) tailor their assistance to the unique needs of patients with diabetes and low HL.
Methods: Surveys were conducted among 239 VA healthcare system patients with type 2 diabetes who were 30-70 years old, had A1c&gt;8% or high blood pressure, did not have dementia or need help with basic activities of daily living, and had an unpaid supporter who was involved in their care. Patients reported the frequency of supporter involvement with diabetes management roles (e.g., help filling medications). HL was assessed using two items from the well-validated Chew scale: 1) How often do you have problems learning about medical conditions because of difficulty understanding written information (0=none of the time, 4=all of the time), and 2) How confident are you filling out medical forms by yourself (0=extremely, 4=not at all). Those responding ‘3’ (somewhat) or greater were designated as low health literacy. Logistic regression models were used to identify the independent association between patient HL and types of supporter assistance.
Findings: Patients with low HL were significantly more likely than patients with adequate HL to have a supporter with low HL (32% vs. 18% of supporters, p=0.02). Low patient HL was significantly associated with higher odds of supporters helping with: deciding when to call doctor (AOR=2.21, 95% CI: 1.10-4.42); remembering medical appointments (AOR=2.48, 95% CI: 1.24-4.98); navigating the health system (AOR=2.67, 95% CI: 1.34-5.32); and attending medical appointments with patient (AOR=2.11, 95% CI: 1.11-3.96). Patient HL was not associated with whether supporters helped with filling or taking medications, or managing diet and exercise.
Conclusion: Supporters of patients with low HL were more likely to have low HL themselves, and to help patients with care coordination and equally likely to help with carrying out diabetes medication and lifestyle behaviors compared to patients with adequate HL.

Disclosure
B. Fields: None. A.A. Lee: None. J. Piette: None. R.B. Trivedi: None. D. Obrosky: None. M.K. Mor: Stock/Shareholder; Spouse/Partner; AbbVie Inc. M. Heisler: None. A. Rosland: None.

Funding
U.S. Department of Veterans Affairs (IIR 14–074-1); Michigan Center for Diabetes Translational Research (NIDDK5P60-DK09292); Michigan Claude D. Pepper Older Americans Independence Center (NIA AG-024824)
67-OR: Plasma Copeptin and Risk for Lower Extremity Amputation in People with Type 1 and Type 2 Diabetes
Authors: POTIER LOUIS , ROUSSEL RONAN , MOHAMMEDI KAMEL , SAULNIER PIERRE , MARRE MICHEL , HADJADJ SAMY , VELHO GILBERTO 
Published: June 2019

Recently, an increased risk of lower extremity amputation (LEA) was observed with canagliflozin, a SGLT2 inhibitor, in the CANVAS trial although observational studies showed conflicting results. This association could be related to the contraction of plasma volume induced by SGLT2 inhibition. In this case, copeptin, a surrogate marker of vasopressin, should be associated with LEA. Our aim was to analyze the association between LEA and plasma copeptin in 4 cohorts of patients with type 1 and type 2 diabetes (T1D, T2D). Analysis were done in 2 pooled cohorts of patients with type 2 diabetes (DIABHYCAR, SURDIAGENE, n=4532) and 2 pooled cohorts of patients with type 1 diabetes (GENESIS, GENEDIAB, n=712). Cox regression model was fitted to compute hazard ratio (HR) and 95% CI for incident LEA by tertiles of copeptin at baseline. C-statistic, integrated discrimination improvement (IDI) and continuous net reclassification improvement (cNRI) were used to assess the prognostic value of copeptin in LEA discrimination. Mean follow-up was 5.3 years for DT2 and 6.3 for DT1. Incidence of LEA was 1.6% (T1), 2.6% (T2) and 3.3% (T3) for DT2 (p&lt;0.001) and 3.9% (T1), 3.3% (T2) and 10% (T3) for DT1 (p=0.003). In a Cox multivariable analysis model (adjusted for cohort, sex, diabetes duration, hypertension, previous cardiovascular and peripheral arterial disease and glomerular filtration rate), HR for LEA was 1.91 (1.13-3.24; p=0.016) in DT2 and 2.76 (1.05-7.66; p=0.04) in DT1, both for T3 vs. T1. Plasma copeptin yielded incremental information for the risk of LEA in DT2: C-statistic change 0.012 (p=0.005), IDI: 0.007 (0.005-0.025, p=0.05), cNRI: 0.13 (0.03-0.29, p=0.03). Plasma copeptin is significantly associated with an increased risk of LEA in patients with T1D and T2D. Mechanisms underlying this association are not known but could be related to hydration status. Our results suggest a potential role of contraction volume effect of SGLT2 inhibitor in the higher risk of LEA possibly associated with this class.

Disclosure
L. Potier: Advisory Panel; Self; Merck Sharp & Dohme Corp. Consultant; Self; Sanofi. R. Roussel: Advisory Panel; Self; Merck Sharp & Dohme Corp., Sanofi. Consultant; Self; Abbott, AstraZeneca, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Physiogenex. Research Support; Self; Janssen Pharmaceuticals, Inc. K. Mohammedi: None. P. Saulnier: None. M. Marre: Advisory Panel; Self; Servier. Board Member; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S. S. Hadjadj: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk A/S, Sanofi, Servier. Research Support; Self; Bayer AG, Janssen Research & Development. Speaker's Bureau; Self; Abbott, Valbiotis. G. Velho: None.
671-P: Patients Feel Responsible for Self-Care and Understand That Clinic Visits Are Vital, but Want More Interim Support
Authors: WOLF RACHEL , YEAGER KATE A. , CAUDLE JANE , WAN CLAIRE , BARNES CATHERINE S. , ZIEMER DAVID C. 
Published: June 2019

Routine clinic visits provide intermittent opportunity for patients and providers to review patient status and adjust diabetes management. Yet little is known about patient views of the clinic role in managing diabetes.
Purpose: To examine patient perceptions of the role of clinic visits.
Methods: A research nurse conducted semi-structured, audiotaped interviews with a convenience sample of 25 participants from a study of a coaching intervention in an urban diabetes clinic. Participants had A1c ;&gt;7, at least two clinic visits and a prescription for insulin or high dose oral agents. Two qualitative researchers analyzed transcript content to identify themes on the clinic role in diabetes management.
Results: The population was 96% black, 52% female, with mean age of 56 years and A1c of 8.3%. Most participants (76%) reported household incomes &lt; $15,000/year. Four main perception themes were identified: (1) “It’s on me.” (2) being held accountable (3) management prescription and (4) supportive relationships. Almost all felt responsible for following their diabetes management plans (88%). They perceived that clinic encounters provided assessment/feedback of their diabetes status and management and gave them incentive to improve self-care. They often expressed faith in providers and a sense that providers would give them the guidance to improve health. Some patients reported collaboration (36%) with providers, and they often valued nurse educators as integral to personalized, holistic care. Participants lamented visit time constraints and lack of support between visits. Yet some overcame these barriers by seeking out information on their own and preparing for visits ahead of time.
Conclusions: Diabetes requires a significant degree of self-management. Patients view clinic encounters as an important component of diabetes care that supports their self-management but desire more contact in and between visits.

Disclosure
R. Wolf: None. K.A. Yeager: None. J. Caudle: None. C. Wan: None. C.S. Barnes: None. D.C. Ziemer: None.

Funding
American Diabetes Association (7-05-CR-03 to C.S.B.)
68-LB: Being Physically Active Does Not Rescue Skeletal Muscle Microvascular Dysfunction in Overweight Individuals
Authors: BETIK ANDREW C. , MORRISON DALE J. , PARKER LEWAN , ROBERTS-THOMSON KATHERINE , KESKE MICHELLE 
Published: June 2019

Skeletal muscle microvascular blood volume increases after a meal to increase glucose and insulin delivery to the muscle. In obese individuals this microvascular action in muscle is lost (Keske et al. 2009 Diabetes Care). However, exercise training can improve muscle microvascular responses in the postprandial state (Russell et al. 2017 Diabetes Care). We hypothesized that people who are overweight but are habitual exercisers would have similar increases in microvascular perfusion following a mixed meal as people who are lean and exercise regularly.
Methods: Nine lean (LEAN+Ex, BMI &lt; 23 kg/m2) and five overweight (OW+Ex, BMI &gt; 27 kg/m2) physically active participants (&gt; 75 min of vigorous intensity or &gt; 150 min of moderate intensity exercise per week) were recruited. Body composition was assessed by DEXA. After an overnight fast, participants underwent a mixed meal challenge (1214 kJ). Thigh muscle microvascular responses were assessed by contrast-enhanced ultrasound at rest and 1 hour after the mixed meal.
Results: Data are presented in Table 1 (Mean ± SE, * p&lt;0.05 vs. LEAN+Ex; + p&lt;0.05 vs. resting).
Conclusion: The postprandial increase in microvascular blood volume in the Lean+Ex group was not observed in the OW+Ex group. These data suggest that habitual exercise is not sufficient to overcome the negative effects of being overweight on muscle microvascular responses to a mixed meal.

Disclosure
A.C. Betik: None. D.J. Morrison: None. L. Parker: None. K. Roberts-Thomson: None. M. Keske: None.

Funding
Institute for Physical Activity and Nutrition
68-OR: The Combined Impact of ABI and TcPO2 on Three-Year Mortality in Patients with Type 2 Diabetes and Foot Ulcers
Authors: FAGHER KATARINA , LONDAHL MAGNUS 
Published: June 2019

A diabetic foot ulcer (DFU) is associated with increased cardiovascular risk and mortality independently of ulcer etiology (ischemic, neuro-ischemic or neuropathic). Traditional cardiovascular risk factors can partly, but not alone explain this risk increment. Ankle-brachial index (ABI) is the most commonly used test when diagnosing peripheral vascular disease and is also considered a marker for increased cardiovascular risk. However, ABI do not reflect microvascular dysfunction, a condition often seen in DFU patients. Transcutaneous oxygen pressure (TcPO2) is considered to better evaluate microvascular function and has in previous studies shown correlations with both wound healing and survival. The aim of this study was to evaluate the combined impact of a low TcPO2 (&lt; 30 mmHg) and a pathological ABI (&lt; 0.8 or ≥1.4) on 3-year mortality rates in patients with DFU. We evaluated 202 type 2 diabetic patients with DFU, aged 18-85 years. As shown in the Figure, individuals with a combination of pathological ABI and low TcPO2 had the worst survival rates, with 3-year mortality of 54%, compared to 42% in those with pathological ABI alone and 21% in those with normal ABI/TcPO2. Age did not differ between groups (median 75, 75, 74 years respectively).
In conclusion, combining ABI and TCPO2 in routine assessment could provide additional predictive information when risk stratifying patients with type 2 diabetes and DFU.

Disclosure
K. Fagher: Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. M. Londahl: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Novo Nordisk A/S, Sanofi.

Funding
Swedish Diabetes Foundation; Skåne County Councils Research and Development Foundation; Lund University
680-P: Impact of Continuous Glucose Monitoring Shared Medical Appointments on Planned Self-Management Changes
Authors: BLANCHETTE JULIA E. , NOE DAWN , GALLOWAY NICHOLAS , SULLIVAN HILLARY , HA ANNY , ISAACS DIANA 
Published: June 2019

Introduction: Continuous glucose monitoring (CGM) measures glucose up to 288 times per day allowing people with diabetes (PWD) to see in real-time how medications, food, exercise, and stress, affect glucose levels. Clinicians interpret this information to make lifestyle and medication recommendations.
Objective: To identify common learning outcomes and planned self-management changes resulting from CGM shared medical appointments. Study Design: A two-part CGM Shared Medical Appointment was led by certified diabetes educators (pharmacists, nurses and dieticians). Professional CGM devices were inserted and participants returned the following week for removal, discussion and education in a group format. Inclusion criteria for this study were as follows: age &gt; 18 years, &gt;3 days of CGM data, and attendance of both classes. A post-course survey was given with structured interview questions asking (1) “What is one thing you learned from the CGM class experience?” and (2) “Which changes do you plan to make to your diabetes care?” Questions were answered in written format. After digital transcription entry, data were coded and analyzed using content analysis to devise themes by two reviewers.
Findings: A total of 170 PWD participated in the CGM class and 140 (82.35%) completed the post-course survey. Class sizes ranged from 3-6 participants. The most common learning outcomes were nutrition self-management knowledge (35.77%), pattern interpretation (18.25%) and blood glucose awareness (13.87%). The most common planned self-management changes were nutrition related (56.82%), self-management behavioral goals (24.42%) (log patterns, increase monitoring frequency) and medication adjustments (23.48%) (basal rates, carbohydrate ratios, timing and consistency of medications).
Conclusion: Continuous Glucose Monitoring Shared Medical Appointments are an innovative strategy to facilitate lifestyle changes and medication adjustments for people with diabetes.

Disclosure
J.E. Blanchette: Consultant; Self; Dexcom, Inc., Tandem Diabetes Care. D. Noe: None. N. Galloway: None. H. Sullivan: None. A. Ha: Consultant; Self; Tandem Diabetes Care. D. Isaacs: Advisory Panel; Self; BD, Sanofi-Aventis.
686-P: Temporal Association of Adherence to Diabetes Self-Management and Glycemic Control from Adolescence to Adulthood in a Longitudinal Cohort of Women with Type 1 Diabetes (T1D)
Authors: SEREIKA SUSAN M. , FISCHL ANDREA F. , CHARRON-PROCHOWNIK DENISE 
Published: June 2019

Adherence to recommended diabetes self-management (DSM) is essential for glycemic control. Little is known regarding the association between DSM adherence and glycemic control as adolescents transition to adulthood. This secondary analysis examined the association of DSM adherence and glycemic control in adolescence and its temporal association with DSM adherence and glycemic control reported as adults in women with T1D. Data from female adolescents who participated in a preconception counseling intervention trial were linked with data collected in adulthood via a retrospective survey. DSM adherence was assessed regarding following a diet plan, checking blood sugar, taking insulin, exercising regularly, and keeping appointments and summed as a score ranging 5 to 25, where higher scores suggest greater DSM adherence. Glycemic control was measured via self-report (scaled as 1=poor to 4=excellent) and finger stick A1c. Of the 30 T1D women followed (100% Caucasian, Age [M±SD]: 25.8±2.4 years, Age at T1D diagnosis: 8.6±4.8 years), as teens most reported being adherent to the five DSM activities on average "most of the time" (20.4±2.4), being in good to excellent control (n=20, 66.7%; 2.8±0.7), and having a mean A1c of 7.5±0.7%, with moderate correlations between DSM adherence and self-reported glycemic control (r=.50, p&lt;.001) and A1c (r=-.41, p=.005). As adults, mean DSM adherence improved (23.1±3.3, p=.001), while no significant changes were found for either self-reported glycemic control (2.7±0.8, p=.476) or A1c (7.2±1.0, p=.342). DSM adherence in adolescence was not associated with DSM adherence in adulthood (r=.21, p=.276), yet moderate associations were found for self-reported glycemic control (r=.51, p=.004) and A1c (r=.59, p=.044). These findings suggest DSM adherence may improve as adolescent females transition to adulthood and is related to glycemic control both in adolescence and adulthood.

Disclosure
S.M. Sereika: None. A.F. Fischl: None. D. Charron-Prochownik: None.

Funding
American Diabetes Association (1-11-CT-10, 7-02-CR-06 to D.C-P.)