bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep and Glycemia in Adolescents with Type 1 Diabetes
Authors: GREY MARGARET , RECHENBERG KAITLYN 
Published: June 2018

Nearly 70% of adolescents have chronic sleep problems (quality, quantity, and/or altered circadian rhythm). Adolescents with type 1 diabetes (T1D) are subject to nocturnal blood glucose fluctuations that may result in restless sleep and require self-care that disrupts sleep. Deficient sleep may also contribute to insulin resistance. Few studies of sleep characteristics and their association with glycemic control have been conducted. Our aim was to describe sleep characteristics in adolescents with T1D and its relationship with glycemic control.
Adolescents with T1D (ages 10-16) were recruited from the Yale Program. For 7 days, participants wore a wrist actigraph, which was used to calculate sleep/wake cycles using 30-second epochs, and a continuous glucose monitor (CGM). The Pittsburgh Sleep Quality Index (PSQI) was used to assess subjective sleep reports. The sample included 30 participants age 13.4+1.9, 67.9% female, 29.2% minority, BMI percentile 75+25%, diabetes duration 7.4+ 4.5 years, and 97% on insulin pumps.
Hemoglobin A1c (A1c) levels (8.29+1.38%) and CGM (46.3+14.9% time in hyperglycemia) indicated poor glycemic control. Actigraphy showed inadequate total sleep time (7.33+19 hours), but good sleep efficiency (80.0+20.3%). Higher MESOR (rhythm adjusted mean) (r=0.25) and lower circadian quotient (r=-0.31) were associated with higher A1c. Greater circadian quotient was associated with more glucose variability (r=0.41). Greater WASO (wake after sleep onset) was associated with higher glucose (r=0.26), HBGI (high blood glucose index) (r=0.27), and more hyperglycemia (r=0.25). Higher MESOR was associated with lower LBGI (low blood glucose index) (r=-0.39) and less hypoglycemia (r=-0.42). Higher amplitude was associated with lower LBGI (-0.35) and less hypoglycemia (r=-0.39).
These results suggest that insufficient sleep is common among adolescents with T1D and is associated with poorer glycemic control. Further research is required to determine if improving sleep will improve glycemic control.

Disclosure
M. Grey: None. K. Rechenberg: None.
How Does Risk Screening for Kidney Disease Influence Diabetes Distress?
Authors: JOENSEN LENE E. , MADSEN KRISTOFFER P. , FRIMODT-MOLLER MARIE , TOFTE NETE , WILLAING INGRID , LINDHARDT MORTEN , ROSSING PETER 
Published: June 2018

Background: Screening for future risk of diabetic kidney disease (DKD) in people with type 2 diabetes (T2D) and normal kidney function was conducted in the clinical multicenter intervention trial PRIORITY (Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria). Risk screening was based on a urinary proteomic analysis categorizing the patients at high or low risk for DKD. Little is known about how risk-assessments affect patients. However, screening for DKD is likely to increase diabetes distress (DD), as DD is linked to specific diabetes stressors such as worrying about complications.
Aim: To investigate to what extent DD was affected by screening and individualized information about future risk of DKD.
Methods: Of 436 participants in the Danish part of PRIORITY, 217 were asked to complete a full diabetes distress scale (DDS) and 139 completed DDS at screening visit (T1) and after provision of screening results (T2, 6 weeks after T1). DDS was repeated in 84 at a follow-up visit (T3, 12 months after T2). DD differences were explored with wilcoxon signed-rank test and subgroup differences with paired t-test.
Results: Participants’ mean age was 61 years, 37 % women, mean diabetes duration 10 years, mean HbA1c 54mmol/mol, 4 % had high overall DD and 12 % were categorized as having high risk of DKD. No significant changes were found in DD between T1, T2 and T3. Mean DD differences [SD] between T1 to T2 was 0.02 [0.38], p=0.65 and between T2 and T3 0.01 [0.35], p=0.88. No significant differences in DD changes were found when comparing participants with high vs. low initial DD or when comparing participants in high vs. low risk of DKD. However, few participants had high DD at T1 and few had high risk of DKD.
Conclusions: The study indicated that screening for future risk of DKD does not increase DD in people with T2D. Future studies should explore potential subgroup differences further as well as the mechanisms behind the results.

Disclosure
L.E. Joensen: None. K.P. Madsen: None. M. Frimodt-Moller: None. N. Tofte: None. I. Willaing: None. M. Lindhardt: None. P. Rossing: Advisory Panel; Self; Novo Nordisk A/S, AstraZeneca, Boehringer Ingelheim GmbH. Research Support; Self; AstraZeneca, Novo Nordisk A/S. Advisory Panel; Self; Astellas Pharma US, Inc.. Stock/Shareholder; Self; Novo Nordisk A/S. Advisory Panel; Self; Bayer AG.
Education for Family Members Is Effective for Improved Glycemic Control of Patients with Type 2 Rather than Type 1 Diabetes Mellitus—A Meta-analysis
Authors: KODAMA SATORU , FUJIHARA KAZUYA , ISHIGURO HAJIME , HORIKAWA CHIKA , YACHI YOKO , ISHIZAWA MASAHIRO , MATSUNAGA SATOSHI , TANAKA SHIRO , KATO KIMINORI , SONE HIROHITO 
Published: June 2018

Although the importance of support of patients by family members is emphasized for diabetes care, evidence of achieving adequate glycemic control (GC) through instructing family members to help in self-management care of diabetes patients has not been established. This meta-analysis assessed the effect of family-oriented diabetes programs on GC. The pooled A1C change shown in 31 studies that were retrieved from systematic literature searches for clinical trials presenting data on the net effect of family education on the reduction in glycohemoglobin A1C (A1C) (i.e., difference in A1C change between intervention groups involving family members and that not involving family members [control group]) was -0.45% (PP&lt;0.001). When separating trials limited to type 1 and type 2 diabetes, the pooled A1C values were -0.35% (P=0.001) and -0.71% (P&lt;0.001), respectively (Figure). Current meta-analysis indicates that involving family members in diabetes education programs is an effective strategy for improved GC predominantly in patients with type 2 diabetes. Figure legend: Forest plot of differences in changes in A1C between intervention and control groups. Effect size below zero indicates an A1C reduction larger in the intervention group than in the control group.

Disclosure
S. Kodama: None. K. Fujihara: None. H. Ishiguro: Research Support; Self; MSD K.K., Sanofi K.K., Eli Lilly and Company. C. Horikawa: None. Y. Yachi: None. M. Ishizawa: None. S. Matsunaga: None. S. Tanaka: None. K. Kato: None. H. Sone: Research Support; Self; Novo Nordisk Inc., Eli Lilly and Company, MSD K.K., Chugai Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Daiichi Sankyo Company, Limited, Ono Pharmaceutical Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Sanofi, Kowa Pharmaceuticals America, Inc., Eisai Inc..
Prevalence and Factors Associated with Sleep Disorders in Japanese Patients with Type 2 Diabetes
Authors: OTAKA HIDEYUKI , MURAKAMI HIROSHI , MIZUSHIRI SATORU , KAMBA AYA , DAIMON MAKOTO 
Published: June 2018

Background: Sleep disorders are frequently reported in patients with type 2 diabetes. However, there are few reports on the prevalence and correlates of sleep disorders in diabetics. This study investigated the prevalence and factors associated with sleep disorders in type 2 diabetics.
Research Design and Methods: In total, 544 patients with type 2 diabetes mellitus (311 males, 233 females; age 63.9 ± 12.6-years-old; HbA1c, 7.1 ± 0.9%) and 1,161 control subjects (38.1% males; 54.5 ± 15.4-years-old; HbA1c 5.8 ± 0.6%) were included. Participants used self-administered questionnaires on sleep attitude (Pittsburgh Sleep Quality Index; PSQI), quality of life (the Short Form 36 Health Survey; SF-36), depression (the Center for Epidemiologic Studies-Depression scale), and personality (Ten Item Personality Inventory). The socio-demographics, laboratory data, and medical history were collected from medical records.
Results: The number of subjects with sleep disorders (PSQI &gt; 5) was higher in diabetic patients (25.9%) than control subjects (20.6%) (p = 0.02), although sleeping time was significantly longer in diabetic (7.42 hours) than in control subjects (7.09 hours) (p &lt; 0.01). Among diabetic patients, the sleep disorders group showed higher percentages of females (p &lt; 0.01), spouseless subjects (p &lt; 0.01), insulin users (p &lt; 0.01), 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 on the neuroticism scale than patients without sleep disorders (p &lt; 0.01). All SF-36 scores were lower in patients with sleep disorders. No differences were found in age, body mass index, 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. Otaka: None. H. Murakami: None. S. Mizushiri: None. A. Kamba: None. M. Daimon: None.
Pancreatic Beta Cell O-GlcNAc Transferase Overexpression Increases Susceptibility to Streptozotocin- and High-Fat Diet–Induced Diabetes in Female Mice
Authors: MOHAN RAMKUMAR , RUAN HAI-BIN , YANG XIAOYONG , ALEJANDRO EMILYN 
Published: June 2018

The nutrient-sensor O-GlcNAc transferase (OGT), the sole enzyme that adds an O-GlcNAc-modification onto proteins, was shown to regulate β-cell survival and function as β-cell deletion of OGT induces diabetes and islet failure in mice. We hypothesized that β-cell OGT overexpression (Rip-cre;OgtOE) would confer protection from streptozotocin (STZ)-induced β-cell failure and high-fat diet (HFD)-induced diabetes. Female mice are typically resistant from HFD- or STZ-induced diabetes. However, the molecular mechanisms underlying this sexual dimorphism are unclear. Here, we uncovered that Rip-cre;OgtOE mice show normal peripheral insulin sensitivity and glucose tolerance in normal chow but when challenged female transgenic mice alone develop glucose intolerance post 8-weeks of HFD and severe hyperglycemia 1-week post STZ treatment. Surprisingly, male transgenic mice are neither protected nor impaired when compared to controls in both treatments. Molecular interrogation of islets validated efficient overexpression of OGT in both sexes by confirming protein expression of the reporter transgene (GFP). However, significant increase in OGT protein was observed only in islets of female Rip-cre;OgtOE mice, suggesting sex difference in OGT protein regulation. Transcriptome analysis by RNA sequencing shows increased expression levels of genes involved in acute inflammation (Ggt5, Ncf1, Ptgs1, Alox5ap) and immune response via agranulocyte adhesion and diapedesis (Glycam1) in islets of female Rip-cre;OgtOE mice, providing a mechanism of susceptibility to STZ and HFD-induced islet failure. Indeed, pancreas analysis shows increased islet infiltrating lymphocytes in female Rip-cre;OgtOE compared to control post 22 weeks of HFD treatment. Together, these data highlight the novel role of OGT in inflammation induced by STZ and HFD in islets and emphasize the importance of OGT dosage and O-GlcNAc cycling in β-cell survival.

Disclosure
R. Mohan: None. H. Ruan: None. X. Yang: None. E. Alejandro: None.
Markup Methodology to Culturally Tailor Preexisting Preconception Counseling (PC) Program for Latina Adolescent Girls with Diabetes and Their Mothers
Authors: ABUJARADEH HIBA , PETERSON-BURCH FRANCES M. , OLSHANSKY ELLEN , MONTGOMERY KEIRSTEN , CHARRON-PROCHOWNIK DENISE 
Published: June 2018

Latinas with diabetes are at a higher risk for reproductive health (RH) complications. READY-Girls is an evidence-based PC program recommended by the ADA for adolescent girls. PC should be culturally tailored for the Latina population. This reports on qualitative data, including markups of the existing READY-Girls book, that informed the tailoring of READY-Girls PC program. Key pages of READY-Girls book were given to Latina mothers (M) and their daughters (D) with diabetes in either English or Spanish [(18 D: 6 reviewed both, 12 English); (12 M: 4 reviewed both, 2 English, 6 Spanish)]. Daughters were 13 to 21 years old, 44% had T1D. Participants were given paper-and-pencil open-ended questions about readability, understanding and sensitivity to the Hispanic culture; and asked to markup the book by writing comments on the pages and using assigned symbols to communicate thoughts (e.g., * = liked this, ? = don’t understand, XX phrase = inappropriate). Responses to questions and markups were written verbatim, clustered and analyzed to identify major themes, using a qualitative descriptive method, 4 researchers discussed themes and reached consensus. Findings: 1) book was: a) easy to read, understand, and interesting; b) acceptable to Latina culture, but add topics, “talking with parents about being sexually active”, “resources to prevent teen pregnancy”, and c) taught the importance of PC. 2) Illustrations were: a) informative, but removing those of bodily changes during puberty could be less offensive to Latina culture; b) adding facial pictures.
Conclusion: Markup methodology was effective in communicating thoughts about modifying the book and adapting it for Latinas. This methodology could enhance qualitative data collection especially when inquiring about sensitive topics such as reproductive health. Overall, M-D participants liked the program, found it useful and provided helpful suggestions for cultural modifications.

Disclosure
H. Abujaradeh: None. F.M. Peterson-Burch: None. E. Olshansky: None. K. Montgomery: None. D. Charron-Prochownik: None.
How Improving Stress Improves Glucose Control
Authors: SAKKAL SAAD 
Published: June 2018

Background: 90% of people with diabetes have stress, insomnia, decreased energy, temperature, appetite, weight, libido changes, and sympathetic/parasympathetic disturbance. These hypothalamic stress response disturbances result in impaired glucose control.Treating stress, sleep in short term studies(1-6 weeks) improves lifestyle, nutrition, exercise, and glucose control. Few studies have tested the hypothesis that improving stress will improve glucose control in long-term treatment.
Methods: We compared 80 stress-Rx adherent patients who achieved better sleep quality with 80 who did not. We recommend stress-Rx techniques four times daily like Benson’s relaxation exercises, deep breathing, meditation, and prayers. We quantified feeling of well-being, sleep duration extension, measured glucose control with AM insulin/glucose ratio, HgA1c, and in-target glucose when CGMS was available (16 patients). All patients followed our standard diabetes treatment protocol for type 2 including MIND nutrition plan and aerobic exercise 10 minutes after each meal (HIIT).
Results: At 12 months, adherents to Stress-Rx who achieved improved sleep improved the feeling of well-being by 78%, sleep increased 28 minutes, sleep onset latency decreased by 8 minutes. Insulin/glucose ratio was 16/133=0.12, HgA1c 7.1%, HgA1c&lt;7 in 69%, and in-target glucose in 76% on CGMS (9 patients). On the other hand, in 80 patients who did not follow Stress-Rx and did not achieve improved sleep quality, feeling of well-being in 40%, sleep increased by 4 minutes,sleep onset latency decreased by 2 minutes. Insulin/Glucose ratio was 27/160=0.17, HgA1c 7.7%, HgA1c&lt; 7 in 46%, and in-target-glucose in 58% on CGMS (7 patients.) Medications were 3 in both groups. Percentage needing basal insulin at the end was 8% in the good stress-Rx group, 16% in the non-improved sleep group.
Conclusion: Stress-Rx Improved insulin resistance with improved glucose control. Improved sleep, exercise, nutrition, and sympathetic outflow probably contributed 30%.

Disclosure
S. Sakkal: None.
Effectiveness of Digital Interventions for Improving Glycemic Control in Persons with Poorly Controlled Type 2 Diabetes—A Systematic Review and Meta-regression Analysis
Authors: KEBEDE MIHIRETU M. , ZEEB HAJO , PETERS MANUELA , HEISE THOMAS L. , PISCHKE CLAUDIA R. 
Published: June 2018

Objective: Digital interventions may assist patients with type 2 diabetes with improving glycaemic control. We aimed to synthesize effect sizes of digital interventions on glycated hemoglobin (HbA1c) levels and to identify effective features of digital interventions targeting patients with poorly controlled type 2 diabetes.
Research Design and Methods: MEDLINE, ISI Web of Science and PsycInfo were searched for randomized controlled trials (RCTs) comparing the effects of digital interventions with usual care. Two reviewers independently assessed studies for eligibility and determined study quality, using the Cochrane risk of bias assessment tool. The Behavioural Change Technique Taxonomy v1 was employed to identify behavior change techniques (BCTs) employed in interventions. Mean HbA1c differences were pooled using Analysis of Covariance to adjust for baseline differences and pre-post correlations. To examine effective intervention features and to evaluate differences in effects sizes across groups, meta-regression and subgroup analyses were performed.
Results: Twenty three arms of 21 RCTs were included in the meta-analysis (n= 3787 patients, 52.6% in intervention arms). The mean HbA1c baseline differences ranged from -0.2% to 0.64%. The pooled mean HbA1c change was statistically significant (-0.39 (95% CI: [-0.51, -0.26]) with substantial heterogeneity (I-squared statistic, 80.8%)) and a significant HbA1c reduction was noted for web-based interventions. A baseline HbA1c level above 7.5%, β=-0.44 (95% CI: [-0.81, -0.06]) and the BCTs ’problem solving’, β=-1.30(95% CI: [-2.05, -0.54]) and ’self-monitoring outcomes of behavior’, β=-1.21 (95% CI: [-1.95, -0.46]) were significantly associated with reduced HbA1c levels.
Conclusions: Digital interventions appear effective for reducing HbA1c levels in patients with poorly controlled type 2 diabetes.

Disclosure
M.M. Kebede: None. H. Zeeb: None. M. Peters: None. T.L. Heise: None. C.R. Pischke: None.
The Three I's of Diabetes Integration in Emerging Adulthood—Developing a Framework to Individualize Diabetes Care
Authors: MARKOWITZ BENJAMIN , PRITLOVE CHERYL , MUKERJI GEETHA , LAVERY JAMES V. , PARSONS JANET A. , ADVANI ANDREW 
Published: June 2018

Transition of care occurs within the developmental context of emerging adulthood (EA; 18-24 years), in which diabetes self-management is challenged as an individual learns to cope with diabetes and develop their independence. With the goal of helping providers individualize support as patients begin adult care, we conducted a qualitative study with 33 emerging adults with type 1 diabetes (51% female, age 20.6±0.3 years, diabetes duration 12±1 years). Individual semi-structured interviews allowed participants to depict their lived experiences with diabetes. We employed a narrative approach to the analysis of interview transcripts and constant comparison was used to identify similarities and differences in narrative typology and thematic content. We identified that participants’ accounts of living with diabetes could be grouped into three broad categories: Ingrained (n=14), Intrusive (n=12) and Inconspicuous (n=7). We interpreted these accounts as different “lenses” through which individuals perceive their diabetes during EA. Participants conveying an Ingrained lens perceived diabetes to be comfortably settled within their daily lives and described self-confidence for management. Participants conveying an Intrusive lens perceived diabetes as disrupting their daily living and described moral sensitivity towards management (i.e., being seen as a ’good’ or ’bad’ self-manager). Participants conveying an Inconspicuous lens told stories that demonstrated their efforts to minimize their diabetes and described disregard for management. HbA1c levels were lower in participants conveying an Ingrained lens (HbA1c (%), Ingrained 7.4±0.2, Intrusive 9.3±0.5 (p&lt;0.01 vs. Ingrained), Inconspicuous 8.4±0.3). Although movement between these domains may be fluid, mixed or incomplete, this framework provides a heuristic strategy to recognize emerging adults’ varying views of their diabetes and presents opportunities for individualizing care accordingly.

Disclosure
B. Markowitz: None. C. Pritlove: None. G. Mukerji: None. J.V. Lavery: None. J.A. Parsons: None. A. Advani: Research Support; Self; AstraZeneca, Boehringer Ingelheim GmbH. Other Relationship; Self; Boehringer Ingelheim GmbH.
What Is Health-Related Quality of Life? Perspectives from Diabetes Care Providers
Authors: CAO VIENA T. , ESHTEHARDI SAHAR S. , MCKINNEY BRETT M. , ANDERSON BARBARA , MARRERO DAVID G. , THOMPSON DEBBE , HILLIARD MARISA E. 
Published: June 2018

Background: While health-related quality of life (HRQoL) is gaining recognition as an important patient-reported outcome, little is known about how diabetes care providers define or apply HRQoL in practice. The purpose of this study was to identify how diabetes care providers conceptualize HRQoL for youth and adults with type 1 diabetes (T1D) to help guide efforts to more routinely assess and intervene to improve HRQoL.
Methods: As part of a larger qualitative study on T1D-specific HRQoL, semi-structured qualitative interviews were conducted with 8 diabetes care providers (5 pediatric providers, 3 adult providers, 62.5% male) via focus groups or individually. Sessions were audio-recorded, transcribed, and coded to derive common themes.
Results: Providers identified three key components of T1D-specific HRQoL: (1) their patients’ day-to-day functioning, including the ability to engage in everyday activities and its impact on their emotional well-being; (2) their patients’ medical management, including diabetes self-management behaviors and presence of complications and hypo/hyperglycemia; and (3) the impact of T1D on their patients’ personal relationships, including the impact on the HRQoL of their parents/partners.
Conclusion: Providers described three aspects of T1D-specific HRQoL: everyday functioning, medical considerations, and interpersonal relationships. This extends the HRQoL literature from other chronic condition populations, which has not emphasized provider perceptions of HRQoL, has primarily identified medical domains such as disease-specific symptoms/complications, and provides little understanding of HRQoL of other family members. Together with findings about patient/family perspectives on HRQoL from the larger study, the current findings about how diabetes care providers conceptualize diabetes-specific HRQoL are necessary to help guide clinical processes to routinely assess and enhance HRQoL across the lifespan.

Disclosure
V.T. Cao: None. S.S. Eshtehardi: None. B.M. McKinney: None. B. Anderson: Advisory Panel; Self; Sanofi-Aventis. D.G. Marrero: None. D. Thompson: None. M.E. Hilliard: None.