bluuebunny/crossref_metadata_2025_split huggingface dataset:
865-P: Some Diabetes Words Really Do Hurt—Measuring the Emotional Burden of Diabetes Language
Authors: BEENEY LINDA J. , HINTON RENE' , OVERLAND JANE 
Published: June 2019

Opinion-based consensus guidelines promote the use of certain diabetes-related words and avoidance of others, based on the assumption they cause distress. Our study tested this hypothesis using a validated tool to systematically assess the emotional responses of people with type 1 and type 2 diabetes to diabetes-specific language.
Methods: The Diabetes Language Task (DLT), a tablet-based Application, includes words and phrases derived from consensus guidelines and other published research. Each word/phrase is rated on 2 scales assessing levels of Anxiety and Distress. T-tests were used to determine differences between the recommended Avoid and Use Language and among sub-groups, applying the Bonferroni correction for multiple comparisons.
Results: The DLT was completed by 90 study participants (Median age= 50 years (range 19-75 years); 66% female; 59% with type 1 diabetes; median A1c=8% (range 6-13%); median diabetes duration=15 years (range 3 months-45 years)) attending public and private diabetes services. Hypotheses were confirmed in 8/14 (57%) comparisons of Avoid vs. Use words, e.g., ‘suffering from diabetes’ was rated more distressing than ‘person living with diabetes’ (p&lt;0.00001) and ‘non-compliant’ rated more distressing than ‘making choices’ (p&lt;0.00001). Other terms assumed to be negative were rated as positive by study participants including ‘nondiabetic’, ‘normal’, ‘in control' and ‘adherent.’ Complications-related terminology including ‘Amputations’, ‘Blindness’, 'Kidney damage’ and ‘Disease progression’ generated the highest levels of distress and anxiety within the DLT. Few differences in emotional reactions were found according to type of diabetes, complications status or A1c.
Conclusions: Study findings provide support for some published diabetes language recommendations but also highlight discrepancies and identify the need to address the use of Complications Language.

Disclosure
L.J. Beeney: None. R. Hinton: Other Relationship; Self; Medtronic, Novo Nordisk Inc., Roche Diabetes Care. J. Overland: None.

Funding
Australian Diabetes Educators Association; Australian Diabetes Research Foundation
870-P: Utilities to Measure Valuation of Diabetes in Haiti
Authors: BELANGER-BISHINGA CLEMENT , PARTRIDGE COLIN , BAPTISTE EDDY JEAN , CHARLES LARCO MARIE-NANCY , LARCO PHILIPPE , VON OETTINGEN JULIA E. , ALTENOR KETLY 
Published: June 2019

Background: Assessing the valuation of diabetes in a low-income country such as Haiti is novel and may improve culturally sensitive values-based counseling. Objectives: To assess how Haitians with diabetes value quality of life with disability and diabetes.
Methods: Cross-sectional study in Haiti of adult participants with diabetes type 1 (T1D) and type 2 (T2D), recruited from diabetes clinics. We asked “If born tomorrow, how many years of disabled life (y) would you trade to avoid lifelong disability” for 4 hypothetical scenarios of mild, moderate, severe and profound disability and 4 hypothetical scenarios of T1D and T2D with and without complications (T1D, T2D, T1D+C and T2D+C). Utility scores were calculated as: (life span - y)/life span, where death = 0 and full life without disability = 1 with &gt;0 indicating better than death (BTD) and &lt;0 indicating worse than death (WTD). We also evaluated religiosity, support and perceived rejection.
Results: One hundred adults with diabetes (65% female, 57% T1D, mean age 26±14y for T1D and 46±18y for T2D) participated. On 5-point Likert scales, scores for religiosity were 4.2±0.8; instrumental support 3.5±0.9; emotional support 3.1±0.9; and perceived rejection 2.2±0.9. Utilities were &gt;0 (BTD) for mild and moderate, and &lt;0 (WTD) for severe and profound disabilities. Patients with T1D valued all diabetes scenarios as &gt;0 (BTD). Patients with T2D valued T2D and T2D+C scenarios as &lt;0 (WTD) and assigned lower utilities to scenarios T1D (p=0.01), T2D (p=0.03) and T2D+C (p=0.01) but not T1D+C (p=0.16). Having T2D and lower religiosity predicted lower utilities for scenarios T2D (p=0.002 and p&lt;.0001) and T2D+C (p=0.0009 and p=0.0006) after adjusting for age, sex, support and rejection.
Conclusions: In Haiti, major disabilities are valued as worse than death. Patients with T1D and T2D value T1D as better than death, whereas patients with T2D, but not T1D, perceive T2D as worse than death. Stronger religious beliefs but not other measures of support influence the valuation of quality of life with diabetes.

Disclosure
C. Belanger-Bishinga: None. C. Partridge: None. E. Jean Baptiste: None. M. Charles Larco: None. P. Larco: None. J.E. von Oettingen: None. K. Altenor: None.
871-P: The Impact of Integrated Behavioral Health in a Diabetes Center
Authors: MACGREGOR KRISTIN L. , DEMARTINI KELLY S. , BARRY SAMANTHA A. , DERR ALAN G. , THOMPSON MICHAEL J. 
Published: June 2019

Integrated behavioral healthcare (IBH) is recommended as the gold standard to address psychosocial factors in diabetes management. While it is well documented that psychosocial interventions improve outcomes, there is a dearth of literature on the benefits of integrating behavioral health providers (BHP) into standard diabetes care. IBH involves collaborating with physicians, nurses, educators, and dieticians to formulate comprehensive treatment plans, and has the potential to have a substantial impact on diabetes management beyond any standalone intervention. The purpose of this study was to examine the impact of IBH on HbA1c levels in patients seen by BHPs. Data were drawn from electronic medical records and included demographic characteristics, dates of each IBH encounter, and A1c’s beginning one year before first BHP visit through one year post initial visit. Patients with a baseline A1c over 8% who had at least one visit with a BHP in a diabetes clinic at a large academic medical center were included (n = 374). Piecewise mixed effects growth mixture models were run to assess whether A1c slope was different between two time periods: pre-initial BHP visit and post-initial BHP visit. Random intercepts and random slopes were used to best model the variability in encounter frequencies among patients. The overall model was significant (Wald χ2 = 48.19, p&lt;0.001). The slope for the period before initial BHP visit was not significant (p=0.28), indicating no evidence of linear decrease or increase in A1c values. The slope for the period after initial BHP visit was significant (p&lt;0.001) and negative (z=-6.45), indicating that A1c values showed a significant, linear decrease over the first year after an initial BHP visit. These results provide early evidence that BHP encounters are associated with statistically significant reductions in A1c values in the year after first encounter, illustrating the benefit of IBH in diabetes care.

Disclosure
K.L. MacGregor: None. K.S. DeMartini: None. S.A. Barry: None. A.G. Derr: None. M.J. Thompson: None.
874-P: Experiences of Young Professionals with Type 1 Diabetes Mellitus Launching into the Workplace
Authors: SAYLOR JENNIFER , YORGASON JEREMY B. , MILLETT MALLORY A. , JACKSON AMY L. , NESS MICHELLE , FLOREEN SABINO ANNA 
Published: June 2019

Every year 1.5 million individuals are diagnosed with type 1 diabetes mellitus (T1DM), with an expected increase of 1.8% each year. Independent diabetes management may present unique challenges for young adults with T1DM transitioning to the workplace. In this qualitative study, we explore the experiences of young professionals living with T1DM (20-30 years old) as they launch their professional careers and transition to adulthood while living with a chronic condition. We conducted two in-person focus groups with subjects at the College Diabetes Network in Boston, MA during a weekend retreat. After obtaining informed consent, the 12 participants (5 males, 7 females) attending were randomly selected into each focus group that lasted approximately 60 minutes. Subjects were 24±2.24 years old on average with a mean hemoglobin A1c of 7.9±2.65. Time since T1DM diagnosis ranged from 3 to 20 years with a mean of 9±5.68 years. All but one subject used a pump and continuous glucose monitor for T1DM management. Four subjects were current students (2 undergraduate, 2 graduate) and 8 were employed after completing their bachelor's degrees. Four researchers conducted a thematic analysis of the verbatim transcripts. We followed Merriam’s (2009) qualitative analysis process of open coding, axial coding, and establishing consensus among coders. Five main themes emerged from the focus groups including (1) challenges around disclosure of T1DM in professional settings, (2) support from family, friends, and workplace, (3) accommodations for T1DM in college and the workplace, (4) benefits and challenges associated with diabetes management technology, and (5) having a sense of ownership of T1DM. The theme of T1DM management ownership in the current study goes beyond illness management behaviors to being part of the person’s identity and body image. Results have important implications for young professionals with T1DM launching professional careers.

Disclosure
J. Saylor: None. J.B. Yorgason: None. M.A. Millett: None. A.L. Jackson: None. M. Ness: None. A. Floreen Sabino: None.
877-P: Correlates of Retention among Participants in the National Diabetes Prevention Program (National DPP) Lifestyle Change Program, 2012-2017
Authors: MASALOVICH SVETLANA , SOLER ROBIN , SMITH BRYCE , JABRAH RAJAI , ELY ELIZABETH , CANNON MICHAEL 
Published: June 2019

Background: The National DPP lifestyle change program (LCP) is proven to prevent or delay type 2 diabetes among adults with prediabetes. The yearlong LCP consists of a minimum of 22 coach-led group-sessions offered at weekly and then monthly intervals. Program retention is highly correlated with desired outcomes but can be challenging to achieve.
Methods: We analyzed data from organizations that participate in CDC’s Diabetes Prevention Recognition Program. Specifically, we computed weekly retention proportions and used random effects models to account for confounding and organization-specific correlation. We limited our analyses to the 38,441 individuals who enrolled in CDC-recognized in-person LCPs from 2012-2017.
Results: Retention typically dropped 1%-2% each week, but dropped ∼5% between weeks 1-2 and between weeks 16-17, where session frequency typically transitions from weekly to monthly. Retention at 18 weeks varied by years of age (46% for 18-29, 53% for 30-44, 60% for 45-54, 67% for 55-64, 68% for 65-75), race/ethnicity (70% for non-Hispanic whites, 60% for non-Hispanic blacks, 52% for Hispanics, 51% for Other), mean physical activity minutes (13% for 0, 49% for 1-30, 72% for 30-149, 85% for ≥150), and mean weekly percentage of body weight lost (32% for ≤0, 66% for 0-0.25, 73% for 0.25-0.5, 74% for ≥0.5). Retention did not vary by sex (63% for men, 63% for women). The random effects model results were consistent with these findings.
Conclusions: Our results demonstrate the need to identify strategies to improve retention, especially among individuals who are younger or are members of racial/ethnic minority populations, and among those who report less physical activity or weight loss. Strategies that address retention after the first session and during the transition from weekly to monthly sessions, offer the biggest opportunity for impact.

Disclosure
S. Masalovich: None. R. Soler: None. B. Smith: None. R. Jabrah: None. E. Ely: None. M. Cannon: None.
88-LB: Effects of Grape Skin Extract (GSE) on Glycemic Response to a Starch Challenge in Prediabetic Subjects
Authors: ALKASEM MEIS , ABDALHAKAM IBRAHEM , SULEIMAN NOOR N. , ISKANDARANI AHMAD NABIL , SAMRA TAREQ A. , MIR FAYAZ AHMAD , MOHAMMAD RAMZI M. , ABOU-SAMRA ABDUL-BADI , ZHOU KEQUAN , SKARULIS MONICA C. 
Published: June 2019

Prediabetes is a condition leading to increased risk of diabetes and its complications and cardiovascular disease. Annually, ∼10% prediabetic subjects progress to T2D. We, and other investigators, reported that grape skin extract (GSE) impacts postprandial glycemia through alpha glucosidase inhibition. This study aims to examine the effect of GSE on glycemic response to a starch challenge in healthy prediabetic subjects. The study was approved by the IRB of Hamad Medical Corporation. Subjects were screened from a high-risk population based on family history and/or fasting glucose (5.7-7.3 mmol) and IGT confirmed with 75 gram OGTT. Subjects were randomized to GSE capsule 600 (N=4), 1200 (N=8), 1800 (N=15) or 2400 mg (N=14). Each received a meal of 35 gram (uncooked weight) rice with or without the assigned dose of GSE and blood glucose was measured at time 0, 15, 30, 60 and 120 minutes. Area under the curve (AUC) was calculated using the trapezoidal method and the subjects were classified into “responders” or “non-responders” if AUC after GSE was reduced by at least 1 SD.
A total of 41 eligible subjects (83% male; age 29±8 years; BMI 23.2%±5.9, 34% Arab, 24% African, 17% Asian, 24% Indian) with prediabetes were enrolled. A total of 4 (9.7%)subjects decreased AUC by 2SD; 24% decreased by 1 SD and the remainder had no positive response to a single dose of GSE. There were no responders to 600 mg; 2 in 1200 mg; 4 in 1800 mg; and 3 in 2400 mg dose. There were no differences between the responders and non-responders in clinical or biochemical characteristics.
In conclusion, 24% of prediabetic subjects had a positive response to GSE in a starch challenge test. The value of the test in characterizing prediabetic subjects who may benefit from GSE to reverse their prediabetic condition is currently under further investigation. In Qatar, the prevalence of diabetes is 17% and expected to increase. Studies to develop natural products to prevent diabetes are of great public health interest.

Disclosure
M. Alkasem: None. I. Abdalhakam: None. N.N. Suleiman: None. A.N. Iskandarani: None. T.A. Samra: None. F.A. Mir: None. R.M. Mohammad: None. A. Abou-Samra: None. K. Zhou: None. M.C. Skarulis: None.

Funding
Qatar National Research Fund
88-OR: hsTroponin and NT-proBNP in Type 1 Diabetes (T1D): Association with Incident Cardiovascular Disease (CVD) and Major Atherosclerotic Cardiovascular Events (MACE)
Authors: COSTACOU TINA , SAENGER AMY K. , ORCHARD TREVOR J. 
Published: June 2019

High-sensitivity troponin T (hsTnT), a marker of CVD, and N-Terminal pro B-Type Natriuretic Peptide (NT-proBNP), a marker of heart failure, have not been widely studied in type 1 diabetes. We thus assessed the ability of these markers to independently predict CVD and MACE in a cohort with childhood-onset T1D (n=583, mean age 29 and duration 21 years) during a median follow-up of 21 years. CVD was defined as CVD death, myocardial infarction, revascularization, angina, or ischemia, and MACE as CVD death, myocardial infarction, or stroke. hsTnT and NT-proBNP were assessed with electrochemiluminescence immunoassays. Median hsTnT was 5.0 ng/L (IQR: 2.0, 10.0) and median NT-proBNP was 22.0 pg/mL (7.0, 61.0). In Cox proportional hazards models allowing for diabetes duration, gender, BMI, smoking status, HbA1c, hypertension status, HDL and non-HDL cholesterol, white blood cell count, estimated glomerular filtration rate and albumin excretion rate, both log hsTnT (HR=1.30, 95% CI: 1.06-1.59) and log NT-proBNP (HR=1.29, 95% CI: 1.13-1.48) independently predicted CVD. However, the prediction of CVD between models with and without these two markers improved only marginally (Uno’s concordance statistic p=0.06). Furthermore, log hsTnT was a slightly weaker predictor of MACE (HR=1.22, 95% CI: 0.97-1.55) compared with log NT-proBNP (HR=1.28, 95% CI: 1.11-1.47). The addition of these two markers to models already including traditional risk factors did not enhance MACE prediction (p=0.39).
In conclusion, although hsTnT and NT-proBNP independently predicted both CVD and MACE, they marginally increased the area under the curve only for CAD in this type 1 diabetes cohort.

Disclosure
T. Costacou: None. A.K. Saenger: None. T.J. Orchard: Consultant; Self; Boehringer Ingelheim International GmbH.

Funding
National Institutes of Health (DK34818); Rossi Memorial Fund
880-P: Polypharmacy Is Not Associated with Emotional Distress in Adults with Type 2 Diabetes
Authors: SOLON CARLY A. , SEARS MALKA Z. , HOOGENDOORN CLAIRE J. , SENG ELIZABETH K. , MARGOLIS SETH A. , GONZALEZ JEFFREY S. 
Published: June 2019

Aim: Polypharmacy, depression, and disease-specific distress are prevalent in type 2 diabetes (T2D). Polypharmacy may add to the emotional burden of treatment. Our group previously showed that insulin use is linked with increased distress; however, few studies have examined polypharmacy in relation to mental health in T2D. The present study examined cross-sectional relationships between the number of medications and emotional distress in a T2D sample.
Method: Adults with T2D (N=120, age=56(9.7), 64% female, 25% Hispanic/Latino) self-reported medication regimens and diabetes distress; depression was assessed by clinical interview. Due to severely skewed and kurtotic outcome variables, we used logistic regression with emotional distress dichotomized at clinical cutoffs. Independent relationships were assessed between the total number of medications (oral + insulin) and emotional distress, adjusting for age, sex, presence of diabetes complications, and insulin (yes/no). The moderating effect of insulin was examined.
Results: Number of prescribed medications (M=6.5(3.8)) was not associated with depression (OR=1.09 [95% CI: 0.97-1.21]), diabetes (OR=0.97 [95% CI: 0.88-1.07]) or regimen (OR=0.97 [95% CI: 0.88-1.08]) distress. In multivariate models, age was negatively associated with higher odds of depression (OR=0.95 [95% CI: 0.91-0.99]), diabetes (OR= 0.95 [95% CI: 0.91-0.99]) and regimen (OR=0.94 [95% CI: 0.90-0.99]) distress. Diabetes complications were associated with 3.08-fold increased odds (95% CI: 1.28-7.40) of depression. Insulin use did not moderate the relationship between number of medications and emotional distress.
Conclusion: The number of prescribed medications was not associated with depression or diabetes distress, suggesting that polypharmacy alone does not account for psychological aspects of perceived disease burden. As age was a notable predictor, younger individuals may be at more risk for the negative psychological impact of T2D and its treatment.

Disclosure
C.A. Solon: None. M.Z. Sears: None. C.J. Hoogendoorn: None. E.K. Seng: Consultant; Self; Eli Lilly and Company, GlaxoSmithKline plc. Other Relationship; Self; Haymarket Media. S.A. Margolis: None. J.S. Gonzalez: None.
882-P: Overcoming Family and Cultural Challenges for Chinese American Patients with Diabetes: Provider Guidelines
Authors: CHESLA CATHERINE A. , CHUN KEVIN M. , KWAN CHRISTINE M. 
Published: June 2019

Despite unique cultural beliefs regarding health and family roles for Chinese immigrants, limited clinical guidance is available for primary care providers to addresses T2DM in this population. Our aim was to articulate cultural and family challenges in T2DM and detail clinical guidance for clinicians.
Method: As part of a CBPR intervention trial, interdisciplinary Chinese and American researchers, community partners, and a Chinese American CAB created clinical recommendations based on: a) evidence on Chinese health beliefs and practices, b) prior interpretive study of this population by our research team and c) practical clinical wisdom of community partners: a Community Health Center and a historically significant social service agency serving new Chinese immigrants.
Results: A structured clinical guideline (in Chinese and English) highlighted cultural and family challenges to T2DM management, and potential provider responses. Cultural health challenges included (partial list): Chinese health metaphors centered on balance versus control; dietary preferences that contradicted diabetes diets; respect for authority inhibiting querying health providers; face concerns constraining illness disclosure and family support requests; communal concerns that prioritized relationships over diabetes adherence; and preferences for authoritative versus collaborative health care approaches. Provider guidelines included: employing Chinese health metaphors (balance); highlighting self-care as a form of family care; flexibly providing both directive medical advice and encouraging patient agency, and normalizing diabetes as a chronic but not disabling condition. Dissemination of guidelines to local primary care clinics has been positively reviewed.
Implications: Caring for ethnically diverse populations is demanding for diabetes providers and evidence-based guidelines for culturally tailored care is warranted.

Disclosure
C.A. Chesla: None. K.M. Chun: None. C.M. Kwan: None.

Funding
National Institute of Nursing Research (R01NR009111)
884-P: Mi Puente: A Care Transitions Intervention for At-Risk Hispanics with Multiple Cardiometabolic Conditions
Authors: BRAVIN JULIA I. , ANDERSON MICHELLE L. , CLARK TAYLOR , SAVIN KIMBERLY L. , LEDESMA DUVIA LARA , EUYOQUE JOHANNA A. , FORTMANN ADDIE L. , PHILIS-TSIMIKAS ATHENA , GALLO LINDA 
Published: June 2019

Hispanics are disproportionately affected by chronic cardiometabolic conditions (e.g., obesity, diabetes). Unmet behavioral health needs (e.g., mental health problems, stress, lack of health care) contribute to these disparities. Sustainably reducing Hispanic health disparities demands innovative, cost-effective interventions that address both behavioral and physical health. A randomized controlled trial is underway to evaluate Mi Puente - i.e., a Behavioral Health Nurse (BHN) + volunteer Community Mentor (CM) intervention designed to reduce readmissions in N = 560 Hispanics with ≥ 2 cardiometabolic conditions and ≥ 1 behavioral health concern(s) hospitalized at a safety-net hospital near the U.S./Mexico border in San Diego, CA. Qualifying patients at high-risk for readmission are identified via automated electronic medical record reports. The BHN triages patients’ needs, provides education, and conducts tailored coaching and goal-setting. Post-discharge, the BHN conducts telephone follow-up at 1-week, and CMs provide referrals to community resources and transition support via phone for up to 1-month. Prevalent behavioral health concerns were: chronic stress (52.5%), health-related distress (37.3%), and lack of routine medical care (19.8%). Preliminary process data indicated that the BHN met with 82.5% of participants prior to discharge; challenges related to medication adherence (28.7%) and access to outpatient care (41.1%) were common. Approximately 80% received ≥1 CM phone call (M = 1.7± 1.1); the transition home and follow-up appointment(s) were frequently addressed (both 97.9%). Findings reveal high levels of unmet behavioral health needs among hospitalized Hispanics, and the feasibility of a sustainable, low-cost, team model that builds upon personnel commonly found in hospital settings - i.e., nurses and volunteers. Important “lessons learned” will be presented to inform future care transitions programs in high-risk, underserved groups.

Disclosure
J.I. Bravin: None. M.L. Anderson: None. T. Clark: None. K.L. Savin: None. D. Lara Ledesma: None. J.A. Euyoque: None. A.L. Fortmann: None. A. Philis-Tsimikas: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc., Glooko, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Stock/Shareholder; Spouse/Partner; Ionis Pharmaceuticals, Inc., Novo Nordisk Inc. L. Gallo: None.

Funding
National Institutes of Health