bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Second Diabetes Campaign Round for Diabetic Palestine Refugees at Unrwa Health Centers
Authors: KISHK NADA M. ABU , SHAHIN YOUSEF M. , TURKI YASSIR , MITRI JOANNA , SEITA AKIHIRO 
Published: June 2018

Introduction: UNRWA has a mandate to provide assistance and protection to a population of around 5 million Palestine refugees (PRs) in Jordan, Lebanon, Syria, West Bank and Gaza. UNRWA is the main primary healthcare provider for them. DM is a common problem among PRs with a prevalence of 11.0%. A high percentage of these patients are obese (64.0%) or overweight (26.0%). In 2013, UNRWA conducted the first round of a DM campaign to raise DM patients’ awareness on healthy lifestyle and to improve their ability to manage DM. In 2014, a second round was conducted with the same aims.
Method: Using a Quasi-experimental study, DM1, DM2 or DM2 and HTN patients’ diagnosed ≥ 1 year prior to study initiation were included. 1,600 participants from the 32 UNRWA’s largest health centers (HCs) were included. Each HC conducted weekly group sessions for six months, including education, healthy cooking, and physical exercise. Body measurements, 2hrPPGT, blood pressure and the attendance of sessions, were collected on a weekly basis. Demographical data, pre- and post- questionnaires and cholesterol levels were collected before and after the campaign. Paired T-test in SPSS Version 21 was used.
Results: Out of 1,600 patients, 1,599 [1187 (74.0%) females and 412 (26.0%) males] completed the campaign; 576 (36.0%) patients had DM2, 960 (60.0%) had DM2 and HTN and 62 (4.0%) had DM1. After the campaign, the average weight loss was 2.6 kg (95% CI: 2.4-2.7). In addition, 22% lost ≥5%, 25% lost 3%-5%, and 30% lost 1%-3% of their weight. Significant improvements were seen in blood glucose, cholesterol and waist circumference (p≤0.001 for all). The attendance rate of the sessions was 70.6% in total.
Conclusions: This campaign has focused on healthy lifestyle awareness raising using group sessions with various activities, has resulted in better DM care outcomes of PRs with DM. Such campaigns need to be sustained and expanded. Local community and NGOs partnerships observed during the campaign should be strengthened and sustained.

Disclosure
N.M. Abu Kishk: None. Y.M. Shahin: None. Y. Turki: None. J. Mitri: Research Support; Self; National Dairy Council, Kowa Pharmaceuticals America, Inc.. Research Support; Spouse/Partner; AbbVie Inc., Janssen Pharmaceuticals, Inc., Takeda Pharmaceuticals U.S.A., Inc., Gilead Sciences, Inc.. Consultant; Spouse/Partner; Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Biogen, AbbVie Inc.. A. Seita: None.
The Impact of Restricted Gestational Weight Gain on Fetal Growth during Dietary Treatment in Women with Gestational Diabetes Mellitus
Authors: KURTZHALS LISE , NØRGAARD SIDSE , RONNEBY HELLE , SECHER ANNA L. , TABOR ANN , MCINTYRE H. DAVID , DAMM PETER , MATHIESEN ELISABETH R. 
Published: June 2018

Aim: To investigate the impact of maternal gestational weight gain during dietary treatment (GWG-diet) on fetal growth in pregnancies complicated by gestational diabetes (GDM).
Material and Methods: A retrospective cohort study of 382 consecutive women diagnosed with GDM &lt;34 weeks and live singleton births in our center in 2011-2017. The women were stratified according to restricted (53%), appropriate (17%) and excessive (31%) weekly GWG-diet (Institute of Medicine guidelines) to estimate compliance to a calorie-restricted diabetes diet (1700 kcal daily). Insulin therapy was initiated according to local clinical guidelines.
Results: Glucose tolerance, HbA1c, GWG before dietary treatment (GWG-before) and fetal abdominal circumference standard deviation (SD) score were comparable across the three GWG-diet groups at referral at 276±51 weeks. The women were followed for 100 ±51 weeks, 54% received insulin therapy and the average GWG-diet in the three groups was 0 kg, 3 kg and 5 kg, respectively. Women with excessive weekly GWG-diet, also had increasing HbA1c (p=0.014) during dietary treatment and infants with a birth weight SD-score of 0.59 ±1.6, while women with restricted weekly GWG-diet also had decreasing HbA1c (p=0.001) during dietary treatment, and infants with a birth weight SD-score of 0.15 ±1.1, without intrauterine growth restriction. Excessive GWG-diet and late pregnancy HbA1c were predictors of infant birth weight SD-score (p&lt;0.001) after correction for parity, uptake area, pre-pregnancy BMI and insulin therapy.
Conclusion: Restricted GWG-diet was associated with more appropriate fetal growth in women with GDM. GWG-diet and late pregnancy HbA1c were modifiable clinical predictors of infant birth weight SD-score.

Disclosure
L. Kurtzhals: None. S. Nørgaard: None. H. Ronneby: None. A.L. Secher: None. A. Tabor: None. H. McIntyre: Speaker's Bureau; Self; Novo Nordisk Inc.. Research Support; Self; Danish Diabetes Academy. P. Damm: Advisory Panel; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S. E.R. Mathiesen: Speaker's Bureau; Self; Novo Nordisk A/S. Other Relationship; Self; Novo Nordisk A/S, Novo Nordisk Foundation, Novo Nordisk A/S.
Evaluating the Effect That Diabetes Education Has on Acute-Care Nurses' Knowledge Level
Authors: KUCHTA JACKIE 
Published: June 2018

Although there are published inpatient diabetes guidelines, successful implementation is often met with resistance and fear of complications in treated patients. This is often due to a lack of knowledge among healthcare providers and nurses (RNs), which increases the risk of complications, dysglycemia, length of stay and readmissions. Diabetes affects every hospitalization and healthcare organizations need to provide all RNs with the education to reduce the effects of uncontrolled or undiagnosed diabetes. This project developed a 25-question, multiple choice test to evaluate acute-care RNs knowledge on inpatient diabetes management and was evaluated to determine the validity and reliability of the test. Validity was verified by a certified nurse leader with advanced diabetes management to ensure the questions were within a registered nurses scope of practice and an endocrinologist verified comprehensive inclusion of published inpatient diabetes guidelines across the continuum. The questionnaire was completed by 13 RNs and included a focus on pathophysiology of type 1 and type 2 diabetes, non-insulin agents, insulin, acute complications, nutrition, and sick day management. A paired t-test statistical analysis was conducted to determine the reliability of the questionnaire post-administration of diabetes education to the same group of RNs. The comparison showed an improvement in the overall diabetes knowledge level with a mean score of 79.7%, SD= 3.796, compared to pre-test mean score of 67.38%, SD= 14.86 and t= -3.524, p=0.004. Additional variables evaluated through a two way ANOVA (F[2, 10], f=.931, p=.426) showed no significant effect were the years of experience or level of nursing degree on the overall scores. In order to further strengthen the reliability of the questionnaire, the project should be repeated throughout the organization including all inpatient nursing departments. Additional variables that should be evaluated for effect include nursing unit and type of experience.

Disclosure
J. Kuchta: Other Relationship; Self; Medtronic MiniMed, Inc..
Durability of Glycemic Control in a Diabetes Education Insurer-Based Intervention in Primary Care
Authors: ZUPA MARGARET , ARENA VINCENT C. , THEARLE MARGARET B. , JOHNSON PATRICIA A. , SIMINERIO LINDA M. 
Published: June 2018

Background: Models that address the needs of patients with diabetes mellitus (DM) in primary care (PC) are needed, as health systems move to value-based care. To support DM patients at high risk, an insurer-based program that paired nurse practice care managers (PCM) with certified diabetes educators (CDE) was designed to improve outcomes for DM patients with complex needs.
Objective: To assess the durability of glycemic improvement after diabetes self-management education and support (DSMES) intervention within a model that relies on a PCM to identify, refer, and provide ongoing support to complex patients who received a CDE intervention in PC.
Methods: 2 CDEs, serving rural and urban areas, were introduced as team members into PC practices. CDEs provided DM training to PCMs who then proactively identified and referred patients under clear criteria (DM related ER visits, hospitalizations, HbA1c&gt;9, reported barriers to care) for DSMES in collaboration with PC provider and PCM. Post CDE intervention, the PCM was available for follow-up and ongoing support. HbA1c was monitored every 3 months after intervention and compared to baseline value to assess durability of improvement in glycemic control.
Results: Of 222 patients referred, 1had 6 and 80 had 12-month data for analysis. Patients were 52% female; mean age 57 (SD 13.43). Mean HbA1c decreased from 9.6 to 8.4 over 6 months and 9.2 to 8.1 over 12 months (p&lt;0.001). Improvement in glycemic control was maintained for at least 1 year after intervention. There was no significant change in BMI over this time.
Conclusions: A model where CDEs partner with PCMs, who identify, refer, and provide ongoing support to patients post-CDE delivered DSMES, is an effective and feasible intervention to improve and sustain DM outcomes in PC. This collaborative approach expands opportunities to meet complex needs of DM patients and can contribute to the ability of practices and health plans to provide an effective intervention with ongoing patient support.

Disclosure
M. Zupa: None. V.C. Arena: None. M.B. Thearle: None. P.A. Johnson: None. L.M. Siminerio: None.
The Relationship between A1C and Hypoglycemia in the Diamond Study
Authors: REDDY MONIKA , GIMENEZ MARGA , MOSCARDO VANESSA , OLIVER NICK 
Published: June 2018

We revisited the well-known inverse relationship between A1C and hypoglycemia using data from phase 1 of the Diamond clinical trial that compared usual care to real-time continuous glucose monitoring (CGM) in subjects with type 1 diabetes using MDI and with A1C levels from 7.5% to 9.9%. Data from 157 subjects (104 and 53 in the CGM and control groups, respectively) were analyzed. The percentages of sensor glucose (SG) values ≤70 mg/dL (≤3.9 mmol/L) (“%≤70”) and of those indicating clinically significant hypoglycemia (≤54 mg/dL [≤3.0 mmol/L]) (“%≤54”) during the initial and final weeks of the 24-week study were calculated for each subject and compared to corresponding baseline and 24-week A1C values. At baseline, the percent ≤70 was similar for the two groups (p=0.24), as was the percent ≤54 (p=0.10). There was a trend toward more hypoglycemia for subjects near the minimum allowed A1C value of 7.5% (Figure A). At 24 weeks (Figure B), there were significant between-group differences in favor of CGM at both thresholds, and the association between decreasing A1C and increasing exposure to SG values ≤54 mg/dL was attenuated. Subjects in the CGM group averaged ∼16 minutes/day with SG ≤54 mg/dL. These data suggest patients with access to CGM alerts and alarms take appropriate and timely measures to nearly eliminate exposure to clinically meaningful hypoglycemia. CGM allows safe intensification of MDI therapy and achievement of near-normal A1C levels.

Disclosure
M. Reddy: Advisory Panel; Self; Roche Diabetes Care Health and Digital Solutions. Other Relationship; Self; Dexcom, Inc.. M. Gimenez: None. V. Moscardo: None. N. Oliver: Advisory Panel; Self; Dexcom, Inc., Roche Diabetes Care Health and Digital Solutions, Medtronic. Research Support; Self; Dexcom, Inc., Roche Diabetes Care Health and Digital Solutions. Other Relationship; Self; Novo Nordisk A/S, Takeda Development Centre Europe Ltd..
Real-World Patterns of Daytime and Nocturnal Hypoglycemia during Flash Continuous Glucose Monitoring
Authors: PRYOR HEATHER , BUDIMAN ERWIN S. , XU YONGJIN 
Published: June 2018

This study evaluated patterns of daytime and nocturnal hypoglycemia during flash continuous glucose monitoring using the FreeStyle LibreTM system. Users scan the sensor to collect the current glucose, trend, and up to 8 hours of glucose readings which are automatically stored every 15 minutes. The internet-connected PC-based software uploads the de-identified 90-day reader data to a database. De-identified data from September 2014 to September 2017 of all sensors with at least 120 hours of operation were analyzed from 237,747 readers and 1,569,588 sensors worldwide (88% from Europe). Readers were ranked by scan frequency and allocated to 20 equally sized groups. The association of significant hypoglycemia (≤54 mg/dL) and scan rate were analyzed. Users performed a mean (SD) of 13.2 (9.0) glucose scans per 24 hours, with 11.5 (8.1) during the day (06:00-23:00) and 1.7 (1.5) during the night (23:00-06:00). Time in significant hypoglycemia (≤54 mg/dL) decreased from 24.2 to 15.2 minutes/day comparing low with high frequency scanners during the 17-hour day period (p&lt;0.001), with a similar pattern overnight (19.0 and 12.7 minutes/night, p&lt;0.001). When expressed as a proportion of time, hypoglycemia accounted for 2.4 to 1.5% of daytime glucose (for low to high frequency scanners), prevalence of night time hypoglycemia was 4.5 to 3.0%. The benefits of scanning frequently during the day are evident at night time.

Disclosure
H. Pryor: Employee; Self; Abbott. Employee; Spouse/Partner; Abbott. E.S. Budiman: Employee; Self; Abbott. Stock/Shareholder; Self; Abbott, AbbVie Inc. Y. Xu: Employee; Self; Abbott.
Cost-Effectiveness of Diabetes Self-Management Education and Support in the Community—Projections from a Randomized Controlled Trial
Authors: PIATT GRETCHEN , YE WEN , KUO SHIHCHEN , SINCO BRANDY R. , HERMAN WILLIAM H. , SPENCER MICHAEL S. , PALMISANO GLORIA , HEISLER MICHELE , KIEFFER EDITH C. 
Published: June 2018

To impact clinical and behavioral diabetes care, understanding the cost-effectiveness (CE) of diabetes self-management education and support (DSME/S) in community settings is critical. We aimed to determine the long-term CE of 2 DSME/S modalities (Community Health Worker (CHW) vs. CHW + Peer Leader (PL)), compared to enhanced usual care (EUC), in reducing risk of diabetes complications in Hispanic adults with type 2 diabetes (diabetes) in metro-Detroit. CE analyses were based on empirical outcome data from a randomized controlled effectiveness trial. Eligible subjects were recruited from one Federally Qualified Health Center and randomized to 1) 6 months of CHW-led DSME + 12 months of CHW-led telephone outreach, 2) 6 months of CHW-led DSME+ 12 months of PL-led weekly group sessions with telephone outreach, or 3) EUC. We used the validated Michigan Model for Diabetes to estimate the CE of the 2 DSME/S modalities compared to EUC over a 10-year simulation time horizon, discounting costs and benefits at 3% annually. Trial-based costs and outcomes were used; other data regarding costs, disease progression, mortality, and utilities were from published literature. From a healthcare sector perspective, CHW+PL was associated with lower costs ($76,599 vs. $77,203 in CHW and $76,779 in EUC) and increased health benefits (quality-adjusted life-years (QUALY): 5.137 vs. 5.1in CHW and EUC) compared to CHW and EUC, respectively, in the model time horizon. CHW was associated with higher costs but yielded similar QALYs compared to EUC. The greater intervention costs of CHW + PL were completely or substantially offset by savings arising from averted diabetes complications compared to CHW or EUC. Using CHW+PL for DSME/S appears to be a sound investment and may be cost-saving for Hispanic adults with diabetes in metro-Detroit.

Disclosure
G. Piatt: None. W. Ye: None. S. Kuo: None. B.R. Sinco: None. W.H. Herman: Other Relationship; Self; Merck Sharp & Dohme Corp., Lexicon Pharmaceuticals, Inc.. Consultant; Self; Janssen Scientific Affairs, LLC.. Research Support; Spouse/Partner; Nestlé. Other Relationship; Self; American Diabetes Association. Advisory Panel; Self; National Committee for Quality Assurance (NCQA). M.S. Spencer: None. G. Palmisano: None. M. Heisler: None. E.C. Kieffer: None.
Younger Patients with Type 2 Diabetes Have Poorer Self-Care Practices Compared with Older Patients—Results from the Australian National Diabetes Audit
Authors: NANAYAKKARA NATALIE , PEASE ANTHONY J. , RANASINHA SANJEEVA , WISCHER NATALIE , DE COURTEN BARBORA , ZOUNGAS SOPHIA 
Published: June 2018

Introduction: Type 2 diabetes is increasingly diagnosed among younger people. Patient engagement with self-care practices is crucial for the optimal management of type 2 diabetes. This study examines the self-care practices of younger and older patients with type 2 diabetes.
Methods: Data were analysed from the Australian National Diabetes Audit (ANDA) that included 2552 adult patients with type 2 diabetes from 56 participating Diabetes Centres. Pre-specified demographic and clinical variables were obtained. Self-care variables (physical activity, following dietary recommendations, medication adherence and monitoring blood glucose levels) were compared in patients ≤64 years and &gt;64 years of age.
Results: Mean age (±SD) of participants was 63±13 years overall, 53±9 years for the younger group and 73±6 years for the older group. Mean diabetes duration was 9±8 years and 15±10 years for younger and older patients, respectively (p&lt;0.01). A greater proportion of younger patients had HbA1c levels above 7.0% compared with older patients (76% vs. 68%, p&lt;0.001). A greater proportion of younger compared to older patients reported difficulty following dietary recommendations (50% vs. 32%) and forgetting medications (37% vs. 22%) (all p values &lt;0.001). A smaller proportion of younger compared with older patients reported monitoring their blood glucose levels as often as recommended (60%vs. 70%, p&lt;0.001). Younger age was associated with a 2-fold increase in the odds of not following the recommended self-care practices after adjustment for gender, smoking, insulin therapy, depression and allied health attendance (all p values &lt;0.001).
Conclusion: Despite shorter diabetes duration, younger age was associated with worse glycaemic control and poorer diabetes self-care practices among patients with type 2 diabetes. Targeted strategies are urgently required to optimise diabetes self-care practices and thereby improve glycaemic control.

Disclosure
N. Nanayakkara: None. A.J. Pease: None. S. Ranasinha: None. N. Wischer: None. B. de Courten: None. S. Zoungas: Advisory Panel; Self; AstraZeneca.
Glucose Variability and Flash Glucose Monitoring in the Real World
Authors: JANGAM SUJIT , XU YONGJIN , HAYTER GARY , DUNN TIMOTHY 
Published: June 2018

High glucose variability is associated with increased hypoglycemia. Previous analyses of real-world data have shown that increased testing using flash glucose monitoring (FreeStyle LibreTM system) is associated with lower hypoglycemia and hyperglycemia. Here we studied: 1) The relationship between glucose variability and hypoglycemia/hyperglycemia during flash glucose monitoring 2) The relationship between increased glucose testing and glucose variability. De-identified glucose data is collected from individuals using the system when they upload data from their readers to the desktop software. Data from 237,747 individuals was analyzed. To understand the relationship between variability and hypoglycemia/hyperglycemia, individuals were divided into groups of high and low glucose variability using CV=36% as the threshold. Hypoglycemia (time below 70mg/dL) and hyperglycemia (time above 180mg/dL) metrics were then analyzed in the two groups. To understand the impact of testing frequency on glycemic variability, individuals were divided into 20 equal sized groups spanning the full range of daily testing frequency. Average CV was then calculated for each group. It was observed that individuals with high variability showed 35% more hyperglycemia (10.1±5.9 hours/day) compared to individuals with low variability (7.5±7.0 hours/day). Similarly, individuals with high variability showed 167% more hypoglycemia (144±281 minutes/day) compared to those with low variability (54±185 minutes/day). It was observed that increased testing with the system was associated with lower glucose variability. CV decreased from 40.6% to 34.5% from the lowest to highest testing frequency groups. High variability is associated with both increased hyperglycemia and hypoglycemia in a large sample population from the real world. Increased testing is associated with decreased glucose variability.

Disclosure
S. Jangam: Employee; Self; Abbott. Y. Xu: Employee; Self; Abbott. G. Hayter: Employee; Self; Abbott. T. Dunn: Employee; Self; Abbott.
The Role of Diabetes Educators in Reduction the Risk of Hypoglycemia in Type 1 Patients during Fasting Ramadan
Authors: MOURAD SAHAR 
Published: June 2018

Background/Objectives: Fasting Ramadan for type 1 patients could be a challenging for both patients and physicians due to complications such as hypoglycemia, so in this study we choice to introduce glucose sensor and intensify the role of diabetes educator follow-up for type 1 patients who already on pump and willing to fast Ramadan for the first time.
Design and Methods: This is a pilot prospective cohort study. Total of 6 patients (4 females and 2 males) with type 1 diabetes were recruited. Their mean age is (21.8+/-2.2) years, diabetes duration(11.1+/-2.3) years, mean duration on insulin pump is (4+/-1.6)years. Insulin basal rates of infusion were reduced 5-10% during fasting hours and increased between 5-10% after breaking fast. Weekly follow-up visits during Ramadan took place as well a daily follow-up by phone with the educator. Patients were asked to wear glucose sensor for entire days of fasting to detect hypoglycemia.
Results: An (28.8+/- 8.6) units for 24 hours of basal insulin were set before fasting, and (26.8+/- 7.5) units for 24 hours of basal insulin were required for fasting Ramadan, and from that (15.1+/-4.3) units was basal insulin for total hours of fasting(14 hours), part of it explained by food habitus and lack of activity during Ramadan.
An average of blood glucose was (11.1+/-2.1) mmol/l an hour before futoor, (9.7+/-3.8) mmol/l two hours after futoor, and (12.5+/- 3.4) mmol/l at suhoor.
On the first week, four hypoglycemic episodes (BG less than 3.9 mmol/l), daily follow-up by diabetes educator, pop up visit in educator office and weekly visit to physician and educator office reduce the episode of hypoglycemia by the 2nd week till the 4th week of Ramadan.
Conclusions: The use of glucose sensor together with adjustment of basal insulin wasn’t enough to minimzing the fear of fasting Ramadan but with role of diabetes educator reduce the risk of further hypoglycemia episode.

Disclosure
S. Mourad: None.