bluuebunny/crossref_metadata_2025_split huggingface dataset:
845-P: Relationship between Financial Hardship and Glycemic Control in Older Adults with Diabetes
Authors: WALKER REBEKAH J. , GARACCI EMMA , EGEDE LEONARD E. 
Published: June 2019

Background: Evidence exists that socioeconomic status influences health, however, there is no consensus on the best measures to use when concerned with clinical outcomes. The aim of this analysis was to better understand the individual and cumulative influence of financial hardship on glycemic control in older adults with diabetes.
Methods: Using nationally representative data from 2012 and 2014 Health and Retirement Survey, we investigated 2,682 older adults with self-reported diabetes. Measures of financial hardship included 1) difficulty paying bills, 2) ongoing financial strain over 12 months or longer, 3) decreasing food intake due to lack of money, and 4) taking less medication than prescribed due to cost. Each measure was investigated individually, then a cumulative score of hardships for each person was created. Linear models for the relationship on continuous HbA1c were run unadjusted, then adjusted for age, gender, race/ethnicity, education, marital status, employment status, household income and asset quartiles, and comorbidity count.
Results: 58.5% of the sample reported at least 1 financial hardship, 37.5% reported 2+. After adjustment, a significant relationship existed with an increasing number of hardships associated with a 0.10 increase in HbA1c (95% CI 0.04, 0.15). While the adjusted relationship between ongoing financial strain and decreasing food intake due to money was no longer significant, difficulty paying bills (0.25, 95% CI 0.14, 0.36) and decreased medication usage due to cost (0.22, 95% CI 0.07, 0.36) remained significant. Once fully adjusted, the relationship with income lost its significance.
Conclusion: Financial hardship had a cumulative influence on glycemic control, with an increasing number of hardships associated with worse HbA1c. Difficulty paying bills and cost related non-adherence were independently associated with glycemic control, suggesting these may be better measures than income when considering the influence on clinical outcomes.

Disclosure
R.J. Walker: None. E. Garacci: None. L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases.

Funding
National Institutes of Health
85-LB: A Phase 1b/2 Clinical Trial of Dantrolene Sodium in Patients with Wolfram Syndrome
Authors: ABREU DAMIEN , PEARSON TONI S. , BUCELLI ROBERT C. , SIMPSON ASHLEY , BROWN CRIS M. , KRIES KELLY , GU HONGJIE , STONE STEPHEN I. , TYCHSEN LAWRENCE , STAVERN GREGORY VAN , WHITE NEIL H. , MARSHALL BESS A. , HERSHEY TAMARA , URANO FUMIHIKO 
Published: June 2019

Wolfram syndrome is a rare, progressive neurodegenerative disorder characterized by juvenile-onset diabetes, optic nerve atrophy and mutation of the WFS1 gene. Calcium dyshomeostasis is a key mechanism underlying neuronal and pancreatic β-cell death and dysfunction in this endoplasmic reticulum (ER) disorder. Dantrolene sodium is an FDA-approved muscle relaxant that preserves ER calcium through inhibition of ryanodine receptor (RyR) activity. We therefore hypothesized that dantrolene could have therapeutic potential for Wolfram syndrome. Our preclinical studies showed that dantrolene improves β-cell and neuronal cell survival in mouse and induced pluripotent stem (iPS) cell models of Wolfram syndrome. To translate these findings to humans, we conducted the first clinical trial in 19 Wolfram syndrome patients through a 6-month phase 1b/2 study of dantrolene sodium with an optional extension phase up to 24-months (NCT02829268). The endpoints of this study were to assess: (1) dantrolene safety and tolerability in pediatric and adult Wolfram syndrome patients and (2) its effects on remaining β-cell, visual and neurologic functions and quality of life measures. Among pediatric subjects, dantrolene was well-tolerated at a daily dose of 0.5mg/kg in those &lt; 50kg and 2mg/kg in those &gt; 50kg. Adults tolerated dantrolene well at 50mg - 100mg daily. Common adverse events included mild fatigue, diarrhea, headache and hypoglycemia. A mild increase in 30-minute mixed-meal-stimulated C-peptide was observed in subjects after 6- and 12-months of dantrolene treatment. No significant changes were observed in visual or neurological functions or quality of life measures, although mild improvement in disease severity was noted by the Wolfram Unified Rating Scale. These findings suggest that dantrolene is safe for use in Wolfram syndrome at the specified doses and support further study of dantrolene in a randomized, placebo-controlled trial.

Disclosure
D. Abreu: None. T.S. Pearson: None. R.C. Bucelli: None. A. Simpson: None. C.M. Brown: None. K. Kries: None. H. Gu: None. S.I. Stone: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Speaker’s Bureau; Self; AbbVie Inc. L. Tychsen: None. G. Van Stavern: None. N.H. White: None. B.A. Marshall: None. T. Hershey: Research Support; Spouse/Partner; Sage Pharmaceuticals. F. Urano: Board Member; Self; Healthbeat. Research Support; Self; Aetas, Amylyx, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. Stock/Shareholder; Self; CytRx. Other Relationship; Self; Novus Biologicals.

Funding
National Institutes of Health (R21DK113487-02)
850-P: Modeling Pathways between Psychological Distress, Emergent Symptoms and Side Effects, and Endpoint A1C during Treatment
Authors: TESTA MARCIA A. , SU MAXWELL , SIMONSON DONALD C. 
Published: June 2019

Achieving glycemic targets is often hampered by emerging symptoms and side effects (SSE). We previously showed that higher baseline psychological distress was associated with worsening treatment-related SSE; however, causal pathways among demographic, psychological and endpoint A1C (E-A1C) measures remain unclear. To explore these pathways, we used latent variable, structural equation models (SEM) and pooled data from 17 randomized clinical trials (N = 5209 patients, 712 centers) employing 32 different regimens of insulin and oral agents alone or in combination during 24 -52 weeks of treatment. Questionnaires of psychological distress (PD) and well-being (PWB) (24 items), and SSE distress (54 items) were completed longitudinally. At baseline, 707 patients (13.6%) were T1D (54.2% male, age 32.7 ± 14.4 years, A1C 8.0 ± 1.0%, BMI 25.1 ± 3.9 kg/m²) and 4,502 (86.4%) were T2D (58.5% male, age 57.3 ± 10.3 years, A1C 8.7 ± 1.3%, BMI 30.8 ± 5.2 kg/m²). The PD latent variable consisted of depression, anxiety, and loss of behavioral control scales. Controlling for baseline age, sex, A1C, BMI and SSE, the SEM model indicated that for T2D a 1 standard deviation (sd) better baseline PD in the PD --&gt;SSE path resulted in an 11% sd improvement in SSE, while a 1 sd improvement in the SSE --&gt; E-A1C path resulted in a 15% sd decrease in A1C (both p &lt; 0.001). Neither coefficient was significant for T1D. Adding a PWB latent variable to the combined T1D and T2D SEM added no explanatory value, while adding an additional feedback path (E-A1C--&gt;SSE) showed that influences could be bidirectional (p &lt; 0.001). Results indicate that pre-existing mental health conditions, as well as worsening treatment-emergent symptoms and side effects, can interfere with A1C lowering. These findings support therapeutic regimens that include a plan for the proactive treatment of psychological and symptom distress to improve diabetes medication acceptance and adherence in order to better achieve diabetes treatment goals.

Disclosure
M.A. Testa: Stock/Shareholder; Spouse/Partner; GI Windows, Inc. Stock/Shareholder; Self; Phase V Technologies, Inc. M. Su: None. D.C. Simonson: Stock/Shareholder; Self; GI Windows, Inc. Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc.

Funding
Patient-Centered Outcomes Research Institute (CE1304-6756)
851-P: Sleep and Quality of Life in Adolescents with Type 1 or Type 2 Diabetes
Authors: FAULKNER MELISSA S. 
Published: June 2019

Poor sleep due to the influence of mobile technology and hectic schedules is common in adolescents and may affect overall diabetes management. The purpose of this study was to examine associations between sleep quality and perceptions of physical health, emotional well-being, self, family support, friendships and life satisfaction in adolescents with diabetes. Seventy-six adolescents with either T1D (n = 49; 25 males) or T2D (n= 27) completed a self-report global measure of sleep quality using a 5-point scale with higher values representing more sleep difficulty and measures of quality of life based upon subscales from well-validated and reliable instruments. These included the Kiddo KINDL® and the Diabetes Quality of Life Instrument for Youth with higher values on a 5-point scale indicating more positive perceptions of quality of life and life satisfaction. Hemoglobin A1c% (HbA1c) was obtained using the Abbott IMx® assay method.
Adolescents with T2D were significantly older (15.2±2.0 vs. 14.0±1.4 years), had higher body mass index z-scores (2.0±0.6 vs. 0.6±0.9) and less duration of diabetes (2.0±1.8 vs. 5.5±3.2 years) (P &lt; 0.01). There were no group differences in median scores for sleep quality or mean HbA1c (8.1±2.4 vs. 8.8±1.8) and no association between HbA1c and sleep quality. Using Spearman rho correlational analyses, there were significant associations between sleep quality and perceptions of physical health (rho = -.44), self (rho = -.19), family (rho = -.20), friends (rho = -.23) and life satisfaction (rho = -.25), P &lt;0.05). Significant associations were stronger in those with T1D, ranging from rho = -.36 to -.64, including emotional well-being, likely due to the larger sample size for those with T1D.
Results indicate those with greater sleep difficulty had lower quality of life. Greater emphasis on overall sleep quality and personal health and relationships are needed in future research and the clinical management of diabetes in adolescents.

Disclosure
M.S. Faulkner: None.

Funding
National Institutes of Health (R01NR07719)
859-P: Social Support and Diabetes Distress among Adults with Alabama Medicaid
Authors: PRESLEY CAROLINE A. , MONDESIR FAVEL L. , AGNE APRIL A. , RIGGS KEVIN R. , PISU MARIA , LEVITAN EMILY B. , BRONSTEIN JANET M. , CHERRINGTON ANDREA 
Published: June 2019

Background: Diabetes distress affects up to 45% of adults with diabetes and is associated with reduced treatment adherence and poor glycemic control. We evaluated diabetes distress and the relationship between social support and diabetes distress in adults with Medicaid.
Methods: We surveyed a population-based sample of adults, aged 19 to 64 years old, covered by Alabama Medicaid, and diagnosed with type 2 diabetes. Diabetes distress was measured with the 17-item Diabetes Distress Scale (DDS) assessing emotional burden, physician-related distress, regimen-related distress, and interpersonal distress. A score of &lt;2 indicates little/no distress, 2-2.9 moderate distress, and ≥3 high distress. Social support was assessed by the question “How much support do you get for dealing with your diabetes?” and responses were categorized as low, moderate, or high social support. We performed multivariate logistic regression of diabetes distress by social support, adjusting for demographics, disease severity, self-efficacy, and depressive symptoms.
Results: In total, 541 individuals participated; 72% were female, 40% white, 58% black, and 3% Hispanic. Mean diabetes distress score was 1.7 (SD 0.88); 72.8% of participants had little/no diabetes distress, 16.8% moderate distress, and 10.4% high distress. Most participants (56.9%) reported high social support, but 13.5% reported low and 29.6% moderate social support. Participants who reported low and moderate social support were significantly more likely to have high diabetes distress (≥3) than those who reported high social support, adjusted odds ratio 14.3 (95% CI 5.2, 39.1) and 4.2 (95% CI 1.6, 10.7), respectively. This relationship was present for each diabetes distress domain, with particularly strong relationships between low social support and high interpersonal and regimen-related distress.
Conclusions: Interventions seeking to reduce diabetes distress in adults with type 2 diabetes may benefit from a focus on improving social support.

Disclosure
C.A. Presley: None. F.L. Mondesir: None. A.A. Agne: None. K.R. Riggs: None. M. Pisu: None. E.B. Levitan: Consultant; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Amgen Inc. J.M. Bronstein: None. A. Cherrington: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
860-P: Benefits of Real-Time Sharing and Following of Continuous Glucose Monitoring Data from Youth
Authors: PARKER ANDREW , DERDZINSKI MARK , PUHR SARAH , WELSH JOHN , WALKER TOMAS C. , JIMENEZ ANNIKA 
Published: June 2019

Background: Children and adolescents with diabetes may use data from continuous glucose monitoring (CGM) in management decisions and may share it in real time with others involved in their care. CGM systems from Dexcom (San Diego, CA) allow real-time sharing with up to 5 remote “Followers.” We explored associations between the presence of Follower(s), device utilization, and glycemic parameters.
Methods: We used estimated glucose values (EGVs) from a convenience sample of 25,000 CGM users of Dexcom's G5 or G6 system ages 2-24 that were uploaded between 5/1/2018 and 9/30/2018 by an app that allows for sharing. The number of Follower(s) was established on 8/10/2018. Each day with ≥1 valid EGV was counted as a day of device usage. Comparisons were made with two-sided Welch’s t-tests.
Results: Overall, 90.0% of the population used the sharing feature and had ≥1 Follower; the mean numbers of Followers for patients ages &lt;8, 8-14, and 15-24 years were 2.73, 2.69, and 1.83, respectively. In all 3 age groups, having a Follower was associated with lower mean EGVs, more EGVs in the 70-180 mg/dL range, fewer EGVs in hypo- or hyperglycemia, and more device utilization (Table).
Conclusions: Real-time sharing and following of CGM data may encourage consistent device usage and facilitate timely interventions by parents of young children with diabetes or improve self-care behaviors among adolescents and young adults with diabetes.

Disclosure
A. Parker: Employee; Self; Dexcom, Inc. M. Derdzinski: Employee; Self; Dexcom, Inc. S. Puhr: None. J. Welsh: Employee; Self; Dexcom, Inc. T.C. Walker: Employee; Self; Dexcom, Inc. A. Jimenez: Employee; Self; Dexcom, Inc.
861-P: Barriers to Technology Use in Pediatric Patients with Type 1 Diabetes
Authors: TSAI DAVID , REID MARK W. , FLORES GARCIA JAQUELIN J. , RAYMOND JENNIFER 
Published: June 2019

Type 1 diabetes (T1D) affects many youth in the United States and the incidence is rising. Diabetes technology such as insulin pumps and continuous glucose monitors (CGM) have been associated with improved glycemic control and improved quality of life. However, as of 2015 only 60% of children used a pump and only 6% used CGM. The use of diabetes devices is even lower in minorities. Potential barriers to device uptake in the T1D population have been described, but studies were mostly conducted in adults who were predominantly white, of higher socioeconomic status, and privately insured.
Youth with T1D (n=143) followed at Children’s Hospital Los Angeles were surveyed to investigate barriers to diabetes technology and explore potential differences between Latinx and non-Latinx populations. Latinx patients reported higher percentage of never having used CGM (64.6% vs. 41.3%, p=0.005) or pump (50.8% vs. 28.6%, p=0.002), and were found to have higher HbA1c levels (9.3% vs. 8.1%, p=0.0002). Latinx patients had less positive attitudes toward general and diabetes technology as seen in Table 1.
Less positive attitudes toward technology in general may contribute to the lack of exposure to diabetes devices in the Latinx community. However, physician-perceived barriers might also contribute to the differences. Further investigation into patient and physician-perceived barriers will assist in improving patient adoption of diabetes technology.

Disclosure
D. Tsai: None. M.W. Reid: None. J.J. Flores Garcia: None. J. Raymond: Other Relationship; Self; Insulet Corporation.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
864-P: Utilizing Certified Diabetes Educators to Manage Smoking Cessation
Authors: SCHWARTZ ABBY , DEPALO LOUIS R. , SIMONSON JULIE K. , WEINBERGER ELISHEVA , RODRIGUEZ MARIA ELENA , ROSENBERG DEBORAH L. , KARTASHEVSKY JENNIFER 
Published: June 2019

Introduction: Many health systems lack internal smoking cessation programs despite the need to personalize smoking cessation support for patients. Though smoking cessation services are important, systems often lack needed resources to create programs from scratch. Mount Sinai Hospital System implemented a smoking cessation program by cross training CDEs as smoking cessation health coaches since they were embedded across the network and experts in health behavior change.
Methods: The entire CDE team was trained via WebEx lectures and through shadowing a tobacco treatment specialist pulmonologist in her practice. Patient and HCP engagement materials were developed as well as EHR enablement and policies/procedures to support the new program. The initial, target population was smokers with upcoming surgery since they were a discrete population and likely motivated to quit smoking to improve surgical outcomes. CDEs created personalized smoking cessation plans with patients and obtained medications through collaborative discussions with the patients’ primary care physician.
Results: Eight CDEs participated. The CDEs report increased job satisfaction by operating at the top of their licenses and learning a new therapeutic area. Patient and provider feedback has been strongly positive, and the program is expanding.
Conclusion: CDEs may serve as an internal resource to expand smoking cessation services within a health system.

Disclosure
A. Schwartz: None. L.R. DePalo: None. J.K. Simonson: Employee; Self; Pfizer Inc. E. Weinberger: None. M.E. Rodriguez: None. D.L. Rosenberg: None. J. Kartashevsky: None.

Funding
Pfizer Inc.
873-P: "I Had Nobody to Represent Me"—How Patient Perceptions of Diabetes Health Care Providers' Age, Gender, and Ethnicity Impact Shared Decision-Making
Authors: AHMAD TEHMINA , HARI SHRIYA , CLEARY DEVIN E. , YU C. 
Published: June 2019

Background: When patients and clinicians establish diabetes care plans together, patients are more likely to successfully manage their diabetes. Although studies reveal diabetes healthcare provider (HCP) bias and healthcare inequities, the potential impact of patient perceptions of their diabetes HCP is unknown. We explored how patient perceptions of their diabetes HCP influences treatment plans and shared decision-making (SDM).
Methods: Adult participants with diabetes receiving diabetes care at community sites, primary care, or specialty clinics were invited to participate in semi-structured 30- to 45-minute interviews. Interviews were conducted from Nov 2018 to Jan 2019. Responses were qualitatively analyzed with NVivo for emergent themes.
Results: We conducted 28 interviews with participants aged 34-81. Participants were female (16), male (11), FtM (1), and white (9), black/Caribbean (11), Asian/South Asian (4), Middle Eastern (2) and Hispanic (2). We identified the following themes: 1) Hidden bias for stated preference of HCP ethnicity: While most participants stated no preference, we identified hidden preferences via cultural relatability as well as evidence of color blindness. 2) Impact of HCP characteristics on SDM: Participants felt junior HCPs had up-to-date knowledge, while others preferred senior HCPs’ clinical experience. HCP gender and ethnicity impacted SDM via relatability; participants who related to their HCP were more likely to engage in a care plan. 3) Other factors affecting HCP preference: Participants preferred HCPs who provided patient-centered care, characterized by individualized referrals, trusting relationships, and HCPs’ investment in patient success.
Conclusion: Diabetes affects persons of all ages, genders, and ethnicities. Exploring how patient perceptions of HCPs inform shared decision-making offers insight into systemic barriers to equitable person-centered care.

Disclosure
T. Ahmad: None. S. Hari: None. D.E. Cleary: None. C. Yu: None.
889-P: Early Engagement in a Continuous Care Intervention Predicts One-Year Improvements in Weight and HbA1c among Adults with T2D
Authors: ADAMS REBECCA N. , MCKENZIE AMY , ATHINARAYANAN SHAMINIE J. , HALLBERG SARAH , MCCARTER JAMES P. , PHINNEY STEPHEN 
Published: June 2019

We previously showed that a digitally-monitored continuous care intervention (CCI) including nutritional ketosis (NK) substantially improved weight and HbA1c in adults with T2D. In this intervention, health coaches provided personalized nutrition guidance informed by biomarker data participants entered into a mobile app. Here, we examined whether indicators of early treatment engagement (i.e., messaging coaches, logging biomarkers, achieving NK) predicted the decreases in weight and HbA1c at 1 and 2 years. 262 adults with T2D (mean age=54 years, 67% female, mean HbA1c %=7.6, 92% obese) in the CCI were counseled to eat a whole foods very low carbohydrate diet. The percentage of days participants messaged their coach and logged ≥1 biomarker or symptom, and percentage of blood beta-hydroxybutyrate (BHB) readings ≥0.5 mM (indicating NK) during the first 10 weeks were obtained from the app. Weight and HbA1c were measured in clinic. We conducted correlation and GLM intent-to-treat analyses to assess relations between measures of treatment engagement and percent change in weight and HbA1c from baseline to 1 and 2 years. Coach messaging and logging were not correlated with percent change in weight or HbA1c; however, a greater percentage of BHB readings ≥0.5 was correlated with a greater percent decrease in weight (r=-0.25, p=0.001) and HbA1c (r=-0.19, p=0.004) from baseline to 1 year (but not 2 years). In GLM analyses, a greater percentage of BHB readings ≥0.5 predicted greater percent decrease in weight (b=-0.06, p=0.01) and HbA1c (b=-0.06, p=0.03) at 1 year after accounting for coach messaging, logging, and baseline demographic and medical characteristics. Results indicate that greater adherence to NK during the first 10 weeks explained a significant proportion of the variance in weight loss and A1c reduction, whereas simple app-based engagement did not. Future analyses should explore the role of maintaining NK over the remainder of the year on 1 year outcomes.

Disclosure
R.N. Adams: Employee; Self; Virta Health Corp. A. McKenzie: Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. S.J. Athinarayanan: Employee; Self; Virta Health Corp. S. Hallberg: Advisory Panel; Self; Atkins Nutritionals, Inc. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. J.P. McCarter: Employee; Self; Virta Health Corp. S. Phinney: Advisory Panel; Self; Atkins Nutritionals, Inc. Board Member; Self; Virta Health Corp. Employee; Self; Virta Health Corp. Stock/Shareholder; Self; Virta Health Corp. Other Relationship; Self; Beyond Obesity.