bluuebunny/crossref_metadata_2025_split huggingface dataset:
698-P: Factors Significantly Associated with Adherence to Diabetes Medications: Findings from a Large Japanese Claims Database
Authors: YAGUCHI YUTA , FUJIHARA KAZUYA , OSAWA TAEKO , YAMAMOTO MASAHIKO , KANEKO MASANORI , KITAZAWA MASARU , HARADA MAYUKO , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , YAMANAKA NAUTA , SEIDA HIROYASU , SONE HIROHITO 
Published: June 2019

Poor medication adherence is a well-known barrier to meeting therapeutic goals in diabetes mellitus (DM). We aimed to clarify the status of medication adherence and determine clinical variables significantly associated with medication adherence in Japanese patients with DM using a large claims database. Analyzed were data from 7459 patients with DM whose medical records on oral hypoglycemic agents (OHA) were available for at least 1 y (mean age 53 y, HbA1c 7.2%). Medication adherence was evaluated by the proportion of days covered (PDC); PDC &lt;80% was defined as non-adherent. Multivariate logistic regression model was used to identify clinical variables significantly associated with non-adherence. The mean PDC was 80.4%, and 33.1% of patients were non-adherent. The PDC for sulfonylureas, biguanides, thiazolidines, α-glucosidase inhibitors, glinides, and DPP-4 inhibitors were 82% 82%, 79%, 79%, 73%, and 84%, respectively. The PDC for OHA was negatively correlated with HbA1c, LDL cholesterol, and triglycerides. HbA1c decreased by 0.2% with 25% increases in PDC. Logistic analysis indicated that older age and ≥3 concomitant medications were significantly associated with adherence while male sex and smoking were significantly associated with non-adherence (Figure), implying the necessity for effective strategies to improve medication adherence in patients in these categories.

Disclosure
Y. Yaguchi: None. K. Fujihara: None. T. Osawa: None. M. Yamamoto: None. M. Kaneko: None. M. Kitazawa: None. M. Harada: None. Y. Matsubayashi: None. T. Yamada: None. N. Yamanaka: None. H. Seida: None. H. Sone: Research Support; Self; Astellas Pharma Inc., Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Kowa Pharmaceutical Europe Co. Ltd., Kyowa Hakko Kirin Co., Ltd., Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited, Teijin Pharma Limited.
705-P: Health Extension: A Better Way to Manage Diabetes?
Authors: DIETZ CHRISTINA J. , TILKEMEIER PETER , SHERRILL WINDSOR W. , MCFALL DANIELLE E. , STANCIL MICHELLE D. , PARISI MICHELLE A. , BEAUCHAMP CELIA , WHITE HANNAH N. 
Published: June 2019

Background: Given the increasing number of individuals with diabetes who live in settings with limited access to care, new models of care delivery for management of diabetes are critical. Health Extension for Diabetes (HED), a community-based non-clinical diabetes education program delivered by a Health Extension Agent, is based on the AADE7 Self-Care Behaviors for Managing Diabetes.
Methods: This intervention is a mixed-methods research study with a primary outcome to reduce/prevent complications associated with diabetes. Goal assessment metrics were selected by clinical, non-clinical and evaluation staff, and resulted in 3 categories: health behaviors, health outcomes, and healthcare utilization. Pre/post analysis of graduates in HED cohorts 1-3 focuses on health behaviors and health outcomes with emphasis on 2 crucial measures, diet and exercise. Pre/post data were compared using Stata 15.
Results: Table 1 shows client demographics and the pre/post analysis of several variables collected during evaluation process.
Conclusion: Overall, this novel educational diabetes self-management support intervention was found to be effective shown through the short-term outcome measures. This new method increased client physical activity and confidence (self-efficacy) in regard to diabetes management while lowering consumption of sugary beverages.

Disclosure
C.J. Dietz: None. P. Tilkemeier: None. W.W. Sherrill: None. D.E. McFall: None. M.D. Stancil: None. M.A. Parisi: None. C. Beauchamp: None. H.N. White: None.

Funding
Greenville Health Authority
706-P: Enrollment in a Diabetes Prevention Program in the San Francisco Safety Net
Authors: KIM STEPHANIE , TANG AUDREY H. , KUO CHARLOTTE , GARCIA REBECA S. , KIM SARAH , MURPHY ELIZABETH 
Published: June 2019

There is a crucial need for successful strategies for DPP enrollment and implementation in safety net populations which are disproportionally affected by diabetes. We examine enrollment outcomes in a DPP referral program in the San Francisco Health Network, a safety net serving over 140,000 patients. Overweight patients with prediabetes are referred via an electronic consultation system from 20 community primary care and weight management clinics. Eligible Spanish- or English-speaking patients are contacted by a patient navigator, screened for eligibility, given a readiness assessment and if appropriate, invited to participate in either a digital or in-person DPP. Patients interested in an in-person program but not ready for the full DPP are offered the 6-week Diabetes Empowerment Education Program (DEEP). From August 2017 to November 2018, 305 patient referrals were evaluated: 44 (14.4%) did not qualify after chart review (e.g., they already had diabetes, were not prediabetic, or were out of network), 124 (40.7%) were unable to be reached (13 did not have a working phone, 23 had no voicemail, 88 did not return calls) and 137 (44.9%) patients were reached. Of those 137, 26 (19.0%) were unaware that their provider had referred them or were not interested while 111 (81.0%) were interested. Ten of those patients were not ready for the full DPP and chose DEEP. The remaining 101 patients completed the intake process, passed a readiness assessment and chose to enroll in a DPP: 25 (24.8%) chose a digital DPP and 76 (75.2%) an in-person DPP with a nonsignificant trend towards a preference for a digital DPP by younger patients. Thus, of 305 initial referrals less than half (36.4%) were successfully enrolled. The primary challenge was difficulty reaching and engaging patients. Potential strategies to improve patient yield include better education of referring providers on initial readiness assessments, DPP eligibility, and the importance of a good contact number. Measuring weight loss outcomes in these patients will be crucial.

Disclosure
S. Kim: None. A.H. Tang: None. C. Kuo: None. R.S. Garcia: None. S. Kim: None. E. Murphy: None.
708-P: Effectiveness of CHO-Counting on Glycometabolic Control and Comparison between the Methods of I/CHO Ratio Calculation in Subjects with Cystic Fibrosis-Related Diabetes (CFRD)
Authors: GRANCINI VALERIA , GAGLIO ALESSIA , RESI VERONICA , PALMIERI EVA , ORSI EMANUELA 
Published: June 2019

DM is a complication of cystic fibrosis and it’s caused mainly by insulin deficiency. A glycometabolic decompensation, due to incorrect therapeutic management, leads to a worsening of the catabolic state (already caused by malabsorption and high metabolic requests, and a known risk factor for worsening of respiratory function). The therapy for CFRD is insulin. Cho-counting, an effective technique to manage insulin therapy in T1DM subjects, allows patients to achieve a better glycemic control.
Aim: to evaluate the efficacy of cho-counting in patients with CFRD on glycemic control.
Materials and Methods: 21 patients with CFRD, randomized in 2 groups. gr.1: 9 patients performing cho-counting; gr.2: 12 patients followed according to ambulatory standard care. Glycometabolic control was evaluated with: a. variation of HbA1c, b. variation of pre and postprandial average SMBG in a period of 12 months. In group 1, the I/CHO ratio obtained with the 500-formula was compared with those obtained from food and glucose diaries.
Results: gr.1 showed a reduction of HbA1c, compared to gr. 2 (7.4 ± 0.9% to 6.6 ± 0.3%, Δ -0.8% vs. 7.4 ± 1.5% to 7.5 ± 1.4%, Δ + 0.1%, P &lt;0.05). There was also an improvement, even if not significant, in gr.1 and a worsening (p &lt;0.05 for post) in gr.2, of pre and post-prandial average SMBG. In gr.1, the I/CHO ratio obtained through the 500-formula was 1/20. Based on diaries, it was 1/18 for breakfast, 1/25 for lunch and 1/25 for dinner.
Conclusions: Cho-counting is effective in improving glycometabolic control in individuals with CFRD, avoiding the risk to worsen the already delicate metabolic balance of these patients. The use of dietary and glycemic diaries allows to estimate the I/CHO ratio differentiating the insulin needs during the day. This allows a more accurate personalization of the therapy compared to the use of 500-formula, which, in these patients, often overestimate the need for insulin at meals.

Disclosure
V. Grancini: Board Member; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Merck Sharp & Dohme Corp. A. Gaglio: Consultant; Self; Roche Diabetes Care. V. Resi: Speaker's Bureau; Self; Sanofi. E. Palmieri: Speaker's Bureau; Self; Eli Lilly and Company. E. Orsi: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk A/S, Sanofi-Aventis.
709-P: The Use of Advanced Learning Formats and Partnerships to Enhance CME and Diabetes Care
Authors: HOSMER-GALLO CHRISTINA , WELCH LAUREN K. , HEFELE BROOKE 
Published: June 2019

In 2018, Med Learning Group (MLG) launched the THRIVE initiative, a large-scale, multi-faceted continuing medical education series in glycemic control that incorporates a variety of live and online educational activities/tools for enriched comprehension and engagement. This programming included partners such as ADA chapters, AAFP, Pack Health, Health Resources and Services Administration, Public Health Foundation, and the Hypoglycemia Support Foundation to further enhance content and offer an opportunity for long lasting impact on diabetes care. The series launched 3 national summit meetings with expert and local faculty and 25 grand rounds with chart audits in community-based practices/hospitals throughout the country showing improvements in both knowledge and competence. An online enduring program was created to further extend the impact. THRIVE includes unique and innovative tools to enhance the learning experience, facilitate continuous learning and translation into practice, and encourage patient education and dialogue. These included:
App/Mobile website: Features quickly downloadable materials and links to published articles and patient and provider tool kits.
iPads: Facilitate Q and A during live sessions and allow participants to engage in the lecture.
ADA materials: Provided local patient support information to participants.
Chart Audit: Occurred in institutions to identify gaps in care and highlighted change.
Personalized Posters: Choose a variety of images to design unique office posters.
Health advisors: Pack Health provided patients personalized health coaching.
The combination of advanced technology, diverse partnerships, and variety of educational channels ensures a robust delivery and distribution network. CME can advance the conversion of knowledge into practice while also having a visible impact on HCP-patient dialogue. THRIVE outcomes demonstrate how CME creates space for collaboration and partnership among HCPs, patients, and support groups.

Disclosure
C. Hosmer-Gallo: None. L.K. Welch: None. B. Hefele: None.

Funding
Novo Nordisk
716-P: Addressing Barriers to Diabetes Education and Care in Low Socioeconomic Latinos in Georgia
Authors: SONYA HAW J. , FLORES INA CECILIA , PORRAS FIMBRES DENISSE CRISTINA , ROTBERG BRITT , MIGDAL ALEXANDRA , WANG HEQIONG , PASQUEL FRANCISCO J. , UMPIERREZ GUILLERMO E. 
Published: June 2019

Latinos have higher rates of type 2 diabetes, worse glycemic control, and higher rates of diabetic complications than other ethnic groups. The Emory Latino Diabetes Education Program (ELDEP) is a non-profit DSME program that provides free Spanish diabetes education and lifestyle intervention for Latinos with diabetes in Georgia. We present our experience with ELDEP and describe barriers to diabetes care.
Results: A total of 1680 patients attended our program between 2006 and 2018. All subjects were foreign-born and most came from Mexico (71%). Their average age was 48±12 years, female: 63%, BMI: 31±7 kg/m2, 26% with more than 10 years of DM and the majority were not treated with medications (58%). A total of 297 (17.7%) patients returned for at least one follow-up class within 6 months. Most patients who returned were female (67%). The mean HbA1c at presentation was 8.9±2.6%, 7.7±2.0% at 3 months, and 7.4±1.3% at 6 months of follow-up. Compared to women, men had a larger reduction in HbA1c from baseline -1.6±3.0% vs. -0.9±2.1% at 3 months and -2.4±2.9% vs. -1.2±1.8% at 6 months follow-up (p=0.07). Major barriers to care identified: i) low literacy: 36% of patients did not read or write Spanish; ii) poor language proficiency: 87% did not speak, read, or write English; iii) low education level: 19% high school, and 6% college education; iv) low health insurance coverage: 76% had no health insurance, 9% had Medicare or Medicaid, and 8% had private insurance; v) financial: 63% have annual household income &lt; $20,000 and most had severe financial limitations in buying prescribed diabetes regimen; vi) 41% had food insecurity and 47% consumed less than the recommended vegetable intake; and vii) 94% had a low level of acculturation.
Conclusions: Our results identify important cultural and socio-economic challenges to diabetes care faced by Latinos in Georgia. The ELDEP is a successful and easy-to-implement education model that addresses some of these challenges to improve diabetes care in the underserved Latino population.

Disclosure
J. Haw: None. I.C. Flores: None. D. Porras Fimbres: None. B. Rotberg: Employee; Self; Insulet Corporation, Novo Nordisk A/S. A. Migdal: None. H. Wang: None. F.J. Pasquel: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck & Co., Inc. G.E. Umpierrez: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc. Research Support; Self; AstraZeneca, Merck & Co., Inc., Novo Nordisk Inc., Sanofi US.

Funding
Sanofi
72-OR: Clinical Burden and Impact of New-Onset Diabetic Foot Ulcers, Post-Simultaneous Pancreas Kidney Transplantation, and Kidney Only Transplantation
Authors: SHARMA ANGELICA , FOUNTOULAKIS NIKOLAOS , VAS PRASH R. , KARALLIEDDE JANAKA 
Published: June 2019

Background: Patients with diabetes and renal dysfunction are at risk of diabetic foot ulcers (DFU). Whether this risk is modified post simultaneous pancreas-kidney (SPK) or kidney only (KO) transplant is unknown.
Aims: We evaluated the incidence of new onset DFU post SPK and KO transplant performed between 2004 and 2014 in 234 patients with diabetic kidney disease.
Methods: In total 90 (51% male) SPK patients and 144 KO (66% male, 26% type 1 DM) were evaluated in a single centre retrospective study. Median (range) follow-up was 6 (3 to 13) years for both cohorts.
Results: We observed that 16 (17%) of SPK and 22 (15%) KO patients respectively developed a new DFU during follow-up. Nearly 60% of new onset DFU presented within 500 days post SPK transplant. In KO cohort more than 50% of DFU presented within 1000 days post kidney transplant. In both cohorts a history of peripheral vascular disease (PVD) [37.5% vs. 4%] and pre-transplant history of DFU were associated with post transplant DFU p&lt;0.05. In KO cohort, patients who developed a DFU were more likely to have T1DM than T2DM (29% vs. 10%), and had higher pre-transplant HbA1c, (mean ± standard deviation [7.5 ±1.2% vs. 6.8±1.4%, p&lt;0.05]). There was no impact of DFU on SPK transplant failure. In contrast patients with DFU post KO transplant had more than five fold increased hazard ratio (HR) of transplant failure as compared to those without DFU independent of other risk factors [HR 5.19 95% CI (2.05 to 13.18) p=0.001].
Conclusion: There is a residual high burden of new onset DFU post KO or SPK transplantation. Our results highlight the need for greater awareness of regular foot examination, DFU prevention and risk evaluation in post-transplant patients.

Disclosure
A. Sharma: None. N. Fountoulakis: None. P.R. Vas: Other Relationship; Self; Sanofi-Aventis. J. Karalliedde: Research Support; Self; AstraZeneca, Sanofi. Speaker's Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, NAPP Pharmaceuticals Limited.
720-P: Exercise Training Causes Vast Changes in the Circulating Factor Profile of Human Subjects
Authors: MIDDELBEEK ROELAND , RICHARD JEFFREY J. , ROWLAND LESLIE A. , NIGRO PASQUALE , PAN HUI , DREYFUSS JONATHAN , GOODYEAR LAURIE J. 
Published: June 2019

Exercise training induces adaptations to the body that improve metabolic health; however, the molecular mechanisms mediating these beneficial adaptations to training are not well characterized. We hypothesized that exercise training causes adaptations to multiple tissues (e.g., muscle, adipose) that lead to altered secretion of factors from these tissues into the circulation, and that these circulating factors may contribute to the effects of exercise training on metabolic health. To identify novel exercise training-stimulated circulating factors, healthy subjects (n=8, 3 males and 5 females; age=27.0 ± 2.2 years; BMI=21.9 ± 0.9 kg/m2; V?O2peak=28.4 ± 1.2 ml/kg/minute) underwent 10-weeks of aerobic exercise training. Training increased V?O2peak by 17% (p=&lt;0.003). Fasting blood samples were collected pre- and post-training, and 1,310 circulating factors were measured in plasma using aptamer-based proteomics. Remarkably, exercise training significantly altered 293 (22%) of all circulating factors. 164 proteins were increased and 129 proteins were decreased; the majority of which have not been previously identified as exercise training-induced factors. Change in V?O2peak most significantly correlated with baseline levels of Mesothelin (p&lt;0.001, R=0.53), a cell-surface protein that may regulate Insulin-like Growth Factor transport. Change in V?O2peak was also highly correlated with Protein Kinase C Zeta (p=0.005, R=0.3), a kinase involved in AKT3-PI3K signaling and adipocyte glucose transport. Pathway analysis revealed downregulation of the lysosomal pathway, and upregulation of pathways including FC Epsilon Ri signaling, Mtor signaling and WNT signaling, suggesting that exercise training adaptations involve multiple processes, including cellular growth, proliferation and protein degradation. These data define proteomic adaptations to exercise training, and identify biological processes that may mediate the beneficial effects of exercise training in humans.

Disclosure
R. Middelbeek: None. J.J. Richard: None. L.A. Rowland: None. P. Nigro: None. H. Pan: None. J. Dreyfuss: None. L.J. Goodyear: None.

Funding
National Institutes of Health (R01DK099511 to L.J.G.), (K23DK114550 to R.M.); Joslin Diabetes Center (5P30DK36836); Daiichi Sankyo (to L.J.G.); Boston Area Diabetes Endocrinology Research Center (to R.M.)
722-P: Maternal Exercise Improves Metabolic Health of Grand-Offspring
Authors: WAGNER ANA B.A. , KUSUYAMA JOJI , NIGRO PASQUALE , HIRSHMAN MICHAEL F. , GOODYEAR LAURIE J. 
Published: June 2019

Maternal environments are critical factors in determining risk for obesity and diabetes in both first generation (F1) and second generation (F2) offspring. Maternal exercise in mice has been shown to improve metabolic health in F1, including prevention of the detrimental effects of maternal high-fat feeding on F1 offspring. Whether the beneficial effects of maternal exercise can be transmitted to the F2 generation (grand-offspring) is not known. To test this, C57BL/6 females were fed a chow or high fat diet (60% fat) and grouped by housing in cages with (Exercise Trained) or without (Sedentary) running wheels for 2 weeks before breeding (7.04±0.5 km/day) and during gestation (2.2±0.3 km/day). Females were bred with chow-fed, sedentary males. F1 offspring were sedentary and chow-fed. At 8 weeks of age, two male mice (F1) from each litter (selected based on average body weight of the litter), were bred with age-matched female mice from untreated parents. Thus, four groups of F2 offspring resulted based on grand-maternal treatment: sedentary and chow-fed; sedentary and high fat-fed; trained and chow-fed; trained and high fat-fed (n=5-10 litters/group). F2 offspring were sedentary and chow-fed post-weaning. Unexpectedly, there was no effect of grand-maternal high fat diet on F2 glucose tolerance at any age. There was also no effect of grand-maternal exercise on glucose tolerance in offspring at 16 or 24 weeks of age. However, grand-maternal exercise resulted in a tendency for improvement in glucose tolerance in 36-week-old offspring (P=0.07), and a significant improvement at 52 weeks (males: P=0.03; females: P=0.0001). Male and female body weights were not different among F2 groups. F2 offspring from exercise-trained grand-mothers had decreased % fat mass (males: P=0.04; females: P=0.05) and increased % lean mass in males (P=0.04), with a tendency to increase in females (P=0.06) at 52 weeks of age.
In conclusion, grand-maternal exercise training has beneficial effects in the metabolic health of adult male and female F2 offspring.

Disclosure
A.B.A. Wagner: None. J. Kusuyama: None. P. Nigro: None. M.F. Hirshman: Stock/Shareholder; Self; Abbott Laboratories, AbbVie Inc., Amgen Inc., Colgate-Palmolive Company, Medtronic. L.J. Goodyear: None.

Funding
American Diabetes Association (1-17-PMF-009 to A.B.A.W.); National Institutes of Health (R01DK101043)
73-LB: Improvements in Sleep Quality after Cognitive Behavioral Therapy for Insomnia Are Associated with Improved 2-Hour Post-Load Glucose
Authors: LEBLANC ERIN S. , SMITH NING , ALLISON MICHAEL , CLARKE GREG 
Published: June 2019

Poor-quality sleep may be a possible modifiable risk factor in the development of T2DM. We conducted a pilot clinical trial (N=17) to examine the effects of insomnia treatment on insulin resistance in persons with prediabetes. Participants received up to 7 sessions of cognitive behavioral therapy for insomnia (CBT-I), a highly effective, first-line treatment for insomnia. Before and after CBT-I, participants underwent 75-gram oral glucose load test and wore wrist Actiwatches (ActiGraph GT9X Link) to measure sleep indices. Actigraphy data were collected, including wake after sleep onset (WASO; length of periods of wakefulness after sleep onset) and sleep efficiency (SE; ratio of time asleep to time in bed). We calculated the correlation between change in 2-hour post-load glucose and change in WASO and SE in those who completed treatment (at least 6 sessions of CBT-I; N=13). Decreases in WASO and increases in SE after CBT-I (indicating improved sleep) were associated with decreased 2-hour post load glucose levels (see Figure). The estimated Pearson correlations indicated medium-large effect sizes per Cohen’s rule, suggesting a potential reduction in the risk of full T2DM. This small pilot study shows the need for further research on whether treatment of insomnia improves glucose tolerance.

Disclosure
E.S. LeBlanc: None. N. Smith: None. M. Allison: None. G. Clarke: None.

Funding
Kaiser Permanente