bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing Perceptions of Concerns Regarding Complications Including Reproductive Health (RH) in Male and Female Adolescents and Young Adults (AYA) with TID
Authors: FISCHL ANDREA F.R. , CHARRON-PROCHOWNIK DENISE , SEREIKA SUSAN M. , ROFEY DANA L. , BECKER DOROTHY J. , FINNEY JESSICA , DIAZ ANA M. , LIBMAN INGRID 
Published: June 2018

Tight glycemic control decreases risks of complications. Male and female AYA with T1D are vulnerable to poor glycemic control resulting in retinopathy (RET), neuropathy, nephropathy, high blood pressure (HBP), and RH complications. About half of males with T1D report RH complications (e.g., erectile dysfunction) as early as 25 years and up to 10% of women with T1D have pregnancy-related complications; however, these topics are rarely discussed.
Purpose: To describe and compare concerns of diabetes-related complications, including adverse RH outcomes among male and female AYA with T1D.
Methods: A diabetes transition care program for AYA with T1D at an academic children’s hospital provides care and small group discussion-education sessions on relevant topics (e.g., RH with diabetes, complications/prevention, risk behavior, self-care). Participants were given a survey prior to the program to gauge perceptions on T1D complications. Both female (n=19) and male (n=23) participants (aged 17-22 years) ranked concerns for complications from 1 (most) to 5 (least). Mann-Whitney U-tests were used to compare genders on complication rankings.
Results: RET was the greatest concern for both females (n=7; 37%) and males (n=10; 44%). The second most frequently reported concern was RH for females (n=5; 26%) and HBP for males (n=5; 22%). The most frequently reported “least” concerning complication was RH for males (n=9; 39%) and HBP for females (n=11; 58%). A significant difference between genders was HBP (p=.02), where males tended to report greater concern.
Conclusion: Retinopathy was an overall major concern. Gender differences in concerns were found for only HBP. No males ranked RH complications as a major concern. It is imperative to raise awareness and discuss concerns during adolescence. Initiating discussions with health professionals can empower AYA with T1D to maintain healthy lifestyles and prevent complications including RH.

Disclosure
A.F.R. Fischl: None. D. Charron-Prochownik: None. S.M. Sereika: None. D.L. Rofey: None. D.J. Becker: None. J. Finney: None. A.M. Diaz: None. I. Libman: Consultant; Self; Novo Nordisk A/S.
Greater HbA1c Lowering with Tethered vs. Small Insulin Pumps in a Large UK Insulin Pump Service
Authors: DE SOYSA SHANI D. , GREY JOANNA , DAVENPORT KATY H. , GURNELL ELEANOR M. , HARTNELL SARA , EVANS MARK 
Published: June 2018

Aim: To examine the impact of different types of insulin pumps (CSII) on HbA1c lowering control in a large UK type 1 diabetes practice.
Methods: Observational retrospective study of electronic database. We identified 597 adults (≥18 years) in our service who started on CSII between 2002 and 2017 with HbA1c data available at baseline and at 6 +/or 12 months after starting CSII. We classified by the starting pump model/manufacturer into traditional “tethered pumps” (Medtronic n=369; Roche n=79; Animas n=60) and “small pumps” (Omnipod n=79 and Cellnovo n=6). We examined change in HbA1c data (shown here in mmol/mol except where otherwise indicated) over the first year of CSII treatment.
Results: In general, CSII improved HbA1c during the first 12 months (72±0.7 to 64±0.6 and 65±0.6 mmol/mol at baseline, 6 and 12 months). Despite similar starting HbA1c, those using tethered pumps achieved a significantly lower HbA1c compared with small pump users after 6 and 12 months CSII therapy.
Conclusions: In real world data from a large pump service, we found significant differences in glycemic outcomes between different pumps. Those starting on tethered pumps had greater HbA1c lowering over first 12 months.HbA1c Outcomes for Tethered vs small PumpsPump typeInitial HbA1c range mol/mol (%)Baseline HbA1c6 months HbA1cp vs baseline12 months HbA1cp vs baselineTethered (n=509)All starting values71±0.763±0.6*&lt;0.00165±0.7*&lt;0.001Small (n=85)71±0.970±1.6NS69±1.6NSTethered (n=273)≥ 69 (85%)83±0.769±0.8**&lt;0.00171±0.9*&lt;0.001Small (n=43)83±2.377±2&lt;0.0577±2.1&lt;0.05Tethered (n=132)59-68 (7.5-8.4%)64±0.259±0.7**&lt;0.00159±0.8*&lt;0.001Small (n=28)64±0.566±1.4NS64±1.4NSData shown as mean±SEM. * p&lt;0.05, ** p&lt;0.001 for tethered vs small

Disclosure
S.D. De Soysa: None. J. Grey: None. K.H. Davenport: Advisory Panel; Self; Novo Nordisk Inc. E.M. Gurnell: Advisory Panel; Spouse/Partner; AstraZeneca, Pfizer Inc. S. Hartnell: Speaker's Bureau; Self; Medtronic, Roche Pharma. M. Evans: Advisory Panel; Self; Novo Nordisk A/S, Eli Lilly and Company, Cellnovo, Roche Pharma. Speaker's Bureau; Self; Abbott, Novo Nordisk A/S.
Evaluation of a Web-Based Tool for Parents of Teens with Type 1 Diabetes
Authors: WHITTEMORE ROBIN , COLEMAN JULIA L. , DELVY ROBERTA , KATO BERNET , AMBROSOLI JAMES A. , MAURAO MICHAEL P. , ZINCAVAGE REBEKAH , MARCEAU LISA 
Published: June 2018

Parents of teens with type 1 diabetes (T1D) report challenges in maintaining involvement with diabetes care while supporting teen autonomy. We developed a web-based tool to support parents in this transition—Type 1 Teamwork—that provides interactive content and video vignettes of real families on challenges and strategies to transition T1D care from parent to teen. The purpose of this study was to determine the reach (demographic characteristics), participation (web usage and engagement) and short-term effects (parenting stress, perceived stress, parental support for teen autonomy, family conflict, teen A1C) of Type 1 Teamwork. Parents of teens with T1D (11-16 years) were randomized to Type 1 Teamwork (n=81) or a control group (n=81). Parents were 45.6 (±5.3) years of age, 98% female, 91% white, 91% married/partnered, 51% high income, 36% with elevated depressive symptoms, and 40% with elevated anxiety symptoms. Teens had a mean A1C of 7.9 (±1.2), T1D duration of 5.(±3.62) years, with 75% using a pump, 69% using a CGM, and 39% reporting 20 or more episodes of hypoglycemia in the previous 3 months. There were no significant differences between groups on baseline characteristics. Eighty-two percent (n=133) of participants completed 3-month data collection. Parents in the Type 1 Teamwork group who did not access the tool (n=6) were excluded from the comparative analyses. Type 1 Teamwork was accessed a total of 453 times and had 6,614 total pages viewed, with an average of 15 pages and 11 minutes per visit. There was less frequent parenting emotional distress (p=.04) and trends for less family conflict (p=.14) in the Type 1 Teamwork group, with no short-term effect on perceived stress, parental support for autonomy, or teen A1C in change scores over 3 months. Ongoing usage of Type 1 Teamwork may further enhance outcomes in parents of teens with T1D, which we will evaluate at 6 months. More research is needed to engage lower income families in the use of websites to support parent-teen teamwork in T1D.

Disclosure
R. Whittemore: None. J.L. Coleman: None. R. Delvy: None. B. Kato: None. J.A. Ambrosoli: None. M.P. Maurao: None. R. Zincavage: None. L. Marceau: None.
Glycemic Factors Related to Depression in Adults with Type 1 Diabetes
Authors: EGBUONU IFEOMA , TRIEF PAULA M. , ROE CHERYL A. , WEINSTOCK RUTH S. 
Published: June 2018

Objective: To compare glycemic factors (home glucose monitoring, glucose variability, A1c) in adults with type 1 diabetes (T1D) with probable depression to those without depression in a real world setting.
Methods: Adults with T1D at our diabetes center are routinely screened for depression with the PHQ2. If the PHQ2 score is &gt;3, PHQ9 is completed. Medical records were reviewed including device downloads for adults with PHQ9 scores =10 (“depressed”) and age-matched “not depressed” controls (PHQ2 scores =3). Patients with T1D duration &lt;1 year, GFR =30 mL/min/1.73m2, hemoglobinopathy or dementia were excluded.
Results: Of 1292 adults screened, 83 (6.4%) were depressed, and compared to an age-selected group of 171 non-depressed T1D adults (age range 18-72 years, 86% white, 8% black, 99% non-Hispanic, 42% Medicaid). Depressed [mean (SD) PHQ9 score 16.8 (4.3)] did not differ from non-depressed on age [41.7 (15.6) vs. 41.8 (15.7) years], BMI [29.3 (8.8) vs. 28.9 (6.2) kg/m2], T1D duration [21.2 (13.4) vs. 22.0 (15.0) years], or % male [42.2 vs. 40.9]. Meter downloads were available for 215/254 patients (74% of depressed, 90% of non-depressed). The depressed group had higher A1c [9.6% (2.3) vs. 8.6% (1.8) p&lt;0.001], and fewer glucose tests/day [2.8 (2.3) vs. 3.6 (2.5) p=0.048] based on meter downloads. Prior work found that depression did not relate to self-reported glucose monitoring in T1D adults. The groups did not differ on meter % coefficient of variation (CV; mean 42%) or % with hypoglycemia (glucose reading &lt;54 mg/dL). Continuous glucose monitoring (CGM) was used by 38 patients; CGM % CV was also not different in those depressed [35.0 (6.2), n=5] vs. non-depressed [36.0 (6.0), n=33]. The depressed group using CGM had lower A1c, suggesting that CGM use should not be withheld in the presence of depression. The small number of patients using CGM is a limitation.
Conclusion: Adults with T1D and probable depression had higher A1c, less meter use, fewer glucose readings/day, but no difference in glucose variability (% CV) or hypoglycemia (&lt;54 mg/dL).

Disclosure
I. Egbuonu: None. P.M. Trief: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. C.A. Roe: None. R.S. Weinstock: Research Support; Self; Medtronic MiniMed, Inc., Mylan, Kowa Pharmaceuticals America, Inc., Diasome Pharmaceuticals, Inc., Calibra Medical, Dexcom, Inc., Ultradian Diagnostics LLC., JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases.
Affective Communication in Routine Diabetes Care for Adolescents and Young Adults
Authors: HOMMA KIRSTEN , COGEN FRAN R. , STREISAND RANDI , MONAGHAN MAUREEN 
Published: June 2018

High quality communication between health care providers (HCPs) and adolescents and young adults (AYAs) with type 1 diabetes (T1D) may contribute to better diabetes self-care and health outcomes. Health communication reflects both informational content and how information is conveyed, including affect and tone. The aim of this study was to assess HCP affective communication and the relationship between HCP affective communication and glycemic control in AYAs with T1D. As part of a larger study of AYA-HCP health communication, routine clinic visits for 69 AYAs with T1D (M age 17.81 years; 56.5% female) and 8 HCPs (88% female) were audiorecorded. Clinic visits were coded using the Roter Interaction Analysis System (RIAS), a validated coding structure assessing verbal and non-verbal exchanges in a medical encounter. HCP global affective ratings were used to create two composite variables—positive HCP affect (e.g., attentiveness; respectfulness; Cronbach’s a = 0.82) and negative HCP affect (e.g., anger; dominance; Cronbach’s a = 0.75). Hemoglobin A1c (A1c) was taken from the medical chart. The mean A1c was 8.97% (±2.30). Descriptive analyses of positive and negative HCP affect indicated that HCPs expressed a high level of positive affect (M = 4.21) and a relatively low level of negative affect (M = 2.80). Negative affect was positively associated with HbA1c. After controlling for salient covariates (e.g., HCP, race, regimen), A1c accounted for a significant portion of the variance in negative affect during the clinic visit (Adj R2 = .36, ß = 0.57, p &lt; 0.001). This sample of HCPs predominantly exhibited positive affect during routine T1D visits. Glycemic control was not associated with positive affect, but higher A1c was associated with more negative affect. This finding suggests elevated A1c levels may elicit more negative affect in routine diabetes care. Future research should examine these associations over time, including how AYA-HCP health communication quality predicts long-term glycemic control.

Disclosure
K. Homma: None. F.R. Cogen: None. R. Streisand: None. M. Monaghan: Research Support; Self; American Diabetes Association, National Institutes of Health.
Increased Perceived Effort during Low-Intensity Exercise Linked to Type 2 Diabetes
Authors: HUEBSCHMANN AMY G. , WAHL MATTHEW , SCALZO REBECCA L. , RAFFERTY DEIRDRE , REGENSTEINER JUDITH G. 
Published: June 2018

Exercise is a cornerstone of type 2 diabetes (T2D) treatment, but most people with T2D are sedentary. We identified a novel behavioral barrier to exercise in women with T2D compared to nondiabetic women — greater effort during low intensity exercise. We hypothesized that the presence of T2D would confer greater effort for adults across a range of exercise intensities, even when controlling for fitness. As T2D decreases fitness more in women than men, we also hypothesized sex would modify this association. We analyzed secondary data from past sedentary, overweight research participants with and without T2D who were free of cardiopulmonary comorbidities. During graded exercise tests to assess fitness (VO2peak), we repeatedly measured objective effort (heart rate (HR)) and subjective effort (Borg Rating of Perceived Exertion (RPE)). We plotted the rise of RPE and HR, respectively, against increases in relative work rate (%VO2peak: VO2 at work rate divided by VO2peak) at lower intensities below anaerobic threshold (AT) and higher intensities above AT. Adults with T2D (n=57) had similar age and adiposity as those without T2D (n=55), but had lower VO2peak: 20.7± 4.5 vs. 24.5 ± 6.6 ml/kg/min (p&lt;0.05). Below AT, people with T2D had a steeper rise in RPE for each unit increase in %VO2peak than those without T2D (p=0.0029), and this finding was more pronounced in men than women (p=0.004). T2D status did not influence the association of %VO2peak and RPE above AT, or the association of HR and %VO2peak either below or above AT. People with T2D have significantly greater RPE during lower intensity exercise below AT as compared to people without T2D. This finding was not explained by fitness differences and, counter to our hypothesis, was more significant in men. We found no group differences in RPE at higher intensity exercise where physiological inputs tend to dominate behavioral predictors of effort. Future work should further characterize sex-specific mechanisms of exercise effort for people with T2D.

Disclosure
A.G. Huebschmann: Research Support; Self; Merck & Co., Inc.. M. Wahl: None. R.L. Scalzo: None. D. Rafferty: None. J.G. Regensteiner: None.
A Nurse-Led Diabetes Navigation Program for Rural Appalachian Ohio
Authors: BEVERLY ELIZABETH A. , GUSEMAN EMILY H. , COOK KARIE A. , STANDLEY MELISSA 
Published: June 2018

In the Appalachian region of rural southeastern Ohio, diabetes rates are more than double the national average (19.9% vs. 9.4%). Here, diabetes patients are more likely to have a delayed diagnosis, microvascular complications, depression, and lower empowerment. Further, nearly a third of residents are living below the poverty line and suffer from higher unemployment rates, lower educational achievement, poorer health, food insecurity, and lower access to care. Thus, strategies that complement standard diabetes care are critically important to alleviate the burden of complications, reduce health disparities, and improve quality of life. We designed the Diabetes Navigation Program to improve health outcomes and address social determinants of health by expanding access to care and enhancing care coordination via nurse navigators. To date, 47 adult patients with type 2 diabetes have completed the program (94% white, 66% female, 61±16 years old, A1C=9.0±2.7%, 12±8 years duration). At baseline, 24% of patients reported moderately severe to severe depression as measured via the PHQ-9, and 53% reported moderate to serious diabetes distress as measured via the PAID-5. Patients showed a significant improvement in A1C from baseline to 6-month follow-up (mean change: -1.2 points, t=2.23, p=0.017); however, no improvements were observed in depressive symptoms (t=1.37, p=0.199) or diabetes distress (t=1.82, p=0.098). The nurse navigator provided increased insurance coverage (59%), food stamps (50%) and emergency food boxes (16%), permanent or temporary housing (23%), diabetes education (21%), reduced hospital bills (14%), diabetes medication (14%), and emotional support (71%). These data are promising though more data are necessary to evaluate the clinical effectiveness. The next step is to design a randomized controlled trial to test the efficacy of navigation as compared to usual care. In the long term, this work has the potential to reduce health disparities and improve access to care for in Appalachian Ohio.

Disclosure
E.A. Beverly: None. E.H. Guseman: None. K.A. Cook: None. M. Standley: None.
The Relationship between Brain Volume Loss and Cognition in Subjects with T2DM
Authors: HUNT LEANNE , SELVARAJAH DINESH , TESFAYE SOLOMON , WILKINSON IAIN D. 
Published: June 2018

Aim: Mild Cognitive Impairment (MCI) is thought to be a chronic sequelae of type 2 diabetes (T2DM). Cerebral atrophy is known to be associated with cognitive decline, particularly in dementia. Cerebral tissue volumes, in areas associated with cognitive function, were examined in matched patients with T2DM subjects and early cognitive decline. The aim of this study was to compare T2DM patients with and without MCI to identify regional brain volume changes that were specific to MCI.
Method: Seventy-six age and gender matched subjects [30, T2DM+normal cognition (T2DM); 17, T2DM+MCI (T2DM/MCI) and 29, healthy volunteers (HV)] were recruited. All subjects underwent clinical and questionnaire (Addenbrooke’s Cognitive Assessment [ACE-R]) assessments and high-resolution, 3D T1-weighted Magnetic Resonance Imaging (MRI, 3T Philips Ingenia). Cerebral volumes were analysed using voxel based morphometry (VBM, FSL, Oxford).
Results: Demographic data revealed aged-matched participants between all three groups (mean age 69.3-71.5 years, ANOVA, p = 0.164). Mean age of last education was significantly lower in the T2DM/MCI group (mean±SD;15.1 ±0.9 when compared to the other groups (HV 19.3±5.6, T2DM 17.1±2.9) Kruskal-Wallis, p = 0.003. T2DM/MCI ACE-R score (mean±SD; 83±4) was significantly lower compared to other groups (HV=96±2, T2DM=94±3; ANOVA, p&lt;0.001). T2DM/MCI group had significantly lower regional cross-sectional grey matter volumes compared to HV in the left (p#x003C;0.0005) and right hippocampi (p&lt;0.05), left putamen (p&lt;0.05), caudate (p&lt;0.05) and amygdala (p&lt;0.05).
Conclusion: This study demonstrates significantly lower cortical differences in areas associated with cognition in patients with T2DM and early cognitive impairment. Further investigation of both anatomical and functional cerebral involvement is required to examine the pathological mechanisms underlying the increased cognitive impairment risk associated with T2DM.

Disclosure
L. Hunt: None. D. Selvarajah: None. S. Tesfaye: Speaker's Bureau; Self; Pfizer Inc.. Other Relationship; Self; Janssen Pharmaceuticals, Inc., Takeda Development Centre Europe Ltd.. Advisory Panel; Self; Wörwag Pharma GmbH & Co. KG. I.D. Wilkinson: None.
Real-World Effectiveness of a Digital Therapeutic in Improving Glycaemic Control in South Asians Living with Type 2 Diabetes
Authors: SOSALE ARAVIND R. , SHAIKH MAAZ , SHAH ABHISHEK , CHAWLA RAJEEV , MAKKAR BRIJ M. , KESAVADEV JOTHYDEV , JOSHI SHILPA , DESHPANDE NEETA , AGARWAL SANJAY , MAHESHWARI ANUJ , MADHU SV , SABOO BANSHI D. 
Published: June 2018

Background: Insurers in South Asia are challenged by lack of a culturally relevant and clinically effective lifestyle intervention that can be delivered at scale. This study reports results from participants of a real-world pilot using Wellthy Diabetes™ (WD), a digital therapeutic for people living with type 2 diabetes, in collaboration with an insurance provider with the aim to validate WD as a diabetes management and risk reduction tool. WD was developed in scientific collaboration with the Research Society for Study of Diabetes in India (RSSDI).
Methods: A 16-week lifestyle modification program was delivered to persons with T2DM through an Artificial Intelligence (AI) powered smartphone app. The program included behavioral modification training based on structured DSME content, developed along AADE7™ guidelines. The WD app enables users to self-report data on blood glucose, weight, meals, and physical activity and encourages logging through personalized reminders and nudges using an AI-powered digital persuasion model. Participants received real-time feedback and coaching through an AI-powered chatbot and personalized coaching from an expert diabetes coach. A1c measures were conducted at the start and end of the program. This study presents results from 102 program completers who completed follow-up A1c.
Results: The mean pre and post-intervention A1c for 102 program completers (mean age: 50.8 years and 68% males) were 8.51% (95% CI:8.23-8.79) and 8.02% (95% CI: 7.72-8.32), respectively, showing a mean post-intervention reduction of -0.49% A1c (95% CI:-0.73 - -0.25, p=0.01). Sixty percent (n=61) of participants reduced their A1c by the end of the program with a mean reduction of -1.17% A1c (95% CI: 0.75-1.60).
Conclusion: This study demonstrates Wellthy Diabetes as a clinically effective intervention for Health and Life Insurers in South Asia to improve health outcomes and reduce risk for people with type 2 diabetes through improved glycemic control.

Disclosure
A.R. Sosale: None. M. Shaikh: Employee; Self; Wellthy Therapeutics Pvt Ltd. A. Shah: Stock/Shareholder; Self; Wellthy Therapeutics.R. Chawla: None.B.M. Makkar: None. J. Kesavadev: Advisory Panel; Self; Novo Nordisk India Private Limited. Speaker's Bureau; Self; Novo Nordisk India Private Limited. Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; MSD. Speaker's Bureau; Self; MSD. Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca.S. Joshi: None.N. Deshpande: None.S. Agarwal: None.A. Maheshwari: None.S. Madhu: None.B.D. Saboo: None.