bluuebunny/crossref_metadata_2025_split huggingface dataset:
818-P: Diabetes-Specific Family Functioning and Implications for Adults with Type 2 Diabetes
Authors: MAYBERRY LINDSAY S. , GREEVY ROBERT A. , HUANG LI-CHING , ZHAO SHILIN , BERG CYNTHIA 
Published: June 2019

Family involvement affects adults’ management of T2D. Profiles of diabetes-specific family functioning across multiple interrelated dimensions can provide a more complete picture than any single measure.
We queried EMR data to send eligible outpatient adults with T2D a survey link and obtain deidentified data. Participants completed measures of diabetes-specific family functioning (collaborative coping, helpful and harmful involvement, criticism, autonomy support, effectiveness, satisfaction), diabetes distress (Problem Areas in Diabetes-5), and adherence (Adherence to Refills and Medications Scale for Diabetes). K-means clustering identified types with &gt;70% stability. We used sampling weights to correct for imbalance between participants and non-participants in regression models examining associations between type and outcomes, adjusted for sociodemographics, diabetes duration, and insulin status.
Eleven percent (495/5545) of eligible patients accessed the survey and 379 participated. Half were female, 80% were white, with median [IQR] age 59 [50, 67] years, and EMR A1c values taken -9 [-77, 34] days from the survey were 6.9% [6.2, 7.8]. Four types were identified and named: Happily Involved (high collaboration and helpful involvement, high effectiveness and satisfaction), Don’t Need ‘Em (very low collaboration and involvement, low effectiveness and high satisfaction), Feel Alone (very low involvement, effectiveness and satisfaction); and Critically Involved (very high criticism and harmful involvement, moderate effectiveness and satisfaction). Type was independently associated with diabetes distress, adherence, and A1c (all p&lt;.01). Happily Involved and Critically Involved had best and worst outcomes, respectively (all p&lt;.05).
Our empirical typology of diabetes-specific family functioning is relevant to adults’ diabetes distress, adherence, and glycemic control. Types can be used to inform intervention development, tailoring, and evaluation.

Disclosure
L.S. Mayberry: None. R.A. Greevy: None. L. Huang: None. S. Zhao: None. C. Berg: None.

Funding
National Institutes of Health (R03DK113329, K01DK106306)
82-OR: A T1D Genetic Risk Score Combined with Clinical Features and Autoantibodies Enables Accurate Diabetes Classification in a Racial/Ethnically Diverse Population: The Search for Diabetes in Youth Study
Authors: ORAM RICHARD A. , SHARP SETH A. , PIHOKER CATHERINE , FERRAT LAURIC A. , IMPERATORE GIUSEPPINA , SAYDAH SHARON , WILLIAMS ADRIENNE H. , WAGENKNECHT LYNNE E. , LAWRENCE JEAN M. , WEEDON MICHAEL N. , DAGOSTINO RALPH , HAGOPIAN WILLIAM , DIVERS JASMIN , DABELEA DANA 
Published: June 2019

Accurate classification of diabetes type guides correct treatment. We recently showed a type 1 diabetes (T1D) genetic risk score (GRS-1), combined with clinical features and biomarkers discriminates between T1D and type 2 (T2D) and MODY in European adults. We aimed to test the ability of an improved 67 SNP T1D score (GRS-2) to discriminate T1D in an ethnically diverse U.S. pediatric population.
We included 1818 SEARCH Study participants who had a C-peptide at a median (IQR) of 8 (6-9) years post diagnosis. T1D was defined based on severe insulin deficiency (fasting C-peptide &lt;0.25 ng/ml) at follow-up. We generated genetic risk scores from SNP data, and assessed discriminative power of the T1D GRS-2 using the area under the receiver operating curve (AUC) in the three largest ethnic groups in SEARCH: white (n=1101, 95% T1D), black (n=228, 59% T1D) and Hispanic (n=257, 77% T1D). We then assessed the discriminative power of GRSs combined with autoantibody and clinical data.
The T1D GRS-2 was discriminative of T1D across all three ethnic groups AUC (95% CI) for GRS-1 vs. GRS-2 was 0.88 (0.84, 0.93) vs. 0.88 (0.83, 0.92) in white, 0.82 (0.77, 0.87) vs. 0.87 (0.83, 0.92) in blacks, and 0.87 (0.82, 0.92) vs. 0.9 (0.86, 0.95) in Hispanics). Combined risk scores were most accurate at classifying T1D. AUC for different scores were: 0.93 (0.91, 0.95) for type assigned by provider at diagnosis, 0.95 (0.93, 0.96) for age and BMI, 0.95 (0.94, 0.97) for GAD/IA-2/ZNT8 autoantibodies, and 0.99 (0.99, 1.00) for a combined approach using autoantibodies, GRS-2 and clinical features. These results were similar across all race/ethnic groups.
A new T1D GRS-2 is discriminative of T1D in a racial/ethnically diverse pediatric population. Using GRS2 in a combined model of clinical features, autoantibodies and genetics offers near perfect classification of T1D and could be used to accurately classify diabetes type.

Disclosure
R.A. Oram: Other Relationship; Self; Randox Laboratories Ltd. S.A. Sharp: None. C. Pihoker: None. L.A. Ferrat: None. G. Imperatore: None. S. Saydah: None. A.H. Williams: None. L.E. Wagenknecht: None. J.M. Lawrence: None. M.N. Weedon: None. R. Dagostino: Consultant; Self; Acelity, Amgen Inc. W. Hagopian: Research Support; Self; Novo Nordisk A/S. J. Divers: None. D. Dabelea: None.

Funding
National Institutes of Health (UC4DK108173)
823-P: Characteristics of Type 1 Diabetes (T1D) Patients Attending a Young Adult Diabetes Clinic (YADC) as a Component of Transition from Pediatric to Adult Diabetes Care
Authors: JOARDER FARAHNAZ , NAGRA HARPREET , ROCHA LOLIS , ANDREAS LAURA , GUTTMANN-BAUMAN INES , AHMANN ANDREW J. 
Published: June 2019

Objectives: Transition age patients with T1D age 17 to 25 are at high risk of acute and chronic complications and poor glycemic control. Surveys of youth with T1D transitioning to adult care indicate they desire a formal transition process, orientation and introduction to an adult provider team. To address the needs of young adults with T1D, the YADC was created at the Harold Schnitzer Diabetes Health Center (HSDHC).
Methods: The YADC is a comprehensive half day clinic which includes group orientation with peers, behavioral health screening, diabetes education assessment and a medical provider visit. Youth referred for an appointment are given the option to schedule into the YADC. The YADC is part of the larger program Movin’ Up Movin’ On for transition age youth with T1D at the HSDHC.
Results: Thirty-four of 129 referred patients attended the YADC between November 2017 and December 2018. Half transferred care internally from pediatric to adult providers. Patients were predominantly from an urban area. Thirty eight percent had state medical insurance; 62% had commercial insurance. Mean a1c was 9.1. Five of 22 patients with available microalbumin levels screened positive for microalbuminuria. No patients reported retinopathy. Seventeen of 34 patients experienced inpatient admission or an ED visit between 2016 and 2018. Six patients had DKA in the year prior to their clinic visit. Greater than half the patients (20 of 34) had history of depression, anxiety or substance abuse listed in their medical record.
Conclusions: Transition of pediatric to adult care is associated with high risk for acute and chronic complications. This data illustrates the high-risk nature of the YADC attendees and highlights in particular the predominance of behavioral health challenges in this group.

Disclosure
F. Joarder: None. H. Nagra: None. L. Rocha: None. L. Andreas: None. I. Guttmann-Bauman: None. A.J. Ahmann: Advisory Panel; Self; Eli Lilly and Company, MannKind Corporation, Novo Nordisk Inc., Sanofi-Aventis. Consultant; Self; Dexcom, Inc. Research Support; Self; Dexcom, Inc., Medtronic.
825-P: Depressive Symptoms Are Associated with Lower Diabetes Self-Management in Adults with Type 1 Diabetes
Authors: CRISTY R GENO RASMUSSEN , DRISCOLL KIMBERLY A. , SIPPL RACHEL M. , ALMAN AMY C. , KESHAWARZ AMENA , SNELL-BERGEON JANET K. 
Published: June 2019

Depression is increased in people with type 1 diabetes (T1D), and may lead to poor disease self-management and suboptimal glycemic control. Depressive symptoms were assessed in adults with and without longstanding T1D (mean±SD T1D duration 38±8.6 years).
A total of 414 participants with T1D (mean±SD age 51±9 years) and 488 participants without T1D (mean±SD age 55±9 years) completed the Beck Depression Inventory II (BDI-II) and the Diabetes Self-Management Questionnaire (DSMQ).
BDI-II scores were significantly higher in people with T1D (mean±SD 5.4±5.6%) than in those without T1D (3.8±4.7, p&lt;0.0001). In age-adjusted linear regression models, BDI-II scores were higher in participants with T1D vs. those without T1D in both men (LSmean±SE 5.3±0.4 vs. 3.1±0.3, p&lt;0.001) and women (5.6±0.4 vs. 4.4±0.3, p=0.018). Depressive symptoms were higher in women compared to men among participants without T1D (p=0.01), but not among adults with T1D (p=0.56). Among participants with T1D, 9.7% of women and 10.4% of men (p=0.81) reported clinically elevated symptoms of depression (&gt;13), whereas 7.1% of women and 1.7% of men without T1D reported clinically elevated symptoms of depression (p=0.004). Among participants with T1D, a higher BDI-II score was significantly correlated to HbA1c (r=0.21, p=0.0005). In age, sex, and T1D duration adjusted linear regression models, BDI-II scores &gt;13 were associated with significantly lower total scores on the DSMQ (p&lt;0.0001), and on the DSMQ subscales for Glucose Management (p=0.0005), Dietary Control (p=0.002), and Physical Activity (p=0.006) but not Health Care Use (p=0.73). There were no differences in these associations by sex.
Our data demonstrate elevated levels of depressive symptoms in adults with T1D, particularly men, which were associated with lower self-management behaviors. Interventions are needed to address the role of depression on glycemic control and behaviors around glucose management, diet and physical activity in adults.

Disclosure
C.R. Geno Rasmussen: None. K.A. Driscoll: None. R.M. Sippl: None. A.C. Alman: None. A. Keshawarz: None. J.K. Snell-Bergeon: None.

Funding
American Diabetes Association (7-13-CD-10 to J.K.S-B.); National Heart, Lung, and Blood Institute; JDRF International
83-LB: Missed Insulin Bolus Doses Are Associated with Hypoglycemic Fear
Authors: EDWARDS STEPHANIE S. , JOHNSON JENNAL , HOWARD WOLPERT , HE XUANYAO , KAO CHRISTI Y. , MEADOWS ERIC , POON JIAT LING , PRICE DAVID A. , POLONSKY WILLIAM 
Published: June 2019

When people with diabetes (PwD) are introduced to real-time continuous glucose monitoring (rtCGM), they may still struggle to meet glycemic targets, as highlighted by the T1D Exchange. We assessed missed bolus doses (MBD) in relation to psychosocial factors and rtCGM use in PwD using insulin. This 12-week, single-arm, observational study enrolled PwD who reported A1C ≥8% and taking ≥3 insulin boluses/day. We administered the Adult Low Blood Sugar Survey short form (ALBSS), which evaluates hypoglycemic fear at baseline. Data from a connected insulin pen and CGM (1st 6 weeks blinded, 2nd 6 weeks rtCGM) were used to calculate MBD as defined by an 80 mg/dL glucose increase over ≤2 hours not preceded within 1 hour by an insulin dose. A mixed-effect model for repeated measures tested the association of MBD with ALBSS. Logistic regression assessed the relationship of MBD change (blinded to rtCGM) with ALBSS. Covariates in both models were baseline A1C (≤ or &gt;9%), diabetes type and duration, sex, ethnicity, age, and BMI. Participants (N=68), mean age 48 (range 22-65 years), were 44% female, 18% Hispanic, 59% T1D. The mean ALBSS score was 13.7 (range 0-34). In the blinded period, a mean of 0.94±0.39 MBD/day were calculated, which reduced in rtCGM (0.85±0.37 MBD/day, p=0.05). For blinded and rtCGM, more frequent MBD were independently associated with greater hypoglycemic fear (ALBSS, p=0.04) and higher baseline A1C (p=0.001). Participants with greater hypoglycemic fear were more likely to miss more bolus doses even after switching to rtCGM (odds ratio 1.1, p=0.045). MBD were relatively common in PwD using multiple daily injections who had not achieved adequate glycemic control. Hypoglycemic fear was associated with more MBD, even following the introduction of rtCGM. Therefore, when managing PwD using bolus insulin, clinicians should address fear of hypoglycemia as a potential barrier to appropriate dosing. As shown in this exploratory study, without attention to psychosocial factors, technology may not contribute to improved self-care.

Disclosure
S.S. Edwards: Employee; Self; Eli Lilly and Company. J. Johnson: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. H. Wolpert: Employee; Self; Eli Lilly and Company. X. He: Employee; Self; Eli Lilly and Company. C.Y. Kao: None. E. Meadows: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J. Poon: Employee; Self; Eli Lilly and Company. D.A. Price: Employee; Self; Dexcom, Inc. Stock/Shareholder; Self; Johnson & Johnson. W. Polonsky: Consultant; Self; Abbott, Bigfoot Biomedical, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Johnson & Johnson Diabetes Institute, Merck & Co., Inc., Novo Nordisk Inc., Sanofi, Servier.
830-P: Influence of Social Circumstances on Maintenance of Body Weight and Incident Type 2 Diabetes: Analyses from the Diabetes Prevention Program
Authors: NIELSEN JANNIE , ALI MOHAMMED K. 
Published: June 2019

The impact of social and environmental circumstances on success in an intensive behavioral intervention to lose weight and reduce risk of type 2 diabetes is unknown. We examined the association of social and environmental circumstances such as provisions of social relations and support, home and work environment, and adverse life events on weight loss and diabetes incidence in the Diabetes Prevention Program (DPP) randomized controlled trial.
We included data on 650 female and 319 male adults from the DPP lifestyle intervention group with information on social circumstances and body weight at baseline and follow-up after 6 months (24 weeks of lifestyle intervention), 1, and 2 years. We applied Cox proportional hazards model to obtain hazard ratios (HRs), with social circumstances as the exposures and body weight gain (&gt;7%) or development of diabetes as outcome, adjusting for baseline age, sex, marital status, and number of individuals in the home of the participant.
Life style intervention participants who experienced events or changes at work during the DPP trial had a 44% higher risk of developing diabetes [HRR=1.44, 95% CI:1.02;2.04] as compared to lifestyle intervention participants who did not have such experiences at work. Adjustment of body weight gain after the intervention period explained a small component of this risk: 1.38 [95% CI:0.94;2.03]. Negative changes in the home environment [HRR=1.09, 95% CI:0.76;1.56], low provision of social relations [HRR=1.15, 95% CI:0.81;1.65] or adverse life events [HRR=1.14, 95% CI:0.81;1.62] did not increase the HR of developing diabetes. Social circumstances were not associated with &gt;7% body weight increase between the end of the intervention period and 1 or year 2.
Thus, our results suggest that work changes and stresses may worsen the possibility of lowering diabetes risk through intensive lifestyle interventions.

Disclosure
J. NIelsen: None. M.K. Ali: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases; General Clinical Research Center; Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute on Aging; Office of Research on Women's Health; Office of Research on Minority Health; Centers for Disease Control and Prevention
832-P: Diabetes and Doom: Lay Perceptions of Diabetes Stratified by Biometrics in Latinos with Type 2 Diabetes
Authors: GLANTZ NAMINO M. , LAREZ ARIANNA J. , MORALES JESSIKAH , HOPPE CHARIS B. , BEVIER WENDY C. , CONNEELY MARY M. , ALATORRE CARLOS , PACZKOWSKI ROSIRENE , KERR DAVID 
Published: June 2019

Latinos/Hispanics comprise 18% of the U.S. population and have the highest proportion of type 2 diabetes of any racial/ethnic group. Research tends to split quantitative clinical data from qualitative explanatory models of diabetes. In contrast, Mil Familias, a 10-year 1000-family research initiative, combined these two research methods. Trained community health workers asked, “In your own words, what is diabetes?” of 107 Latino adults (54 ± 12 years old, 65% female, 36% on insulin) with self-reported type 2 diabetes in Santa Barbara and measured their biometrics, including HbA1c, insulin use, mental health, and weight. Thematic analysis of participants’ definition of diabetes by 2 independent raters yielded 5 categories based on participant-reported terms: controllable (controlable), sugar (azúcar), body malfunction (cuerpo), illness (enfermedad), doom/death (muerte). To probe the theory that participants who related diabetes with doom (e.g., "silent assassin,” "worst that could happen”) had poorer health than those who did not cite doom, participants were stratified by doom mention and their biometrics (Table). While no pattern between doom and health emerged, the exercise enabled examination of culturally-relevant interactions between traditional biometric outcomes and qualitative perceptions of diabetes (e.g., fatalism) in U.S. Latino adults.

Disclosure
N.M. Glantz: Research Support; Self; Eli Lilly and Company. A.J. Larez: Research Support; Self; Eli Lilly and Company. J. Morales: Research Support; Self; Eli Lilly and Company. C.B. Hoppe: Research Support; Self; Eli Lilly and Company. W.C. Bevier: Research Support; Self; Eli Lilly and Company. M.M. Conneely: Research Support; Self; Eli Lilly and Company. C. Alatorre: Employee; Self; Eli Lilly and Company. R. Paczkowski: Employee; Self; Eli Lilly and Company. D. Kerr: Advisory Panel; Self; Ascensia Diabetes Care, Novo Nordisk A/S, Sanofi. Research Support; Self; Lilly Diabetes. Stock/Shareholder; Self; Glooko, Inc.

Funding
Eli Lilly and Company
836-P: Cannabis Use in Adults with Type 1 Diabetes (T1D) Is Associated with Poor Glycemic Control and Increased Risk for Diabetic Ketoacidosis (DKA)
Authors: SHAH VIRAL N. , TAYLOR DANIEL D. , FOSTER NICOLE C. , BECK ROY , AKTURK HALIS K. , KINNEY GREGORY L. 
Published: June 2019

Cannabis has been legalized for medical or recreational use in 33 states and usage is increasing in adults. A prior study from Colorado showed a two-fold increased DKA risk among adults with T1D using cannabis. This study was aimed to evaluate glycemic control and DKA risk among adults with T1D who use cannabis from the T1D Exchange Clinic Registry (T1DX). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) questionnaire was emailed to 4311 adults at 69 T1DX clinic registry centers. Total Substance Score (TSC) for cannabis was used to classify adults with T1D requiring no intervention (TSC score 0-3), a brief intervention (TSC 4-26), and more intensive intervention (&gt;26). A total of 932 adults with T1D completed the survey (61% female, 90% non-Hispanic white, mean age 38±16 years). The prevalence of cannabis use was 17.8%; prevalence was higher in states where cannabis is legal. Compared to participants categorized as ‘no intervention’ (n=871), cannabis users ‘brief intervention’ (n=61) were younger, had a younger age at T1D diagnosis, had higher A1c, and had similar use of insulin pumps and CGMs. Cannabis use (TSC &gt;4) was associated with increased DKA risk (OR 2.5, 1.0-5.9) after adjusting for age, sex and A1c [Figure]. With the growing use of cannabis among adults with T1D, physicians should be aware of an association between cannabis use and a risk for DKA.

Disclosure
V.N. Shah: Advisory Panel; Self; Sanofi US. Consultant; Self; Dexcom, Inc. D.D. Taylor: None. N.C. Foster: None. R. Beck: Other Relationship; Self; Abbott Laboratories, Ascensia Diabetes Care, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Lilly Diabetes, Roche Diabetes Care, Tandem Diabetes Care. H.K. Akturk: Advisory Panel; Self; Sanofi. Research Support; Self; Eli Lilly and Company, MannKind Corporation, REMD Biotherapeutics. Speaker's Bureau; Self; MannKind Corporation. G.L. Kinney: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
837-P: Diabetes Support Needs in People with Severe Mental Illness and Diabetes
Authors: STENOV VIBEKE , WILLAING INGRID , KNUDSEN LENETTE , HANSEN DORTE L. , JOENSEN LENE E. 
Published: June 2019

Background: People with severe mental illness (SMI) have a two to three-fold higher risk of developing diabetes. Mental healthcare providers have an important role in supporting people with SMI in diabetes management, but little is known about preferences for diabetes support among people with SMI and diabetes. The aim of the study was to explore the needs and preferences for diabetes support in this population.
Method: Semi-structured interviews were conducted with 15 adults with SMI and diabetes recruited from four psychiatric outpatient clinics in Denmark. Interviews were transcribed and analyzed using systematic text condensation.
Results: Participants’ mean age was 47 years, 40% were women, and 80% had T2DM. Mental health diagnoses included schizophrenia, bipolar disorder, severe depression, and personality disorder. Four main themes emerged in relation to support needs and preferences: 1) mental illness care significantly overshadowed diabetes care. It was difficult for people with SMI to prioritize diabetes management; 2) emotional state influenced diabetes management e.g., anxiety was linked to higher fat and sugar intake, and isolation lead to physical inactivity; 3) daily routines were experienced as difficult making diabetes routines even harder to perform, e.g., planning and preparing healthy meals and participating in routine diabetes health visits; 4) support from mental healthcare providers was perceived as crucial for managing diabetes for people with SMI. However, people with SMI experienced that the healthcare providers payed little attention to their physical health including their diabetes.
Conclusions: This study highlights difficulties of living with SMI and managing diabetes care. The results can facilitate the shaping of tailored interventions to support people with SMI in their diabetes management. Further studies are needed to develop and test relevant diabetes support for people with SMI and diabetes including training of mental healthcare providers.

Disclosure
V. Stenov: None. I. Willaing: None. L. Knudsen: None. D.L. Hansen: None. L.E. Joensen: None.