bluuebunny/crossref_metadata_2025_split huggingface dataset:
810-P: Japanese Version of the Diabetes Distress Scale: Validation and Identification of Individuals at High Risk for Diabetes-Related Distress
Authors: TAKAMI NENE , OKAZAKI KENTARO , TAKAHASHI NORIYUKI , SUEMATSU MINA , OHASHI WATARU 
Published: June 2019

Diabetes related distress (DRD) is usual for patients with type 2 diabetes (T2D), which worsens glycemic control through negative effects on well-being and self-care behaviors. Diabetes Distress Scale (DDS) is a globally-used instrument to measure DRD. The aim of this study was to validate the Japanese version of the DDS (DDS-J) and to identify the characteristics of individuals at high risk for DRD.
DDS-J was developed conceptually equivalent to the original version through an appropriate process. A cross-sectional study was conducted in 206 T2D patients (mean age 64.1 years, 62.1% male, mean duration 13.2 years, mean HbA1c 7.6%) at outpatient department of 2 hospitals in Aichi, Japan from February to May 2018. Cronbach's α and test-retest method were used to assess reliability, and factor analysis to analyze validity. The 5-item WHO Well-Being Index (WHO-5) and Patient Health Questionnaire-9 (PHQ-9) scale were adopted to evaluate the criteria-related validity.
Four factors of regimen-related distress (RD), emotional burden (EB), physician-related distress (PD), and interpersonal distress (ID) were extracted by factor analysis. This factor structure was the same as the original. The overall Cronbach's α was 0.92, while ones for RD, EB, PD, and ID were 0.86, 0.89, 0.75 and 0.82, respectively. Test-retest correlation score was 0.63. The DDS-J score showed a moderate and significant correlation with WHO-5 (r=-0.43, p&lt;0.01) and PHQ-9 (r=0.49, p&lt;0.01). To analyze the variables associated with the DDS-J score, a multiple regression analysis was performed with age, BMI, gender, HbA1c, and injection use as independent variables. HbA1c (slope 3.62, p&lt;0.01) and age (slope -0.28, p&lt;0.01) remained significantly associated with DDS-J score with an R2 of 0.22.
DDS-J showed good validity and reliability, and can be used as an effective tool to assess DRD of Japanese adult T2D patients. Those with higher HbA1c and younger age should be paid attention in terms of DRD.

Disclosure
N. Takami: None. K. Okazaki: Advisory Panel; Self; Eli Lilly and Company. Speaker's Bureau; Self; Abbott, Mitsubishi Tanabe Pharma Corporation, Sanofi. N. Takahashi: None. M. Suematsu: None. W. Ohashi: None.
812-P: High Diabetes Distress Associated with Lower Diabetes Quality of Life in College Students
Authors: BEVERLY ELIZABETH A. , GUSEMAN EMILY H. , RENNIE ROCHELLE G. , HEALY AMBER M. 
Published: June 2019

College is an exciting, challenging, and anxiety-provoking time that introduces new barriers to diabetes, such as inconsistent schedules, changes to diet and exercise routines, and social support issues. For students with diabetes, these barriers may contribute to new or existing psychosocial difficulties. The purpose of this study was to assess diabetes distress, depression, and diabetes quality of life (QoL) in a university population with type 1 diabetes (T1D). Using a descriptive, cross-sectional design, students completed the Type 1 Diabetes Distress Scale, Patient Health Questionnaire-9, Self-care Inventory-R, and Diabetes Quality of Life Scale. Linear regression analyses were conducted to assess the relationship between diabetes distress and 1) glycemic control, 2) self-care, 3) diabetes QoL. A total of 56 college students with T1D (age=21.5±5.2 years, 80.4% (n=45) female, 89.3% (n=50) white; A1C=8.2±1.6%; duration 10.3±5.4 years; BMI=25.3±4.2 kg/m2) participated in the study. Of the 56 students, 35.7% (n=20) reported high diabetes distress. The subscales with the highest distress scores included: Powerlessness (57.1%, n=32), Management Distress (50.0%, n=28), and Eating Distress (42.9%, n=24). Further, 23.2% (n=13) of T1D participants also screened positive for severe depression; Fisher’s exact tests showed severe depression was associated with high distress (p&lt;0.001). Linear regression models found high scores of diabetes distress (standardized b= 0.718, p&lt;0.001) were independently associated with lower diabetes QoL after controlling for depressive symptoms, age, and gender; this model accounted for 67% of the variation in diabetes QoL. Using the same model, diabetes distress was not associated with A1C levels or self-care. Participating students experienced high levels of diabetes distress at this university in the Midwest. Additional research is needed to establish potential causal effects of the college setting on diabetes distress levels and diabetes QoL.

Disclosure
E.A. Beverly: None. E.H. Guseman: None. R.G. Rennie: None. A.M. Healy: None.

Funding
American Osteopathic Association (1291708718)
82-LB: In the Eye of the Beholder? Communication in Couples Coping with Type 1 Diabetes
Authors: BAUCOM KATIE J.W. , HELGESON VICKI , BERG CYNTHIA 
Published: June 2019

A growing body of work highlights the need to better understand modifiable relationship processes in couples coping with chronic health conditions. The current study examines associations between couple communication during discussions about type 1 diabetes (T1D) and the relationship and psychological health outcomes of persons with T1D and their partners. Adults with T1D and their partners (N = 398 individuals [199 couples]) completed measures of relationship satisfaction and depressive symptoms. Couples then participated in an 8-min video-recorded discussion about an area of concern related to T1D. Following the discussion, persons with T1D and their partners each completed paper-and-pencil measures of communication. A team of 7 observers subsequently rated communication from the video-recordings. Paper-and-pencil and observer ratings were associated across aspects of communication. We hypothesized that (1) greater destructive communication (e.g., criticism) would be associated with poorer outcomes (i.e., lower levels of relationship satisfaction and higher levels of depressive symptoms), and (2) greater constructive communication (e.g., positivity/warmth) would be associated with superior outcomes (i.e., higher levels of relationship satisfaction and lower levels of depressive symptoms). Data were analyzed with a series of multilevel models in HLM, with both paper-and-pencil and observer measures included as predictors in each model. Consistent with hypotheses, paper-and-pencil measures of communication were generally uniquely associated with adjustment in expected directions. Contrary to hypotheses, observer ratings of communication were not uniquely associated with outcomes when modeled in concert with paper-and-pencil measures of communication. Understanding how persons with T1D and their partners perceive communication around diabetes provides a window into their individual and relationship well-being.

Disclosure
K.J.W. Baucom: None. V. Helgeson: None. C. Berg: None.

Funding
National Institutes of Health
822-P: Awareness, Knowledge, and Health Beliefs of American Indian/Alaska Native (AIAN) Girls and Their Mothers Regarding Risk Reduction of Gestational Diabetes Mellitus (GDM)
Authors: CHARRON-PROCHOWNIK DENISE , SEREIKA SUSAN M. , STOTZ SARAH A. , FISCHL ANDREA F. , O'BANION NANCY , POWELL JEFFREY , ASPAAS MELANIE L. , GOUDEAU SHARNELLA , THORKELSON SHELLEY J. , BEIRNE SANDRA , MOORE KELLY R. 
Published: June 2019

AIAN women have a higher risk for GDM and subsequently type 2 diabetes (T2D) than non-AIAN white females. We adapted a validated diabetes preconception counseling (PC) program for AIAN girls at high risk for GDM and their mothers. This paper presents preliminary baseline data, prior to the intervention, of both the girls and their mothers enrolled in an RCT to evaluate changes in GDM risk-reduction awareness, knowledge, health beliefs and behaviors after the Stopping GDM intervention. Data were collected using a dyadic model; both AIAN girls and their AIAN mothers (adult female caregiver) participated. These findings are on 27 mother (M) - daughter (D) dyads (n=54) from 2 of 4 sites (Southwestern U.S.). D (ages 12-24 years) were at risk for GDM as defined by BMI ≥85thpercentile or family history of T2D, and did not have diabetes (HbA1c &lt; 6.5%). M’s mean (±SD) age was 41.3±14.1 years and 56% (n=15) had at least some college education; D’s mean age was 16.3±2.9 years and 89% were students. M and D completed online questionnaires separately on awareness, knowledge and health beliefs regarding GDM and reproductive health and healthy lifestyle. One open-ended question on awareness of GDM revealed that participants were unaware of GDM or the daughters’ risks. Mean pre-intervention knowledge scores were low for both M and D on diabetes prevention (M: 76.4+14.3, range=54-100%; D: 58.2+12.4, range=27-82%) and reproductive health and GDM knowledge (M: 67.2+11.2, range=46-85%; D: 35.0+18.3, range=0-62%). D had moderate levels of self-efficacy for healthy living (53.2±14.6) and pregnancy planning (86.4±22.6). Most Ds reported no communication with healthcare professionals (HCP) or their Ms regarding GDM or PC [(with HCP=15%; 8%, respectively), (with M= 15%; 4%,)]. Both AIAN mothers and daughters lacked awareness and knowledge of the girl’s risk for developing GDM. Developing culturally relevant PC programs could help decrease these risks.

Disclosure
D. Charron-Prochownik: None. S.M. Sereika: None. S.A. Stotz: None. A.F. Fischl: None. N. O'Banion: None. J. Powell: None. M.L. Aspaas: None. S. Goudeau: None. S.J. Thorkelson: None. S. Beirne: None. K.R. Moore: None.

Funding
National Institute of Nursing Research (1R01NR014831-01A1)
828-P: The Impact of Diabetes and Depression Status on Weight Loss Outcomes in Mexican Patients with Severe Obesity
Authors: FLORES MARCELA RODRIGUEZ , STEPHANO Z. SYLVANA , RABASA MARÍA , MONTOYA JUANA , VELEZ CLAUDIA , GARCIA EDUARDO 
Published: June 2019

Background: There is a well-known association between type 2 diabetes (T2DM) and depression, including inferior outcomes in weight loss treatments. However, obesity guidelines do not address psychiatric interventions during such programs.
Objective: We assessed the impact of T2DM in outcomes (weight loss, psychiatric diagnoses and quality of life) of a six-month public obesity program that incorporated a psychiatric intervention for patients with severe obesity.
Methods: Retrospective analysis of the registry of the behavioral obesity program at Instituto Nacional de Ciencias Médicas y Nutrición in Mexico City after implementation of a psychiatric intervention that includes diagnosis by a single psychiatrist with the DSMV criteria, psychoeducation, psychopharmacological prescription and/or psychotherapy accordingly. We determined weight loss, frequency of psychiatric diagnoses (depression, anxiety, binge eating disorder [BED]), and quality of life according with T2DM diagnosis.
Results: We included 329 subjects (66% women aged 43.7±12.2 years, initial BMI of 44.2±9.6 kg/m2). The frequency of psychiatric diagnoses in patients with and without T2DM was: Depression 43% and 32% (p=0.05), anxiety 25% and 24% (p=0.42), and BED 32% and 32% (p=0.50). Baseline quality of life (QoL) was lower in patients with T2DM than in those without it (p&lt;0.001), and both were prescribed a pharmacological treatment similarly. Subjects with T2DM were prescribed an obesity drug more often (p=0.004) but lost similar weight (p=0.07). Patients with T2DM had higher depression remission, to similar frequency at the end (p=0.42), and QoL improved significantly (p=0.02), but remained lower than in subjects without T2DM (p&lt;0.001).
Conclusion: In subjects with severe obesity and T2DM, pharmacological obesity treatment and a psychiatric intervention and were beneficial for weight loss and depression control. Improvement in QoL might require additional T2DM interventions.

Disclosure
M. Rodriguez Flores: None. S. Stephano Z.: None. M. Rabasa: None. J. Montoya: None. C. Velez: None. E. Garcia: None.
833-P: Relationship between Prediabetes and Depression in Korean Adults
Authors: JEON EONJU , KIM SUNG-WOO , LEE JI-HYUN , SHON HO-SANG 
Published: June 2019

Objective: Currently, emotional well-being is becoming an increasingly important aspect of diabetes care and self-management. Routine screening for depressive symptoms is indicated in high-risk populations, including people with prediabetes and diabetes. However, a limited number of studies about the relationship between prediabetes and depression have been conducted in Asians. The aim of this study was to investigate the potential synergistic relationship between prediabetes and depression.
Methods: This was a cross-sectional survey derived from the 2014 Korea National Health and Nutrition Examination Survey. 9-item Patient Health Questionnaire (PHQ-9) depression-screening test was used. Depression was defined as a score ≥10 on PHQ-9. Prediabetes was defined by the presence of impaired fasting glucose or A1c between 5.7 and 6.4%.
Results: In total, 3848 subjects (1570 Men and 2278 women) aged 16 to 80 years without diabetes were studies. Among them, 1809 (47%) were prediabetes. The prevalence of depression was higher in the participants with prediabetes (4.7%) than without prediabetes (3.4%) (P&lt;0.003). On multivariate logistic analyse, depression was significantly related with prediabetic participant with obesity (odds ratio (OR)= 3.103; 95% confidence interval (CI), 1.295-7.439). However, depression was not related with prediabeteic participant wit underweight (OR =1.001; CI, 0.662-1.514).
Conclusion: This study shows the risk of depression in prediabetes with obesity. Future research is required to examine the mechanisms underlying the associations between prediabetes, mental health, and the risk of diabetes.

Disclosure
E. Jeon: None. S. Kim: None. J. Lee: None. H. Shon: None.
835-P: Examining and Validating Social Support (SS) Related to Reproductive Health (RH) Behaviors and Seeking Preconception Counseling (PC) in Female Adolescents with Diabetes
Authors: ABUJARADEH HIBA , SEREIKA SUSAN M. , BECKER DOROTHY J. , FISCHL ANDREA F. , CHARRON-PROCHOWNIK DENISE 
Published: June 2019

Adolescent girls with diabetes are at risk for RH complications and unplanned pregnancies. Tight glycemic control with PC can reduce these risks. Social support from significant others has improved health outcomes in people with diabetes, and may help adolescent girls regarding RH. This secondary analysis: 1)described the amount (1=no help, to 7=a lot of help) and type of available SS (3 subscales: emotional, informational, and instrumental) perceived by adolescent females with diabetes toward RH behaviors and seeking PC; 2)examined the construct validity among total and subscale scores of a SS measure adapted for RH and diabetes; 3)examined the associations of SS with RH behaviors (e.g., birth control), seeking PC, and RH communication with healthcare providers (HCPs). Baseline data were used from 113 adolescent girls with diabetes (90% T1D; duration of diabetes of 9.3±3.9 years; average HbA1c 8.4±1.7%; mean±SD age of 16.2±1.6 years; 81% white, 20% sexually active), who participated in READY-Girls Trial testing the efficacy of a PC intervention to reduce RH complications among adolescents with diabetes. Teens completed measures on SS, RH behaviors, seeking PC, and communication with HCPs. Descriptive, correlational, and regression analyses were performed. Adolescents perceived on average moderately high levels of SS: total (5.5±1.5), emotional (5.5±1.6), instrumental (5.4±1.5), and informational (5.6±1.5); 31% had some communication with HCPs. There were significant associations between total SS and all its subscales (p&lt;.05) and among all SS subscales (p&lt;.05). Significant associations were found between emotional and instrumental SS with effective use of birth control (p=.047, .055). Our measure of SS appears to have strong construct validity with trends for concurrent validity. Following further psychometric analyses, this SS measure could help advance research in the area.

Disclosure
H. Abujaradeh: None. S.M. Sereika: None. D.J. Becker: Other Relationship; Self; Jaeb Center for Health Research, MannKind Corporation, Sanofi Research & Development. A.F. Fischl: None. D. Charron-Prochownik: None.

Funding
Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD-044097); Children’s Hospital of Pittsburgh (M01-RR-0084); Pediatric Clinical and Translational Research Center; National Center for Research Resources (UL1-RR-024153); National Institute of Nursing Research (P30-NR-03924)
838-P: Financial Incentives to Improve Glycemic Control in Adults with Diabetes: A Pilot Randomized Controlled Trial
Authors: EGEDE LEONARD E. , WALKER REBEKAH J. , PRIGMORE HEATHER L. , WILLIAMS JONI S. , CAMPBELL JENNIFER A. , DAWSON APRILL 
Published: June 2019

Background: Behavioral economics research has identified several decision-making patterns that contribute to poor adherence to medical regimens, however, few studies have investigated the possible influence of financial incentives on diabetes outcomes.
Methods: We randomized 60 African Americans with type 2 diabetes to one of three financial incentive structures: 1) single incentive at 3 months for A1c reduction, 2) two-part incentive for home testing of glucose and A1c reduction at 3 months, and 3) multiple component incentive for home testing, attendance of weekly telephone education classes and A1c reduction at 3 months. The primary outcome was A1c reduction within each arm at 3 months. As a pilot, this study was not powered to test between group differences.
Results: The mean age for individuals was 57.9, with 71.9% women. Each incentive structure led to significant reductions in A1c at 3 months with the greatest magnitude of change from baseline in the group with incentives for multiple components: group 1 mean reduction = 1.25, group 2 mean reduction = 1.73, group 3 mean reduction = 1.74.
Conclusion: Financial incentives across three separate structures led to significant decrease in A1c over 3 months. The magnitude of this effect was large and, in the range, found with diabetes medication trials, rather than smaller effects often seen in behavioral interventions. Therefore, this pilot randomized controlled trial suggests that structured incentives has significant impact on A1c reduction beyond what is typically seen with behavioral interventions and may be an important focus of future interventional studies to improve metabolic control and hence reduce diabetes complication and mortality rates in African Americans with type 2 diabetes.

Disclosure
L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. R.J. Walker: None. H.L. Prigmore: None. J.S. Williams: None. J.A. Campbell: None. A. Dawson: None.

Funding
National Institutes of Health
840-P: Lower Health-Care Utilization among Diverse Adolescents and Young Adults (AYA) Who Receive Culturally Discordant Care
Authors: FLORES GARCIA JAQUELIN J. , RAYMOND JENNIFER , AGARWAL SHIVANI , SANCHEZ ALEJANDRA TORRES , REID MARK W. 
Published: June 2019

Background: AYA with T1D encounter many challenges in managing their diabetes, such as uncontrolled glycemic levels, higher probability of complications, and poor clinic attendance. AYA minorities often encounter health care disparities that could be addressed with culturally competent care, which considers the patient’s diverse background and sociocultural factors like communication, language, and beliefs that may influence health behaviors.
Objective: To assess patient-reported provider cultural competence and health care utilization among diverse AYA population with T1D.
Methods: Patients were recruited during routine diabetes outpatient care visits and asked to complete questionnaires on sociodemographic variables, health care utilization, and clinical experiences and cultural competence as assessed by the Consumer Assessment of Healthcare Providers and Systems (CAHPS).
Results: One-hundred forty three AYA (58.7% Male; 45.5% Latinx, 22.4% non-Latinx white) participated, with an average HbA1c of 9.8% in Latinx and 8.6% in non-Latinx whites. Participants who reported some negative experience with provider cultural competence were marginally lower health care utilizers. Specifically, these AYA went to the ER for diabetes-related problems less frequently (p=0.07), had fewer urgent care visits (p=0.08), went to urgent care for hypoglycemia issues less frequently (p=0.08), and attended fewer diabetes care visits (p=0.07). They also went to urgent care for reasons unrelated to diabetes less frequently (p=0.11) and spent fewer days in the hospital when admitted (p=0.13), but these results were not significant.
Conclusions: AYA who experience culturally discordant care may utilize health care less frequently. It is unclear if AYA receiving discordant care need less healthcare support, or if their experiences lead to avoidance of needed care. Our results are hypothesis-generating and further investigation is needed.

Disclosure
J.J. Flores Garcia: None. J. Raymond: Other Relationship; Self; Insulet Corporation. S. Agarwal: None. A. Torres Sanchez: None. M.W. Reid: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
853-P: Caring for Someone with Type 1 Diabetes: Health-Related Quality of Life of Parents and Partners
Authors: HILLIARD MARISA E. , MINARD CHARLES G. , MARRERO DAVID G. , WIT MAARTJE DE , THOMPSON DEBORAH , VERDEJO ALANDRA , ANDERSON BARBARA 
Published: June 2019

Objective: Health-related quality of life (HRQoL) is a key patient-reported outcome in care and research. The few instruments that assess the HRQoL of parents and partners of people with type 1 diabetes (T1D) emphasize caregiving burden or are usually proxy measures (reporting on behalf of person with T1D). We created measures assessing parents’ and partners’ own HRQoL as part of a larger study to develop and validate a suite of instruments to measure HRQoL in children through older adults with T1D.
Methods: Qualitative interviews (n=81 people with T1D and parents/partners, 8 providers) identified HRQoL themes to include. Drafts were piloted with n=41. Resulting measures were validated with n=644 parents and n=186 partners from 6 T1D Exchange sites across the U.S., including the HRQoL measure (2 times, approx. 3 months apart), measures of relevant constructs (SF-12, Satisfaction with Life Scale, Diabetes Family Impact Scale, Partner Diabetes Distress Scale), and medical chart-confirmed HbA1c. We report exploratory factor analyses (Promax rotation) and psychometric data for the 4 parent measures (child age &lt;8, 8-11, 12-17, 18-25) and 1 partner measure (person with T1D age ≥18).
Results: Each measure had a unique set of 21-30 positive and negative items loading on 3-4 scales. Reliability was good: total score α range=0.80-0.88, test-retest r range=0.75-0.86. Significant correlations between the total HRQoL scores and measures of general quality of life (r=0.30-0.53), mental well-being (r=0.37-0.53), T1D family impact (parents of youth, r=-0.64--0.72), and diabetes distress (parents/partners of adults, r=-0.76--0.75) indicated construct validity. Scores were not correlated with HbA1c.
Conclusions: The new measures of T1D-specific HRQoL in parents and partners have relevant items and factors, and demonstrate strong psychometric properties. These innovative tools will permit assessment of the experiences of parents and partners of people with T1D for use in research and practice.

Disclosure
M.E. Hilliard: None. C.G. Minard: None. D.G. Marrero: None. M. de Wit: Research Support; Self; Sanofi. D. Thompson: None. A. Verdejo: None. B. Anderson: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (2015PG-T1D084)