bluuebunny/crossref_metadata_2025_split huggingface dataset:
715-P: Reimbursement of Transition-Related Services in an Adult Diabetes Clinic
Authors: JOARDER FARAHNAZ , NAGRA HARPREET , ANDREAS LAURA , ROCHA LOLIS , KRAUS KIMBERLY 
Published: June 2019

Objectives: A reimbursement model for a multidisciplinary young adult diabetes clinic supporting pediatric to adult transition of care was examined.
Method: In approximately one year (Dec 2017-Oct 2018), 31 patients with type 1 diabetes (T1D; ages 17-25; 56% males, Hemoglobin A1C ranged from 6.0 to &gt;14.0 (M=9.44, SD=2.07) were billed for attending a Young Adult Diabetes Clinic. Data were extracted via electronic medical record. Reimbursement rates, as noted by Got Transition and American Academy of Pediatrics for Medicare 2018, were used to assess financial sustainability.
Results: Services billed included a 45-minute behavioral health group intervention (96153), emotional/behavioral (96127) and substance use questionnaires (96160). This was followed by a 25 minute diabetes education visit (G0108), a 10 minute warm hand off and a 25 minute medical provider visit (99203). Medical CPT Codes (99213, 99205, and 99204) were reimbursed 76% of the time, producing wRVUs of approximately 50. Behavioral health CPT codes (96150, 96152, and 96127) were reimbursed 46% of the time and produced wRVUs of approximately 14. Approximately $8300 was billed for the half-day clinic over the course of 11 months. Approximately $5700 was returned (68% return rate) and wRVUs were around 70. More than 50% of the patients who agreed to attend the clinic also established ongoing clinical services. The clinic model also supported only 10% of patients being lost to follow-up compared to higher rates previously predicted in the literature.
Conclusions: The half-day, once a month, multidisciplinary transition clinic designed to support transition-age youth with T1D yielded additional funds and increased youth engagement. While not highly lucrative, this may be due to antiquated billing infrastructure and a small sample size. Future studies are needed to assess the link between outpatient engagement, billing, and reduced health crises, hospitalizations and related costs.

Disclosure
F. Joarder: None. H. Nagra: None. L. Andreas: None. L. Rocha: None. K. Kraus: None.
74-LB: Impact of Mild and Moderate High Blood Glucose Excursions on Daily Living in Adults with Type 1 Diabetes
Authors: HUGHES ALLYSON , BISPHAM JEOFFREY , GAREY COLLEEN , LIU JINGWEN , FULLER LILY , NYKAZA EDWARD T. , MENO JASON A. , MCAULIFFE-FOGARTY ALICIA 
Published: June 2019

Introduction: Severe hyperglycemic events and diabetic ketoacidosis (DKA) have significant effects on daily activity however, the effect of mild and moderate glucose excursions on functioning and quality of life (QoL) remains unknown. This study aimed to assess the impact of these excursions on well-being in a well-managed population with type 1 diabetes (T1D) using survey and CGM data.
Methods: Adults with T1D (N = 71), 68.6% female, 93.2% white, aged 44.11 years, average A1c 6.51%, with diabetes for 26.65 years, completed an online survey through T1D Exchange Glu and uploaded CGM data via Tidepool.
Results: Moderate high blood glucose (HBG) excursions were most strongly related to QoL (WHO-5) and happiness (Subjective Happiness Scale, SHS). Participants with fewer mild (&gt; 180 mg/dL) HBG excursions had higher WHO-5 scores indicating better QoL when controlling for income and duration of diabetes. Participants who had longer durations in the same range, regardless if it was time in range or mild or moderate hyperglycemia, had higher SHS scores indicating greater happiness when controlled for income and duration of diabetes.
Conclusions: This study illustrates the impact of mild HBG excursions and glycemic variability on QoL in people with T1D. HBG excursions were related to QoL and glycemic variability was related to happiness further supporting the urgency to decrease the amount of time hyperglycemic. These results indicate the need to increase time in range and decrease overall blood glucose variability. A limitation includes convenience sampling in a very well-managed population. Future research should further investigate the relationships of these factors in a diverse sample.

Disclosure
A. Hughes: None. J. Bispham: None. C. Garey: None. J. Liu: None. L. Fuller: None. E.T. Nykaza: None. J.A. Meno: None. A. McAuliffe-Fogarty: None.
747-P: Risk Factors for Hypoglycemia in Type 1 Diabetes Individuals during Intensive Sport Exercise—Data from the “SportGiveChance: Diabetic Runners and Cyclists for More Sport for All in Europe” Event
Authors: HOHENDORFF JERZY , UCIEKLAK DAMIAN , SKUPIEN JAN , MATEJKO BARTłOMIEJ , GIACOMO ANGELICA DI , MALECKI MACIEJ , KLUPA TOMASZ 
Published: June 2019

Introduction: Hypoglycemia fear seems to be the strongest barrier to physical activity for individuals with type 1 diabetes mellitus (T1DM). The aim of the study was to describe clinical characteristics of participants with T1DM in the intensive sporting event of runs and bike rides, and investigate factors associated with reported hypoglycemia events during the competition, in particular the use of continuous and flash glucose monitoring systems (CGM/FGM).
Methods: The sporting event took place in Spoleto, Italy from 30 August to 2 September 2018. An online survey was distributed among 150 participants with diabetes. Only T1DM patients were invited to complete the survey that included questions on baseline clinical characteristics as well as glucose control and meal related issues during the competition. Logistic regressions were used to determine factors associated with reported hypoglycemia.
Results: There were 35 T1DM individuals who completed the questionnaire; 18 subjects were CGM/FGM users, while the others performed self-measured blood glucose measurements (SMBG) on glucose meters. Mild hypoglycemia episode during the competition was reported by 4 CGM/FGM users and 6 non-users (OR:0.73, CI:0.34-1.53). No severe hypoglycemic episode was reported. BMI≥25 kg/m2 (OR:2.56, CI:1.10-5.98) and subjectively very hard or maximal intensity of the competition (OR:4.09, CI:1.51-15.89) was associated with higher risk of hypoglycemia.
Conclusions: Selected patients with T1DM can participate in intensive sport competitions with relatively low risk of hypoglycemia regardless of either CGM/FGM or SMBG use.

Disclosure
J. Hohendorff: Other Relationship; Self; Abbott, Ascensia Diabetes Care, Novo Nordisk A/S, Sanofi-Aventis. D. Ucieklak: None. J. Skupien: None. B. Matejko: Research Support; Self; Roche Diabetes Care. Other Relationship; Self; Ascensia Diabetes Care. A. Di Giacomo: None. M. Malecki: Advisory Panel; Self; Abbott Laboratories, AstraZeneca, Bioton, Boehringer Ingelheim Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novartis Pharmaceuticals Corporation, Novo Nordisk Inc., Sanofi-Aventis. Speaker’s Bureau; Self; Merck & Co., Inc. T. Klupa: Advisory Panel; Self; Abbott, AstraZeneca, Bioton, Lilly Diabetes, Novo Nordisk A/S. Employee; Spouse/Partner; Ascensia Diabetes Care. Other Relationship; Self; Ascensia Diabetes Care, Boehringer Ingelheim Pharmaceuticals, Inc., Medtronic MiniMed, Inc.
78-LB: Detailing the Experiences of People with Diabetes Using Do-It-Yourself Artificial Pancreas Systems—Qualitative Analysis of Responses to Open-Ended Items in an International Survey
Authors: CLEAL BRYAN , BRAUNE KATARINA , O’DONNELL SHANE , HAUCK BASTIAN , LEWIS DANA M. , SKINNER TIMOTHY C. , RAILE KLEMENS 
Published: June 2019

There is currently a wave of interest in Do-it-Yourself Artificial Pancreas Systems (DIYAPS) but knowledge about how the use of these systems impacts on the lives of those that develop and use them remains limited. Until now, only a select few have been able to give voice to their experiences in a research context. In this study we present data that addresses this shortcoming, detailing the lived experiences of people using DIYAPS in an extensive and diverse way.
An online survey with 34 items was distributed to DIYAPS users recruited through the Facebook groups “Looped” (and regional sub-groups) and Twitter pages of the Diabetes Online Community (DOC). Participants were posed two open-ended questions in the survey, where personal DIY APS stories were garnered; including knowledge acquisition, decision-making, support and emotional aspects in the initiation of DIY APS, perceived changes in clinical and quality of life (QoL) outcomes after initiation and difficulties encountered in the process. All answers were analysed using thematic content analysis.
In total, 886 adults responded to the survey and there were a combined 656 responses to the two open-ended items.
Knowledge of DIYAPS was largely obtained via exposure to the communication fora that constitute the DOC. The DOC was also a primary source of practical and emotional support. Dramatic improvements in clinical and QoL outcomes were consistently reported. The emotional impact on everyday life was overwhelmingly positive. Acquisition of the requisite devices to initiate DIYAPS was sometimes problematic.
The extensive testimony from users of DIYAPS acquired in this study provides new insights regarding the contours of this evolving phenomenon, highlighting factors inspiring people to adopt such solutions and underlining the transformative impact effective closed-loop systems bring to bear on the everyday lives of people with diabetes.

Disclosure
B. Cleal: None. K. Braune: Advisory Panel; Self; Medtronic MiniMed, Inc. Speaker’s Bureau; Self; Dexcom, Inc. S. O’Donnell: None. B. Hauck: Consultant; Self; Bayer AG, Eli Lilly and Company, LifeScan, Inc., Novo Nordisk A/S, Roche Diabetes Care, Roche Pharma. D.M. Lewis: Consultant; Self; Diabeloop SA, Roche Diabetes Care. T.C. Skinner: None. K. Raile: Advisory Panel; Self; Abbott, Lilly Diabetes.
804-P: Alcohol Consumption Patterns among Young Adults with Type 1 Diabetes
Authors: ROBERTS ALISSA J. , LAW JENNIFER R. , SUERKEN CYNTHIA , REBOUSSIN BETH A. , LAWRENCE JEAN M. , TAPLIN CRAIG , MAYER-DAVIS ELIZABETH , PIHOKER CATHERINE 
Published: June 2019

The objective of this study is to describe alcohol consumption behaviors in young adults with T1D and to examine the associations between alcohol consumption, HbA1c, and episodes of severe hypoglycemia in prior 6 months. Data from 602 SEARCH for Diabetes in Youth Study participants age ≥18 years. with T1D were collected from 12/2011 to 6/2015 (50% female, mean age 21.3(SD 2.4), 22% race/ethnic minority). Participants were characterized as alcohol non-drinkers (n=269), drinkers but non-binge drinkers (n=167), or binge drinkers (n=166) based on reported consumption in the past 30 days, using the National Institute on Alcohol Abuse and Alcoholism definition of binge drinking (≥4 drinks females, ≥5 drinks males). Analyses were conducted using one-way ANOVAs, chi-square tests, and logistic regression modeling looking at drinking status and clinical markers. Overall, 55.3% of participants had consumed alcohol in the past 30 days; 27.6% reported binge drinking. Males consumed alcohol more frequently (7.3 days vs. 4.5 days, p&lt;0.0001), consumed more alcohol per occasion (4.7 drinks vs. 3.0 drinks, p=0.0001), and were more likely to be binge drinkers than females (34.2% vs. 20.9%, p= 0.0003). In comparison with 18-20 year old, participants ≥21 years were more likely to have consumed alcohol in the past 30 days and more likely to be binge drinkers, but average number of drinks consumed at a time did not differ. Binge drinkers were older (OR 1.4, 95% CI = 1.2-1.6), had higher parental education (OR 2.6, 95% CI =1.4-4.9), and were more likely to be current (OR 10.5, 95% CI =5.8-19.2) or former (OR 5.8, 95% CI = 3.3-10.1) tobacco users compared to non-drinkers. After adjusting for demographic characteristics, binge drinking was not associated with HbA1c or severe hypoglycemic events relative to non-drinkers. Young adults with T1D in SEARCH report similar alcohol use but higher rates of binge drinking compared to the U.S. population. Binge drinking was not associated with poorer glycemic control or severe hypoglycemia in this cohort.

Disclosure
A.J. Roberts: None. J.R. Law: None. C. Suerken: None. B.A. Reboussin: None. J.M. Lawrence: None. C. Taplin: None. E. Mayer-Davis: None. C. Pihoker: None.

Funding
National Institutes of Health; Centers for Disease Control and Prevention
808-P: A New Measure of Diabetes-Specific Self-Compassion for Parents of Youth with Type 1 Diabetes (T1D)
Authors: TANENBAUM MOLLY L. , WONG JESSIE J. , HANES SARAH , HOOD KOREY K. 
Published: June 2019

Managing T1D is highly demanding while offering little in terms of rewards or positive reinforcement. Parents often experience high levels of emotional distress and burden, with implications for parent and child wellbeing and parent self-efficacy for managing diabetes. Parents may also experience self-criticism regarding their management of T1D. Diabetes-specific self-compassion (SC), or being kind to oneself in the face of challenges that arise in managing diabetes, has the potential to buffer against the negative impact of diabetes distress. The purpose of this study was to create a new tool, the Diabetes-Specific Self-Compassion Scale (SCS-Dp), to assess diabetes-specific SC in parents of youth with T1D. We adapted a previously validated measure for adults with T1D; surveyed parents (N=198; parent: 88% female; 95% non-Hispanic white; M age=44±8.9; child: 46% female; M age=13±3.4, range 2-18 years; 83% insulin pump users; 40% CGM users; A1c from clinic data available for 76 participants: M A1c=8.1±1.3%) and conducted confirmatory factor analysis (CFA), reliability and construct validity analyses. The 19-item SCS-Dp had excellent internal consistency (ɑ=.94; range of item-total correlations: .52-.81). The CFA model showed evidence of good fit: SRMR=0.04; RMSEA=0.05; CFI=0.95; χ2(171)=1637.02, p&lt;0.0001. Validity measures included diabetes distress, diabetes empowerment, diabetes numeracy, and A1c. As predicted, greater SC was associated with lower distress (r=-.68, p&lt;.001) and greater empowerment (r=.43, p&lt;.001) and was not associated with diabetes numeracy (p=.61). SCS-Dp was not associated with A1c (p=.28). Results suggest that the SCS-Dp is a reliable, valid measure of diabetes-specific SC in parents and may help determine points of intervention for this population. Interventions to increase diabetes-specific SC in parents may aid in ameliorating diabetes distress through increasing self-kindness in the context of diabetes-related challenges.

Disclosure
M.L. Tanenbaum: None. J.J. Wong: None. S. Hanes: None. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute.
813-P: Similarities and Differences in Adults’ Experiences with Type 1 and Type 2 Diabetes Distress
Authors: BEVERLY ELIZABETH A. , RENNIE ROCHELLE G. , GUSEMAN EMILY H. , HEALY AMBER 
Published: June 2019

Diabetes is one of the biggest health problems in the U.S., affecting 9.4% of the population and 19.9% of people in southeastern Ohio. Despite the high prevalence of diabetes, it is understudied in this region. One critical outcome that has not been addressed is diabetes distress. The purpose of this study was to explore experiences of diabetes distress in adults with type 1 diabetes (T1D) and type 2 diabetes (T2D). A purposive sample of 36 adults participated in in-depth interviews (55.6% T2D, duration=13.9±13.6 years, A1C=7.6±1.9%, 58.3% on insulin; age=45.8±19.8 years; 58.3% female; 91.7% white). Two researchers independently coded the interviews, met to resolve discrepancies, and agreed on themes. Qualitative analysis revealed 4 themes: 1) Relentless Burden of Self-Care: Both T1D and T2D participants described how hard it was to manage the daily aspects of diabetes, with blood glucose monitoring reported as the most challenging behavior; 2) Perceived Lack of Support: The majority of T1D and T2D participants felt that family and friends did not understand how difficult it was to live with diabetes. Many of these participants chose to hide their diagnosis for fear of stigmatization; 3) Worry about the Inevitability of Complications: All of the participants addressed fears about developing complications, with several experiencing debilitating distress; and 4) Uncertainties about the Cost and Quality of Care: T2D participants voiced more concerns about the cost of care. With rising drug and diabetes supply costs, T2D participants expressed more unease about their future. Further, many T2D participants felt that their primary care providers did not know enough about diabetes to take care of them properly. T1D participants did not report these views.
In conclusion, T1D and T2D shared more common experiences with diabetes distress than not. In southeastern Ohio, people with T1D and T2D diabetes may benefit from group interventions that incorporate problem-solving therapy and emotion regulation.

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

Funding
American Osteopathic Association (1291708718)
846-P: Patients with T2D Are Willing To Do More than Their HCPs Expect to Overcome Therapeutic Inertia
Authors: CHAMBERLAIN JAMES , WOOD RICHARD , ROBERTS MICHELLE , EDELMAN STEVEN 
Published: June 2019

Few patients on basal insulin (BI) reach suggested glycemic goals despite repeated dose titration attempts and availability of other support services/medications. An online quantitative survey was used to explore differences between patient and healthcare provider (HCP) priorities and perceptions of therapeutic regimens and approaches. It was completed by 305 T2D patients on BI &gt;1 year and 240 HCPs. Patient and HCP preferences were compared regarding treatment priorities, estimated time to reach A1C goals, impact of not reaching goals, and willingness to change treatment and do more to reach goals.
Results showed the similarities and differences in patient and HCP views and priorities. Top patient priorities were to: maintain goals long term (62%), stay healthy (44%), and avoid weight gain (43%) vs. HCPs: avoid side effects (55%), consider treatment affordability (53%), and maintain goals long term (45%). It took longer than expected to meet A1C goals (35% each group); of patients, 49% expected goals would not be met; 61% wanted to reach goals faster; 80% were frustrated by slow progress to reach goals. More patients expected to reach goals in 1-5 years (42% vs. HCPs 16%); both groups wanted to reach goals in 6-12 months. More patients would try harder to reach goals than HCPs expected (37% vs. 16%), be willing to visit their HCP more often (42% vs. 17%), consider treatment changes (40% vs. 18%), and try a different injectable (45% vs. 34%). Within 12 months of starting BI, 17% of patients (vs. 68% of HCPs) expected no treatment addition. More endocrinologists (29% vs. PCPs 16%) anticipated titrating BI dose ≥100 U/day. In patients, 61% felt frustrated not reaching goals on BI, whereas HCPs estimated only 36% of patients would be frustrated.
In summary, patients are willing to do more than their HCPs expect. A better understanding of the disparate perceptions and preferences of patients and HCPs could enhance outcomes for T2D patients on BI not reaching glycemic goals and reduce unwarranted complications.

Disclosure
J. Chamberlain: Speaker's Bureau; Self; Merck & Co., Inc., Novo Nordisk Inc., Sanofi-Aventis. R. Wood: Other Relationship; Self; Multiple companies in the diabetes field (&gt;10 companies). M. Roberts: None. S. Edelman: Advisory Panel; Self; BrightSight, InPen, Lexicon Pharmaceuticals, Inc., Novo Nordisk Inc. Board Member; Self; Senseonics. Speaker's Bureau; Self; AstraZeneca, Lilly Diabetes, MannKind Corporation, Merck Foundation, Sanofi-Aventis.

Funding
Sanofi U.S.
847-P: Diabetes-Specific Social Capital through Peer Support—A Study of Facilitators
Authors: JOENSEN LENE E. , OVERGAARD MATHILDE , NØRGAARD KIRSTEN , WILLAING INGRID 
Published: June 2019

Peer support is a method often used in diabetes support and education programs to improve good health and wellbeing among people with diabetes. However, the evidence is insufficient to determine which peer support elements that are effective and the specific approaches to facilitation of peer support are often not explicitly described. Obtaining the experience of diabetes-specific social capital is one important outcome of peer support. However, little is known about how to enhance diabetes-specific social capital. The aim of this study was to explore facilitators of diabetes-specific social capital through peer support in group meetings. Data consisted of audio recordings of plenary discussions from eight peer support meetings conducted in a diabetes specialist clinic and researchers’ observation notes from the meetings. Furthermore, 25 of 30 participants were interviewed. Participants consisted of a group of adults with type 1 diabetes treated with insulin pump. Systematic text condensation was used to analyze data, showing that participants’ experiences of diabetes-specific social capital related to feeling trust, collectiveness, reciprocity and relevant experience sharing. The overall mechanisms found to facilitate diabetes-specific capital related to the provision of 1) practical and concrete insights 2) focused experience sharing and 3) an open and safe forum to talk about diabetes. Specific facilitators included opportunities for participants to e.g., show and tell how they managed diabetes, demonstrating practical diabetes routines during the meetings, experience diversity in how to manage diabetes and be able to joke about diabetes.
This study highlights concrete facilitators of diabetes-specific peer support which makes a significant positive difference to quality of everyday life with diabetes. Further studies are needed to explore in depth the effect of these mechanisms on emotional as well as physical health in larger and various diabetes populations.

Disclosure
L.E. Joensen: None. M. Overgaard: None. K. Nørgaard: Advisory Panel; Self; Abbott, Medtronic, Novo Nordisk A/S. Speaker's Bureau; Self; Bayer US, Medtronic, Roche Diabetes Care, Rubin Medical, Sanofi, Zealand Pharma A/S. Stock/Shareholder; Self; Novo Nordisk A/S. I. Willaing: None.