bluuebunny/crossref_metadata_2025_split huggingface dataset:
Raising a Child with Type 1 Diabetes and Autism—Using Social Media to Identify Barriers and Facilitators
Authors: OSER TAMARA , OSER SEAN M. , BANGALORE KRISHNA KANTHI , HALE DANIEL E. 
Published: June 2018

Children with both T1D and autism pose a distinct challenge, and there is exceedingly little research on T1D self-management in this special population and few resources to guide healthcare providers (HCPs) on how to best partner with families. This qualitative study used an exploratory inductive thematic approach to analyze a public Internet forum authored by caregivers to children with both T1D and autism. All 398 posts were imported into NVivo 11 (QSR International). After codebook development, the primary coders (TO, SO) coded 10% and then 20% of the dataset, with Cohen’s kappa .994 and .996, respectively. With high inter-rater reliability established, coding of all remaining posts was then completed. Inductive thematic analysis revealed the following themes: 1) Parents of children with T1D and autism yearned for support and did not feel understood by the autism community or the T1D community; social media provided much-needed peer support from families that understood the unique experience of raising a child with both conditions. 2) Numerous coping techniques were discussed, including focusing on T1D management first, as glucose levels could affect behavior; establishing concrete rules and routines; and advice on types of needles and technology that might be better tolerated in this unique population. 3) Descriptions of the healthcare experience, including the helpfulness of multidisciplinary teams with endocrinologists and autism specialists jointly developing treatment plans. 4) Challenges in school and camp settings, as well as challenges in finding caregivers. 5) Sensory issues precluding use of technology such as insulin pumps, and the utility of tubeless pumps in overcoming some of these challenges. This study provides valuable insight for HCPs into the challenges these families face and lays the groundwork for future studies to evaluate how HCPs can best care for and advise this unique population.

Disclosure
T. Oser: None. S.M. Oser: None. K. Bangalore Krishna: None. D.E. Hale: None.
Empowerment, Motivation, and Medical Adherence (EMMA)—Results of an RCT in Patients with Poorly Regulated Type 2 Diabetes
Authors: VARMING ANNEMARIE R. , OLESEN KASPER , WILLAING INGRID 
Published: June 2018

Background: Many studies have shown that substantial improvement of glycemic control is difficult in patients with poor glycemic control. Knowledge, competences and motivation are critical requirements for optimal self-management and good glycemic control. The aim of this RCT was to test if a consultation program, EMMA could improve self-management and glycemic control in patients with T2D and poor glycemic control compared to a control group receiving usual care.
Methods: The study was a non-blinded parallel RCT targeting adults with T2D ≥ 1 year and HbA1c ≥ 64 mmol/mol in a Danish diabetes clinic. The intervention consisted of four consultations with nurses using EMMA, which provides a person-centered approach using dialogue tools designed to promote self-reflection, learning and goal-setting (3.5 months). Outcome measures were HbA1c and questionnaire scores investigating determinants of glycemic control according to Self-Determination Theory, such as autonomy support (Health Care Climate Questionnaire (HCCQ)). Consultation processes were evaluated by the level of nurse talk and the actual use of the tools.
Results: Nighty-seven participants completed the study (49 in the intervention group). The HCCQ score was significantly higher in the intervention group at end of the intervention. The increase in HCCQ score was not sustained at the end of follow-up (6 months). HbA1c was slightly reduced in both groups at the end of intervention and at follow-up. Average level of nurse talk in all recorded intervention consultations (n=57) was 37% of total talk-time. Records from the consultations showed that most of the reflection and goal-setting tools were used with &gt;90% of the participants, whereas the learning tools were used with 61%.
Conclusion: The initial increase in autonomy support seemed attributed to the intervention. The non-significant decrease in HbA1c may be ascribed a short intervention period and less professional use of learning tools than intended.

Disclosure
A.R. Varming: None. K. Olesen: None. I. Willaing: None.
Improved Diabetes Medication Convenience in Persons with Type 2 Diabetes after Switching to Insulin Glargine 300 U/mL (U-300)—The Observational OPTIN-D Study
Authors: WIERINGA THOMAS H. , DE WIT MAARTJE , TWISK JOS , SNOEK FRANK J. 
Published: June 2018

Insulin glargine-300 (U-300) provides a flatter and more prolonged profile than U-100, with less risk of hypoglycemia. Real-world evidence of the effect of U-300 on Patient Reported Outcomes (PROs) is lacking. Adults with type 2 diabetes (T2DM) using insulin for ≥6 months and initiating U-300 were included. Data were collected at baseline (start U-300; T0)), 3 (T1) and 6 months (T2). Intention-to-treat mixed model analyses examined change over time in HbA1c, self-reported hypoglycemia and PROs: emotional well-being (WHO-5), hypoglycemia worries (HFS-W), diabetes distress (PAID-SF), diabetes medication convenience (DMSRQ), sleep quality and duration (PSQI), and adherence (1 item SDSCA). Also, the extent to which U-300 fulfilled its expectations was measured at T2 both in physicians and patients. P-value threshold was set at .for the WHO-5 and .01 for other outcomes. In total, 162 persons with T2DM participated: 53.7% men, mean age 64.54 years (9.05), baseline mean HbA1c 62.48 mmol/mol (12.61). Hypoglycemia incidence decreased non-significantly: for symptomatic events from 31.5% (T0) to 24.8% (T2), nocturnal events from 6.8% (T0) to 4.1% (T2), severe events from 4.9% (T0) to 0.0% (T2). HbA1c trended towards a decrease to 60.32 mmol/mol (12.09) (T2). Mean WHO-5 scores trended towards improvement, from 61.73 (T0) to 63.93 (T2). Mean DMSRQ scores improved significantly from 32.70 (T0) to 35.80 (T1) (beta T0-T1 = 3.28; p&lt;.001; 95% CI = 1.67 to 4.89) and 36.96 (T2) (beta T0-T2 = 4.40; p&lt;.001; 95% CI = 2.77 to 6.02). U-300 fulfilled (or exceeded) its expectations in 89,0% of physicians and 92.4% of patients. Other PROs did not change significantly over time. U-300 fulfills physicians’ and patients’ expectations and improves diabetes medication convenience, possibly due to more flexible injection timing. Future research should further explore effects on quality of life in a more diverse population.

Disclosure
T.H. Wieringa: Other Relationship; Self; Sanofi. M. de Wit: Advisory Panel; Self; Sanofi.J. Twisk: None.F.J. Snoek: None.
Program ACTIVE II—Glycemic Improvements Are Sustained over 12 Months with Combination Therapy for MDD in Adults with T2DM
Authors: DE GROOT MARY , GUYTON W. HORNSBY , SAHA CHANDAN K. , YANG ZIYI , PILLAY YEGAN , FITZPATRICK KAREN M. , MATHER KIEREN J. , SHUBROOK JAY H. 
Published: June 2018

Few studies have evaluated the long-term comparative effects of behavioral treatments for major depressive disorder (MDD) on glycemic and psychological outcomes. Program ACTIVE II was a multi-state randomized controlled comparative effectiveness trial of cognitive behavioral therapy (CBT), community-based exercise (EXER), combination treatment (CBT+EXER) or usual care (UC) for adults with MDD and type 2 diabetes (T2DM).
CBT+EXER had a lasting A1c benefit at 6-months (-1.27%; SE: 0.6; p=0.04) and 12 months (-1.42%; SE: 0.6; p=0.03) compared to UC in those with baseline A1c ≥ 7.0%, after controlling for baseline covariates.
At 6-month (N=74) and 12-month (N=64) follow-up assessments, all groups had high rates of MDD full remission (range: 63-93%; NS) and minimal depressive symptoms (BDI total score range: 10.7-15.6; NS).
At 6 months, CBT+EXER had significant improvements in diabetes-related distress regimen burden (p=0.05); and personal support for health (p=0.05) compared to UC. EXER had improvements in negative thoughts (p=0.005), community social support (p=0.005), diabetes-specific quality of life (DQoL; p=0.04) and satisfaction with T2DM (p=0.01) compared to UC. CBT had improvements over UC in personal support for health (p=0.04) and DQoL (p=0.047). At 12 months, all 3 treatment groups reported improved support from health care providers (p=0.03 CBT, EXER and CBT+EXER) compared to UC. CBT+EXER had improved SF-12 Physical Component Scores (p=0.04) compared to UC.
The Program ACTIVE II CBT+EXER intervention had a sustained benefit for A1c beyond the effect of MDD full remission. All 3 behavioral interventions sustained improvements in psychological well-being over 1 year. These findings highlight durable benefits of community-based depression interventions delivered by behavioral health and exercise professionals, which could allow expanded access to depression treatment for T2DM patients in rural and urban areas.

Disclosure
M. de Groot: Consultant; Self; Johnson &Johnson Diabetes Institute, LLC., Eli Lilly and Company.W. Hornsby: None.C.K. Saha: None.Z. Yang: None.Y. Pillay: None.K.M. Fitzpatrick: None. K.J. Mather: Research Support; Self; Merck &Co., Inc., Sanofi-Aventis, Novo Nordisk A/S, Abbott. Advisory Panel; Self; Merck & Co., Inc.J.H. Shubrook: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk Inc., Intarcia Therapeutics, Inc..
HbA1c (You Later)—What Happens to Glycemic Control while Waiting for NICH?
Authors: WAGNER DAVID V. , SACHDEJ RAJKARAN , KOSKELA NATALIE C. , BARRY SAMANTHA A. , HANNAH LUZOD , JAMES-UNREIN ELIZA , HARRIS MICHAEL A. 
Published: June 2018

Objective: Novel Interventions in Children’s Healthcare (NICH) is a community-based, family-focused intervention for youth with T1D who experience self-management difficulty due to social challenges. Previous findings suggest that NICH participation is associated with improved glycemic control. However, conclusions are limited due to possibility that these outcomes are influenced by regression to the mean and not reflective of intervention effect. This study examines whether glycemic control regresses during wait period following referral to NICH.
Methods: Youth with T1D and consistently poor glycemic control were referred to NICH and experienced a wait based on insurance approval and program capacity. Retrospective chart reviews collected HbA1c values in the year prior to referral, during wait period, and during NICH. Thirty-nine youth had lab values for all three time periods. Youth mean age was 15.4 years; 56% were female; and 85% were Caucasian. Mean days prior to referral, on wait list, and during NICH were 365, 161, and 394 days, respectively.
Results: Average youth HbA1c remained relatively stable during the wait-period (t(38)=.509, p=.61), going from 11.6 (SD=1.5) to 11.5 (SD=1.6). Average youth glycemic control significantly decreased to 10.9 (SD=1.6) during NICH intervention compared to prior to referral (t(38)=2.31, p=.03) and during wait period (t(38)=2.30, p=.03).
Conclusions: Youth glycemic control while waiting for NICH remained stable and high, only demonstrating significant and clinically meaningful improvement during NICH involvement. These findings suggest that, while regression to the mean should always be considered as a threat to validity, it may not apply to youth who have a history of significantly elevated A1cs. Thus, improvements experienced by these youth likely represent change associated with their involvement in NICH, and longer waits to access a program like NICH likely increase risk of short- and long-term diabetes complications.

Disclosure
D.V. Wagner: None. R. Sachdej: None. N.C. Koskela: None. S.A. Barry: None. H. Luzod: None. E. James-Unrein: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.
Predictors of Depressive Symptoms in a Clinical Sample of Individuals with Type 1 Diabetes
Authors: STANEK KELLY R. , MAJIDI SHIDEH , VOGELI JO M. , DRISCOLL KIMBERLY A. 
Published: June 2018

Background: Depression screening during routine type 1 diabetes (T1D) clinical care is increasing, but no studies have examined predictors of symptoms in a clinical sample of those with T1D.
Methods: Individuals with T1D ages 10-25 years completed the Patient Health Questionnaire-9 (PHQ-9) during routine T1D clinic visits. PHQ-9 scores range from 0-27 with higher scores reflecting more depressive symptoms. Demographic and T1D-specific characteristics were also collected.
Results: A total of 609 individuals with T1D were screened: 49% female; mean 15.2±3.1 years; 76% Caucasian; 11% Hispanic; 70% private insurance; mean A1C = 9.2±2.2%, mean T1D duration = 5.9±4.4 years; 49% insulin pump (CSII); 26% continuous glucose monitor (CGM). Average PHQ-9 score was 4.0±4.6 (range = 0-24; 67% minimal, 22% mild, 7% moderate, 3% moderately severe, 1% severe). Linear regression analyses revealed female sex, having public insurance and higher A1Cs, and lack of CGM use were significantly associated with higher depressive symptoms (Table). Older age and lack of CSII trended towards significance.
Conclusions: The results of this study demonstrate the importance of screening for depressive symptoms as part of routine T1D clinical care. Results further support potentially targeting individuals with specific characteristics (e.g., females, high A1Cs) for screening when clinic resources to implement screening are limited.
Table.Predictors of Depressive Symptoms. *p&lt;0.05, **p&lt;0.01, ***p&lt;0.001ßSEp-valueAge 0.0660.0590.096Sex -0.0840.3630.036*Insurance-0.1000.3040.013*A1C0.1500.083&lt;0.001***Pump Use -0.0740.3050.085CGM Use -0.0990.2510.021*

Disclosure
K.R. Stanek: None. S. Majidi: None. J.M. Vogeli: None. K.A. Driscoll: None.
RCT of Tailored Cognitive Behavioral Intervention Reduces Regimen-Related Distress—Relationship to Change in Medication Adherence and Glycemic Control at 12-Month Follow-Up
Authors: LUTES LESLEY , CUMMINGS DOYLE M. , HAMBIDGE BERTHA , CARRAWAY MARISSA , PATIL SHIVAJIRAO , ADAMS ALYSSA , SOLAR CHELSEY , LITTLEWOOD KERRY , EDWARDS SHEILA , GATLIN PEGGY 
Published: June 2018

Elevated regimen related distress (RRD) in type 2 diabetes (T2D) is associated with poor glycemic control and lower medication adherence but the strategy for and impact of reducing RRD in primary care is unclear. Data for this study comes from a prospective randomized controlled trial that evaluated the effectiveness of a 16-session severity tailored cognitive behavioral intervention plus lifestyle change counseling (n = 67; IG=intervention group) delivered by trained staff compared to usual care (n = 72; CG=control group), in 139 rural adult patients (mean age = 52.6 ± 9.5 years.; 72% black; BMI = 37.0 ± 9.0) with uncontrolled (mean A1c = 9.6 ± 2.0) T2D (52% on insulin) and co-morbid depressive (PHQ-2) or distress (DDS-2) symptoms at screening in an academic primary care clinic. At baseline and at 12-month follow-up: A1c, regimen-related distress (sub-score of DDS-17), depressive symptoms (PHQ-9), self-care behaviors (SDSCA), and medication adherence (ModMAS) were measured using validated instruments. There were no differences between groups at baseline in mean age, race, gender, or mean values for A1c, body mass index (BMI), PHQ-9, or RRD scores. At 12-month follow-up patients in the behavioral intervention group had significantly greater reduction in RRD scores than those in the control arm (-1.12 ± 1.vs. -0.31 ± 1.22; p = 0.001). Among intervention group patients only, those with an improvement in RRD score of ≥ 1 (n = 32) had substantially greater improvement in A1c [-1.3 ± 1.7 vs. -0.56 ± 1.9; p = 0.09] and self-care behaviors [+1.33 ± 1.38 vs. + 0.88 ± 1.2; p = 0.16] as well as significantly greater improvement in medication adherence [+1.6 ± 1.7 vs. +0.47 ± 2.2; p = 0.02]. A tailored cognitive behavioral intervention reduces RRD in patients with uncontrolled T2D and co-morbid behavioral problems and is associated with improved medication adherence that may be associated with improved glycemic control.

Disclosure
L. Lutes: None. D.M. Cummings: None. B. Hambidge: None. M. Carraway: None. S. Patil: None. A. Adams: None. C. Solar: None. K. Littlewood: None. S. Edwards: None. P. Gatlin: None.
Evaluation of Glomerular Hemodynamic Function by Empagliflozin in Diabetic Mice Using In Vivo Imaging
Authors: KIDOKORO KENGO , SOGAWA YUJI , CHERNEY DAVID , KULASINGAM VATHANY , NAGASU HAJIME , SATOH MINORU , SASAKI TAMAKI , KASHIHARA NAOKI 
Published: June 2018

Improvement of glomerular hyperfiltration via tubuloglomerular feedback (TGF) is considered to be one of the possible pathways for renal protection with SGLT2 inhibition (SGLT2i) in diabetic kidney disease (DKD). However, the mechanisms that regulate renal function in response to SGLT2i have not been fully elucidated. We explored the renal protective mechanisms of SGLT2i with empagliflozin (EMPA), with a focus on glomerular hemodynamic effects and TGF using in vivo multiphoton microscope (MPM) imaging techniques. C57BL/6 mice and spontaneously diabetic Ins2 Akita (AKITA) mice were used. The mice were treated with EMPA (20mg/kg/day) and insulin for four weeks, and single-nephron GFR (SNGFR) was measured using MPM. An nNOS inhibitor (7-nitroindazole, 20mg/kg/day) or a COX2 inhibitor (SC58236, 6mg/L), or an adenosine A1 receptor (A1aR) antagonist (8-cyclopentyl-1,3-dipropylxanthine, 1mg/kg/day) were administered to elucidate mechanisms of TGF signaling and SNGFR regulation. The urinary excretion of adenosine, nitric oxide metabolites (NOx) and the prostanoid PGE2 was also quantified. SNGFR in the AKITA group was higher compared to controls (C57BL/6; 4.9±1.3 nl/min vs. AKITA; 15.8±6.8 nl/min) and decreased in AKITA/EMPA to 8.0±3.3 nl/min (p&lt;0.01). In vivo imaging also revealed concomitant afferent arteriolar dilation (p&lt;0.01) and increased glomerular permeability of albumin in the AKITA group. EMPA ameliorated these changes (p&lt;0.01). Urinary adenosine excretion in the AKITA/EMPA group was higher compared to AKITA (AKITA; 3.4±1.4 nmol/day, AKITA/EMPA; 11.2±3.0 nmol/day, p&lt;0.05), while NOx and PGE2 did not differ. A1aR antagonism, but not nNOS or COX2 inhibition, blocked the effect of EMPA on renal function. EMPA increased urinary adenosine excretion and reduced hyperfiltration via afferent arteriolar constriction, effects that were abolished by A1aR blockade. The adenosine/A1aR system plays a pivotal role in the regulation of SNGFR via TGF mechanisms in DKD.

Disclosure
K. Kidokoro: Research Support; Spouse/Partner; Sanwa Kagaku Kenkyusho Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Chugai Pharmaceutical Co., Ltd., Pfizer Inc., MSD K.K., Boehringer Ingelheim Pharmaceuticals, Inc., Sanofi K.K., Takeda Pharmaceutical Co., Astellas Pharma Inc., TORII PHARMACEUTICAL Co.. Y. Sogawa: None. D. Cherney: Consultant; Self; AbbVie Inc.. Other Relationship; Self; AstraZeneca, Boehringer Ingelheim GmbH, Eli Lilly and Company. Consultant; Self; Sanofi. Other Relationship; Self; Merck & Co., Inc.. Consultant; Self; Mitsubishi Tanabe Pharma Corporation. Other Relationship; Self; Janssen Pharmaceuticals, Inc.. V. Kulasingam: None. H. Nagasu: None. M. Satoh: None. T. Sasaki: None. N. Kashihara: None.
Insulin Adherence Is a Mechanism Underlying Disparities in A1C for Younger Adults with Type 2 Diabetes
Authors: SEARS LINDSAY , HIRSCH ASHLEY , DACHIS JEFF , RAYMOND JENNIFER , HEYMAN MARK , HEAD RACHEL , OSBORN CHANDRA Y. 
Published: June 2018

Background: Diabetes disparities are well-documented. Racial/ethnic minority groups consistently have worse self-care and higher A1cs relative to non-Hispanic whites (NHWs). Less known are the underlying mechanisms contributing to disparities in diabetes outcomes that, if addressed, would mitigate disparities in A1c.
Objective: We tested whether insulin adherence is a mechanism underlying racial/ethnic disparities in A1c.
Methods: Adults (age 18-75 years) with type 2 diabetes (T2D) self-selected to be in a randomized control trial comparing inhalable, ultra-rapid-acting insulin (Afrezza) with One Drop vs. injectable, rapid-acting insulin with One Drop. Eligible persons completed an online survey and NGSP certified A1c test. Survey items collected demographic information and responses to the Adherence to Refills and Medications Scale for Diabetes (ARMS-D) administered for insulin only. SPSS and PROCESS v3.0 were used for descriptive statistics and unadjusted and adjusted mediation models with bootstrapped (10K) CIs for tests of indirect effects.
Results: Participants (N=269) were 50 & 11 years old, 51% male, 30% non-white, with 13 & 8 years since a T2D diagnosis, and A1c 8.8% & 1.8%. Compared to NHWs, non-whites were less adherent to their insulin regimen (ARMS-D = 35.4 vs. 37.2, p&lt;.05) and had a higher A1c (9.2% vs. 8.6%, p &lt; .05). Among younger adults (&lt;49.94 years old), not taking enough insulin was a mechanism linking non-white race/ethnicity to having a higher A1c (unadj. coef.=.40, 95% CI: .09, .79; adj. coef.=.33, 95% CI: .01, .77). Among people over age 50, there was no indirect effect of non-white race/ethnicity on higher A1c via less adherence to insulin.
Discussion: Reducing disparities in insulin adherence may reduce disparities in A1c for younger adults, but not older adults. Other mechanisms underlying diabetes disparities may be age- or cohort-specific. Understanding these nuances can inform interventions aimed at reducing disparities in diabetes.

Disclosure
L. Sears: Employee; Self; Informed Data Systems Inc.. Research Support; Self; MannKind Corporation. A. Hirsch: Employee; Self; One Drop. Research Support; Self; MannKind Corporation. J. Dachis: Stock/Shareholder; Self; One Drop. Board Member; Self; One Drop. Employee; Self; One Drop. J. Raymond: None. M. Heyman: Employee; Self; One Drop. R. Head: None. C.Y. Osborn: Employee; Self; One Drop. Research Support; Self; MannKind Corporation. Stock/Shareholder; Self; One Drop.
Experiences of Enrolling in the U.S. Monogenic Diabetes Registry
Authors: LADSARIA SALLY S. , MONTGOMERY JAZZMYNE , LINDAUER KATHERINE L. , NAYLOR ROCHELLE N. 
Published: June 2018

The U.S. Monogenic Diabetes Registry (Registry) facilitates accurate genetic diagnosis, gene-directed management and longitudinal follow-up of monogenic diabetes. Through the Registry, we currently follow 569 individuals with MODY, 74% of who have had genetic testing through Registry-related studies. We aimed to understand participants’ experiences of accessing, enrolling and participating in the Registry.
Through one-on-one semi-structured interviews participants were queried on how they were diagnosed with MODY, understanding of their diagnosis, and their experiences as Registry participants. An iterative process of coding, analyzing, and summarizing transcripts was completed using thematic analysis.
Data collection and analysis are ongoing. To date, we have conducted 8 interviews. Prolonged misclassification of diabetes type and delayed consideration of and referral for monogenic diabetes evaluation were commonly reported. Participants reported negative effects from diabetes misclassification, including emotional, financial and treatment burden. Participants were generally positive regarding interactions with the Registry. However, long turnaround times for research-based genetic testing results negatively impacted some participants. Levels of provider knowledge, healthcare access, socioeconomic status (SES), culture, language and self-efficacy were identified as important facilitators or barriers to Registry referral and enrollment for accurate MODY diagnosis.
Our study demonstrates multiple negative impacts of delay in MODY diagnosis. It also shows the utility of the Registry in aiding in MODY diagnosis. Efforts should focus on increased visibility of the Registry to diabetes providers and directly to patients. Specific measures to increase knowledge of and facilitate enrollment in the U.S. Monogenic Diabetes Registry among lower SES patients, non-native English speakers and racial and ethnic minorities can help address apparent ascertainment bias within the Registry.

Disclosure
S.S. Ladsaria: None. J. Montgomery: None. K.L. Lindauer: None. R.N. Naylor: None.