bluuebunny/crossref_metadata_2025_split huggingface dataset:
Digital Dietitian—Pilot Study of a Novel Smartphone Application
Authors: FARFAN CHRISTIAN C. , AXELROD CEARA , FRASE DONNA L. , MACKENZIE ANDREW , HAROUSH GAL , CASTORINO KRISTIN 
Published: June 2018

Objective: There is a global need for individualized dietician education for the management and prevention of diabetes. Dietician consultation achieves better outcomes than primary care guidance alone, but long-term diet counseling to support sustained change is costly. Smartphones have provided new, scalable methods for achieving and maintaining lifestyle changes. The primary aim of this study was to determine whether the dietary recommendations made by a Digital Dietician were comparable to those made by a registered dietician in terms of safety, practicality, nutrition, health, and calorie control. A secondary aim was to determine the usefulness of the Digital Dietician to help individuals achieve lifestyle changes.
Methods: Two dieticians analyzed nearly 2,000 dietary recommendations given by the app over 4 months. A five point scale was assigned to each of the following categories: safety, practicality, nutrition, health, and calorie control. In addition, we also measured participant engagement with the app, changes in body weight over time, and participant reported results of their experience with the app.
Results: The overall composite score of the application’s recommendations was 17.9 out of 25 (higher scores indicate better recommendations). Recommendations scored most highly in the safety category, averaging 4.92 out of 5 points (SD ± 0.35), followed by practicality (4.00 ± 1.39), health (3.29 ± 1.09), and nutrition (3.± 1.13), with calorie control receiving the lowest scores (2.65 ± 1.35). Participants indicated that the app helped them achieve their health goals, and we observed an average weight loss of 0.31 pounds per week while the app was being used.
Conclusion: The recommendations given by the app were comparable to those of a dietician. The app also appears to have helped participants set and achieve their health goals. While there is certainly room for improvement, this and other nutrition applications for mobile devices have an exciting potential and offer a framework for evaluation.

Disclosure
C.C. Farfan: None. C. Axelrod: None. D.L. Frase: None. A. Mackenzie: Stock/Shareholder; Self; Johnson & Johnson Services, Inc.. G. Haroush: None. K. Castorino: None.
Impact of the No-Carrageenan Diet on Glucose Tolerance and Insulin Resistance in Adults with Prediabetes
Authors: TOBACMAN JOANNE K. 
Published: June 2018

Previous animal and cell-based studies indicated that exposure to the common food additive carrageenan impaired glucose tolerance and increased insulin resistance. Carrageenan is widely used in processed foods to improve solubility, but predictably causes inflammation, which contributes to insulin resistance by inhibition of insulin signaling. To test if removal of carrageenan from the diet could reduce insulin resistance, we initiated a double-blinded, controlled feeding study in individuals with prediabetes, defined by Hemoglobin A1c values of 5.7%-6.4%. All procedures were approved by the University of Illinois at Chicago IRB. Participants were provided study diets for 12 weeks, which either contained or did not contain carrageenan, and had similar composition of protein, carbohydrate, and fat. An additional group was comprised of individuals who participated in study tests, but ate their usual diet. Subjects on study diets picked up their food weekly at UIC and had blood tests, including 2h glucose tolerance tests performed at entry, 6, and 12 weeks. Inflammatory parameters, including fecal calprotectin, were measured at entry and conclusion. Preliminary study results from 17 participants indicate that the carrageenan-free diet was associated with significant decline in hemoglobin A1c (p=0.004, unpaired t-test, two-tailed), HOMA-IR (homeostatic model for insulin resistance) score (p=0.0064), insulin resistance (p=0.02), and leukocyte phospho-serine IRS-1 (p=0.003) and NF-kappaB, compared to study participants on the control study diet or their regular diet. Study findings indicate significant decline in insulin resistance by removal of carrageenan from the diet. Additional studies of inflammatory parameters, immune cell subsets, and fecal microbiome are pending.

Disclosure
J.K. Tobacman: None.
Carnosine Supplementation Improves Serum Resistin Concentrations in Overweight or Obese but Otherwise Healthy Sedentary Adults—Results From Randomised Controlled Trial
Authors: DE COURTEN BARBORA , UKROPEC JOZEF , MOUSA AYA , UKROPCOVA BARBARA , ALDINI GIANCARLO , BAYE ESTIFANOS 
Published: June 2018

Adipokines play an important role in the regulation of glucose metabolism. We have previously shown that carnosine supplementation in overweight or obese nondiabetic individuals improved glucose metabolism but did not change adiponectin levels, however its effect on other adipokines has not been investigated. We aimed to determine the effect of carnosine supplementation on serum adipsin, resistin and leptin concentrations in these individuals. Twenty-two overweight or obese otherwise healthy adults were randomly assigned to receive either 2g of carnosine (n=13) or identically looking placebo (n=9) for 12 weeks. Serum adipsin, leptin and resistin were analysed using a bead-based multiplex assay (LEGENDPlex™, BioLegend, CA). Carnosine supplementation decreased serum resistin concentrations compared to placebo (mean change from baseline: -35 ± 83 carnosine vs. 35 ± 55 ng/ml placebo, p=0.04). There was a trend for a reduction in serum leptin concentrations after carnosine supplementation (-76 ± 165 ng/ml carnosine vs. 20 ± 28 ng/ml placebo, p=0.06). Change in leptin and resistin were inversely related to change in concentrations of urinary carnosine (r =-0.72, p = 0.0002; r= -0.67, p=0.0009, respectively), carnosine-propanal (r= -0.56, p=0.005; r= -0.63, p=0.001, respectively) and carnosine-propanol (r=-0.61, p=0.002; r = -0.60, p=0.002, respectively). There were no differences between groups in change in adipsin concentrations (both p&lt;0.1). Our findings suggest that carnosine supplementation may normalise some but not all serum adipokine concentrations involved in glucose metabolism in overweight and obese individuals. Further clinical trials with larger samples are needed to confirm these results.

Disclosure
B. de Courten: None. J. Ukropec: None. A. Mousa: None. B. Ukropcova: None. G. Aldini: None. E. Baye: None.
Protein-Restricted Diet Is Effective in Decreasing Glycemia, HbA1c, and Cholesterol in Type 2 Diabetic Subjects by the Activation of the GCN2 Pathway
Authors: FERRAZ RAFAEL C. , BERALDO REBECA A. , GOMES PATRICIA , FOSS MILTON C. , FOSS-FREITAS MARIA CRISTINA 
Published: June 2018

Dietary restriction increases lifespan across the evolutionary spectrum and decreases metabolic disease risk in mammals. It has been shown that amino acid restriction is sufficient to promote some of the beneficial effects of dietary restriction in rodents. This phenomenon is dependent on GCN2 (general control nonderepressible 2), a kinase activated by amino acid restriction that controls protein synthesis and stress response. Our results show that treatment of type 2 diabetic subjects on a protein restriction diet for 4 weeks exhibited a 61% reduction in fasting glucose levels and a 14% decrease in Hb1Ac. These patients had a 32% reduction in Total Cholesterol with a 33% decrease in LDL. We noticed a reduction of 4.5% of body weight, with a decrease of 11% of fat mass and maintenance of lean mass. In addition, all subjects had systemic blood pressure normalization, with a decrease of 23% in systolic pressure and 44% in diastolic pressure. In order to understand in detail the action of protein restriction we evaluated the gene expression in the subcutaneous adipose tissue of these individuals. We observed the activation of GCN2 expression (p=0.0394) and consequently the activation of ATF4 (Activating transcription factor 4) and CHOP (C/EBP homologous protein) (p=0.0360 and p=0.0011 respectively). This findings suggesting that in fact, protein restricted diet affects the GCN2 pathway in humans, modulating the energy metabolism and enabling glycemic and lipidemic control.

Disclosure
R.C. Ferraz: None. R.A. Beraldo: None. P. Gomes: None. M.C. Foss: None. M. Foss-Freitas: None.
High Prevalence of Distress among Patients with Type 2 Diabetes (T2DM)—A Hospital-Based, Cross-Sectional Study from South India
Authors: SANKAR PRASANTH , SASIKUMAR PRIYANKA , MEDAYIL RITUNA , JACOB RITTIN , SASIDHARAN SARANYA 
Published: June 2018

Background: Diabetes distress (DD) refers to unique, often hidden emotional burdens and worries, distinct from clinical depression, that are part of the spectrum of patient experience when managing diabetes.
Aim: To assess DD and its association with various parameters in patients with T2DM.
Methodology: A cross sectional study was done on 262 out-patients with T2DM in a multispecialty hospital in South India. DD was measured by DDS-17, a 17-item self-reported DD scale used with subscales in 4 domains - Emotional burden (EB), Physician, Regimen and Interpersonal distress. Overall score &lt; 2.0 was little or no distress, 2.0-2.9 moderate, ≥3.0 was high distress. Data was analysed using SPSS version 11.5.
Results: Mean age of participants was 59.7 ± 9.1 years. Females constituted 71.8%. BMI was ≤ 25kg/m2 in 32.8%. Duration of diabetes was &lt; 10 years in 42%. Insulin was used by 45%. Mean HbA1c was 8.7±1.7%. Prevalence of DD was 27.9%, with moderate distress in 22.1% and high distress in 5.7%. Mean total DD score was 1.67± 0.59. Mean for EB, physician-related, regimen-related and interpersonal distress were (2.1 ± 1.02), (1.09 ± 0.33), (1.92 ± 0.89), (1.30± 0.76) respectively. Total DD had significant association with BMI (p=0.04), duration of T2DM (p=0.04), HbA1c (p=0.01), neuropathy (p=0.002) and nephropathy (p=0.008). EB, considered most important domain, was associated with duration of T2DM (p=0.02), insulin use (p=0.002), neuropathy (p&lt;0.001), nephropathy (p=0.008), high HbA1c levels (p=0.001), ASCVD in females (p&lt;0.001). Regimen related distress was more in those with high HbA1c (p=0.001) and smokers (p=0.04).
Discussion: The study, first of its kind from South India, identifies high prevalence of DD in this population Assessment of DD should be integrated into patients’ self-care plan. Patients become more involved in managing diabetes if their specific emotional distress are taken care of, and have a better sense of social care, health control and self-efficacy.

Disclosure
P. Sankar: None. P. Sasikumar: None. R. Medayil: None. R. Jacob: None. S. Sasidharan: None.
Economic Evaluation of Group Medical Visits for Adults with Diabetes in Community Health Centers
Authors: WAN WEN , STAAB ERIN M. , HAM SANDRA A. , CAMPBELL AMANDA , SCHAEFER CYNTHIA T. , QUINN MICHAEL T. , BAIG ARSHIYA 
Published: June 2018

Background: Diabetes group visits (GVs) - shared appointments that incorporate medical care, diabetes self-management education, social support, and goal-setting - were recently examined in a network of U.S. community health centers (HCs) and found to improve glucose control and diabetes-related quality of life.
Objective: To evaluate the economic impact of group visits (GV) in adults with diabetes in HCs.
Methods: In a pilot prospective matched case-control trial, we implemented 6 monthly GV sessions in 5 HCs and compared intervention patients (n=49) to control patients receiving usual care within the same HCs (n=72). We conducted patient chart reviews to obtain healthcare utilization data for the prior 6 months, at baseline, 6, and 12 months and collected monthly logs of HC expenses and staff time spent on activities related to GVs, including training, planning, implementation, and evaluation. Total costs included HCs’ expenses and activities and patients’ healthcare use over one year. Wilcoxon rank-sum tests, generalized linear models, and modified Park tests were used to compare the healthcare use and cost data.
Results: Despite each HC spending $17,342 on average (or $1770 per-patient) for the GV preparation and implementation, the per-patient annual total costs were not different between the groups (GV: $3,982 vs. control: $4,287, p=0.73). Most of the benefits were due to GV patients having fewer hospitalizations (p=0.08) and fewer primary care visits that occurred outside the trial (p=0.01). After excluding the staff training costs (mean $7,962 per HC), the GV group had significantly lower total costs ($3,169) than the control group (p &lt;0.01).
Conclusions: The diabetes group visits in health centers improved patients’ healthcare quality without increasing overall healthcare costs. In subsequent GV sessions, excluding the need for staff training, group visits may be cost saving. Future studies should assess the cost-effectiveness of group visits.

Disclosure
W. Wan: None. E.M. Staab: None. S.A. Ham: None. A. Campbell: None. C.T. Schaefer: None. M.T. Quinn: None. A. Baig: None.
Cognitive Behavioral Intervention Produces Comparable Reductions in Regimen-Related Distress in Insulin Users and Nonusers—Twelve-Month Results from COMRADE
Authors: LITTLEWOOD KERRY , PATIL SHIVAJIRAO , CUMMINGS DOYLE M. , LUTES LESLEY , HAMBIDGE BERTHA , CARRAWAY MARISSA , ADAMS ALYSSA , SOLAR CHELSEY , EDWARDS SHEILA , GATLIN PEGGY 
Published: June 2018

Complex treatment and monitoring behaviors that accompany insulin use can be associated with higher levels of regimen-related distress (RRD), poor glycemic control, and lower medication adherence. Whether cognitive behavioral intervention can provide comparable impact on distress levels in insulin-using and non-insulin using patients is poorly described. COMRADE was 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) type 2 diabetes 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, RRD (sub-score of DDS-17), self-care behaviors (SDSCA), and medication adherence (ModMAS) were measured using validated instruments. This analysis specifically examined changes in RRD in insulin users (n = 41, 61%) vs. oral medications and lifestyle change users (n = 26, 39%) in the intervention arm only. While A1c was higher in insulin users at baseline as expected, there were no other significant differences between insulin-users and non-users at baseline. Cognitive behavioral intervention produced comparable improvement in RRD (-1.1 ± 1.1 vs. -1.0 ± 0.9; p = 0.6), self-care behaviors (+1.0 ± 1.3 vs. +1.3 ± 1.3; p = 0.4) and medication adherence (+1.0 ± 1.9 vs. +1.0 ± 2.2; p = 0.9) in insulin users vs. non-users. Insulin users had a greater reduction in A1c (-1.1 ± 1.9 vs. -0.6 ± 1.5; p = 0.3). Tailored cognitive behavioral intervention produces comparable improvements in RRD, self-care behaviors, medication adherence and A1c in insulin users and non-users.

Disclosure
K. Littlewood: None. S. Patil: None. D.M. Cummings: None. L. Lutes: None. B. Hambidge: None. M. Carraway: None. A. Adams: None. C. Solar: None. S. Edwards: None. P. Gatlin: None.
Factors Affecting Noninsulin Antidiabetic Drug Adherence in Patients with Type 2 Diabetes
Authors: PETRENCHIK LINDSAY , ELLEN LOH F. 
Published: June 2018

Adherence to antidiabetic (AD) medication is a multifactorial phenomenon; however, little is known about which factors are the most contributory. Our objective was to conduct a systematic review aiming to quantify the effect of factors associated with medication nonadherence in patients with type 2 diabetes using non-insulin AD (NIAD) drugs. We conducted a systematic literature search of relevant observational studies published from January 1997 through March 2017. Studies were included if they used medication possession ratio (MPR) or proportion of days covered (PDC) to evaluate adherence associated with factors, were published in the last 10 years, and did not include insulin. The factors identified were then grouped based on the dimensions of medication adherence defined by the World Health Organization (WHO). The search yielded 1studies of which 25 met criteria. Socioeconomic factors associated with increased adherence were older age, male gender, and Caucasian race which were supported by 15, 10, and 8 studies, respectively. Health system related-factors associated with increased adherence were a general practitioner as the initial prescriber and mailed prescriptions, which were supported by 2 and 3 studies, respectively. The most prevalent condition-related factors were no hospitalized in the past year, frequent physician visits, and absence of cancer, each of which were supported by 3 studies. In regards to therapy-related factors, patients prescribed metformin, and who have a higher pill burden are more likely to be adherent, which were supported by 5 and 8 studies respectively. Only one study analyzed a WHO defined patient-related factor, which found a negative relationship between patients’ diabetes-related knowledge and adherence.
In conclusion, the major factors reported to be associated with NIAD nonadherence were younger age, female, non-Caucasian race, not using mailed prescriptions, cancer diagnosis, lower number of comorbidities, and a smaller pill burden.

Disclosure
L. Petrenchik: None. F. Loh: None.
Engaging Hispanic Adolescents with Type 2 Diabetes or Obesity in Personalized Exercise
Authors: FAULKNER MELISSA S. , MICHALISZYN SARA 
Published: June 2018

The prevalence of obesity in Hispanic youth (21.9%; Ogden and Flegal, 2015) is the highest of all racial and ethnic groups, increasing their odds for the development of type 2 diabetes (T2D). The purpose of this secondary analysis of a larger trial of a 16-week personalized exercise intervention was to examine differences in exercise adherence and baseline perceptions of benefits and barriers to exercise, exercise self-efficacy and family support to exercise in Hispanic adolescents diagnosed with T2D or obesity. Changes in body mass index, waist circumference, glycosylated hemoglobin (HbA1c), homeostatic model for insulin resistance (HOMA-IR), lipid profile, cardiorespiratory fitness, blood pressure and perception of health were also examined following the intervention. There were 21 adolescents enrolled in the study, 13 with T2D (3 males, 10 females) and 8 who were obese (3 males, 5 females). The personalized programs were based upon individual adolescent choices to promote moderate to vigorous activity (MVPA) and included gym memberships, dance videos, biking, basketball, softball and walking. Adolescents wore the ActigraphTM accelerometer (model GT1M, Pensacola, FL) for tracking exercise throughout the intervention. The completion rate was 88% vs. 59% (67% overall) for obese vs. T2D, with obese adolescents engaging in higher duration of MVPA compared to those with T2D (mean 46.4 ± 33.8 vs. 36.3 ± 16.0 min/day, NS). Perceptions of family support for exercise were associated with benefits of exercise (r = .50, p = .021); barriers to exercise were associated with less MVPA (r = - .56, p = .017). Barriers were significantly higher in those with T2D (p = .01). Despite not meeting recommended activity guidelines, perceptions of health improved for all completing the intervention (p = .01). Future efforts for engaging Hispanic adolescents in regular exercise are warranted to delay the onset of T2D and the development of poor outcomes particularly for those already diagnosed with T2D.

Disclosure
M.S. Faulkner: None. S. Michaliszyn: None.
Impact of Intensive Lifestyle Intervention for Weight Management on Self-Reported Cognitive Function—The Action for Health in Diabetes (Look AHEAD) Randomized Controlled Trial
Authors: DUTTON GARETH R. , ESPELAND MARK , NEIBERG REBECCA H. , CARMICHAEL OWEN , HAYDEN KATHLEEN M. , JOHNSON KAREN C. , JEFFERY ROBERT W. , BAKER LAURA D. , COOK DELILAH , KITZMAN DALANE , RAPP STEVE R. 
Published: June 2018

Background: Intensive lifestyle interventions (ILI) to reduce weight and increase physical activity may preserve higher-order cognition in overweight and obese adults with type 2 diabetes (T2D).
Methods: Adults with T2D who enrolled in a randomized clinical trial of a 10-year ILI compared with diabetes support and education (DSE; N=5,084; mean age=58.7 years; mean BMI=35.9 kg/m2; 36.8% racial/ethnic minority) provided self-assessments of difficulty with memory, problem-solving, and decision-making abilities at baseline and over ≥10 years of follow-up. The Health Utilities Index assessed memory and problem-solving; the Beck Depression Inventory-II assessed decision-making. Analyses included the full sample and sub-groups based on baseline weight status and history of cardiovascular disease (CVD).
Results: At baseline, 12%, 16%, and 23% of all participants reported some difficulty with problem-solving, decision-making, and memory, respectively. For those without baseline self-identified cognitive difficulties in a specific domain, ILI was associated with lower odds of decision-making difficulties at follow-up compared to DSE (odds ratio [OR]=0.85, [95% CI 0.75,0.97]). Among those who were not obese, ILI was associated with lower odds of problem-solving difficulties at follow-up (OR=0.69 [0.51,0.95]). For participants with self-identified cognitive difficulties at baseline who had a history of CVD, ILI may have worsened difficulties in problem-solving at follow-up visits (OR=2.95 [1.38,6.31]).
Conclusions: A long-term ILI targeting weight loss and physical activity may protect self-reported higher-order cognitive abilities in adults with T2D without preexisting memory, problem-solving, or decision-making problems. However, among those with preexisting problems, ILI was not protective.

Disclosure
G.R. Dutton: None. M. Espeland: Consultant; Self; Boehringer Ingelheim GmbH, Janssen Pharmaceuticals, Inc.. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases, National Institute on Aging, National Heart, Lung, and Blood Institute. R.H. Neiberg: None. O. Carmichael: None. K.M. Hayden: None. K.C. Johnson: None. R.W. Jeffery: None. L.D. Baker: None. D. Cook: None. D. Kitzman: Advisory Panel; Self; AbbVie Inc.. Research Support; Self; AstraZeneca. S.R. Rapp: None.