bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interdisciplinary Educative Structured Diabetes Program Effect on Health-Related Quality of Life and Anxiety/Depression Perception in Patients Attending a Primary Care Diabetes Clinic in Mexico City
Authors: SILVA-TINOCO RUBÉN , CUATECONTZI ENEDINA TERESA , ALONSO AMAYRANI GÓMEZ , ROMERO-IBARGUENGOITIA MARIA ELENA , DE LA TORRE-SALDAÑ VIRIDIANA A. , CABRERA-GERARDO MARÍA DOLORES D. , GUZMÁN OLVERA EILEEN B. , GONZÁLEZ ENRIQUE , MEZA DANIELA G. 
Published: June 2018

Quality of life(QoL) is an important health outcome and diabetes affects major components of QoL, including physical, psychological and social. There is limited evidence about the effect of Diabetes Self-Management Education (DSME) on QoL in primary care urban population of low- and middle-income countries. This study evaluated the effect on Health-Related Quality of Life (HRQoL) in patients who attended an interdisciplinary educative structured program at Clínica Especializada en el Manejo de la diabetes in México City-Iztapalapa in 2017. Intervention lasted 5 months and included individual and group sessions in a shared medical appointments model aimed at promoting self-care. In 252 patients with type 2 diabetes, HRQoL was assessed from the EuroQoL 5D-5L, which is a generic instrument for this purpose including 5 dimensions: mobility, self-care, daily activities, pain/discomfort, and anxiety/depression. It reports an indexed score and a visual analogue scale (VAS) score, and highest scores obtainable are of 1 and 100, respectively. Women represented 67%, and 59.6% had elementary or less education. Mean age was 55±10 years old, and mean duration of diabetes was 13±8 years. Indexed score and VAS score increased from 0.76±0.14 to 0.87±0.14 (mean variation 0.1±0.14; p=&lt;0.001) and from 62.6±24 to 88.4±11 (mean variation 25.7±26; p=&lt;0.001), respectively. The highest improvement in a HRQoL dimension was the decreased proportion of patients without problems perception related to anxiety/depression from 63.2% to 26% (p=&lt;0.001). This non-pharmacological therapeutic approach focused on DSME improved HRQoL. Our findings suggest the role of DSME in this population beyond the traditional physical component impact, since it favors the fulfillment of multiple interrelated objectives through different mechanisms, generating a diversity of positive results, including HRQoL.

Disclosure
R. Silva-Tinoco: Speaker's Bureau; Self; Novartis Pharmaceuticals Corporation. E. Cuatecontzi: None. A. Gómez Alonso: None. M. Romero-Ibarguengoitia: None. V.A. De La Torre-Saldañ: None. M.D. Cabrera-Gerardo: None. E.B. Guzmán Olvera: None. E. González: None. D.G. Meza: None.
Cost Calculation and Adherence to ADA Recommendations Based on a Flash Continuous Glucose Monitoring System for People with T1DM or T2DM Using MDI Therapy
Authors: HELLMUND RICHARD 
Published: June 2018

Background: A novel, factory-calibrated, flash continuous glucose monitoring system (flash CGM; FreeStyle Libre™ system) was approved by FDA in September 2017. The clinical benefit of flash CGM as a replacement for routine self-monitoring of blood glucose (SMBG) for people using MDI therapy has been assessed in RCTs in T1DM (Bolinder, 2016) and T2DM (Haak,2017). In both 6-month studies, people using flash CGM achieved a substantial reduction in hypoglycemia compared with those using SMBG, without increasing HbA1c or reducing the dose of insulin. A cost calculation based on ADA recommendations is presented, comparing the acquisition cost of flash CGM with routine SMBG.
Methods: The ADA Standards of Medical Care in Diabetes (2017) recommend between 6 to 10 glucose tests per day for people with diabetes who are using MDI therapy. List prices are $1.42 per strip and $36.00 per sensor. Sensor duration is up to 10 days. In the T1DM RCT, people using flash CGM also used 0.5 SMBG tests/day on average; in the T2DM RCT, people using flash CGM also used 0.3 SMBG tests/day. The calculation is based on a 30-day month.
Results: Monthly cost of 10 SMBG/day is $426.00 and of 6 SMBG/day is $255.60. This is compared with the monthly sensor cost of $108.00, to which should be added the monthly cost of occasional SMBG based on utilization in the RCTs: $21.30 per person per month (PPPM) for people with T1DM and $12.78 for people with T2DM. For those testing 6 times/day, flash CGM saves over $120 PPPM compared with SMBG and it saves over $290 PPPM for people testing 10 times/day. For people testing more than 3 times/day, flash CGM has a lower acquisition cost than SMBG.
Conclusion: For people with T1DM or T2DM who use MDI therapy, flash CGM has demonstrated improved adherence to the ADA recommendation as well as reduced acquisition cost when compared with routine SMBG.

Disclosure
R. Hellmund: Employee; Self; Abbott. Stock/Shareholder; Self; Abbott.
Assessing the Evaluability of Type 2 Diabetes Prevention and Diabetes Management Interventions Focusing on Underserved Populations
Authors: FARRIS KIMBERLY D. , BONNER TIMETHIA , RUTLEDGE GIA E. , SMITH BRYCE 
Published: June 2018

Rates of diabetes and diabetes-related health complications continue to rise among African American and Latino populations. Additional research and evaluations of the National Diabetes Prevention Program (National DPP) and diabetes self-management education and support (DSMES) programs are essential for identifying and disseminating best practices to help underserved populations prevent type 2 diabetes and manage diabetes. Authors implemented a systematic screening and assessment methodology to identify and examine National DPP and DSMES programs in underserved communities that demonstrated high participation rates and improved outcomes within African American and Latino populations. This study describes the screening methods used to identify programs and lessons learned from promising and innovative practices shown to be effective in recruitment and retention of African American and Latino populations into the National DPP and DSMES. Of the 9 National DPP and 9 DSMES programs that met the inclusion criteria, 4 of each were selected for evaluability assessments. Lessons learned regarding recruitment, retention, cultural tailoring, effectiveness of evidence, and organizational capacity were identified. Specific strategies that supported program success included community partnerships, instructor or coaches/participant racial concordance, holding classes in multiple locations, and including more group sessions. A panel of diabetes subject matter experts reviewed information on program design, implementation, and data collection capacity to recommend 4 programs to participate in a rigorous evaluation.

Disclosure
K.D. Farris: None. T. Bonner: None. G.E. Rutledge: None. B. Smith: None.
Aerobic Training Remodels Muscle Lipid Composition and Improves Intrinsic Mitochondrial Function in Men with Type 2 Diabetes
Authors: PINO MARIA F. , STEPHENS NATALIE , YI FANCHAO , HODGES ANDREW P. , PRATLEY RICHARD E. , SMITH STEVEN R. , GOODPASTER BRET H. , SPARKS LAUREN M. 
Published: June 2018

The effects of exercise training on the skeletal muscle (SKM) lipidome and mitochondrial function have not been thoroughly explored in individuals with type 2 diabetes (T2D). We investigated the effects of exercise training on molecular signatures within SKM of T2D, employing integrated multi-omics data analyses including lipidomics [MS/MS-shotgun], global DNA methylation and transcriptomics [RNA-Seq]. Muscle tissue and cellular mitochondrial respiration was quantified by high resolution respirometry. Ten weeks of aerobic training increased monolysocardiolipin (MLCL), a marker of mitochondrial remodeling, reduced total and specific species of sphingomyelin (SM), phosphatidylserine (PS) and ceramides lipid content and improved intrinsic mitochondrial respiration in SKM of T2D without alterations in mitochondrial DNA copy number or cardiolipin content. Exercise training differentially modified 50 DNA methylation sites. Among these genes, NOX4, acts as an oxygen sensor and catalyzes the reduction of reactive oxygen species (ROS), and PLCE1, catalyzes the hydrolysis of phosphoinositol 1,4,5-triphosphate (IP3) and DAG, were hypo-methylated and hyper-methylated, respectively, following training. Exercise training differentially regulated 70 transcripts in SKM of T2D that resulted in enrichments of lipid and amino acid metabolism and β-oxidation pathways.
In summary, aerobic training improves intrinsic and cell autonomous SKM mitochondrial function and modifies SKM lipid composition in men with T2D, with potentially advantageous augmentations of oxidative stress and insulin signaling pathways.

Disclosure
M.F. Pino: None. N. Stephens: None. F. Yi: None. A.P. Hodges: None. R.E. Pratley: Other Relationship; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Eisai Inc., GlaxoSmithKline plc., Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Ligand Pharmaceuticals, Inc., Eli Lilly and Company, Merck & Co., Inc., Novo Nordisk Inc., Pfizer Inc., Sanofi-Aventis, Takeda Development Center Americas, Inc.. S.R. Smith: None. B.H. Goodpaster: None. L.M. Sparks: None.
Factors Associated with Medication Adherence among Type 2 Diabetes Mellitus Patients in Nepal
Authors: SHAKYA PUSHPANJALI , KARMACHARYA BIRAJ M. , SHRESTHA ARCHANA , KULSENG BAARD E. 
Published: June 2018

Background: Diabetes is increasing globally resulting in 1.5 million deaths in 2012. The high mortality is due to life-threatening complications of uncontrolled sugar. Medication helps to control glucose level and prevents its complications.
Objective: To identify the factors associated with medication adherence among type 2 diabetes mellitus (DM) patients.
Methods: A hospital based cross sectional study was conducted among 343 patients visiting Dhulikhel Hospital, Nepal for their regular Fasting Blood Sugar test from September to December 2016. Inclusion criteria were (i) type 2 DM patients (ii) under diabetes medication from at least past three months (iii) aged 18 years or above. We measured medication adherence using Nepali version of 8 item Morisky Medication Adherence Scale (MMAS-8) (© 2007 Donald E. Morisky). Adherence was categorized as high if MMAS score was equal to 8 and moderate/low if it was less than 8. We used standard questionnaire to measure socio-demographic and clinical factors. Multivariate logistic regression was applied to assess factors associated with medication adherence.
Results: Proportion of high and moderate/low medication adherence among the respondents were 60.9% and 39.1% respectively. In multivariate logistic regression, high medication adherence was found to be positively associated with formal education [AOR: 2.43 (95% CI: 1.34, 4.39), p=0.003] and attendance of diabetes counseling [AOR: 1.76 (95% CI: 1.02, 3.04), p=0.04] after adjusting for age, occupation, annual household per-capita income, medicine intake duration and diabetes medicine types. Other variables in the model were not statistically significantly associated.
Conclusion: Formal education and attendance of diabetes counseling were found to positively affect patients’ adherence to medicine. We encourage heath care institutions to provide counseling services to all type 2 DM patients and focus more on those who are least educated.

Disclosure
P. Shakya: None. B.M. Karmacharya: None. A. Shrestha: None. B.E. Kulseng: None.
MicroRNA Regulated Transcriptomic Changes during Aging in Human Skeletal Muscle Are Reversible with Exercise Training
Authors: VALENTINE JOE , GHOSH SANGEETA , MILHOLLAND BRANDON , GELFOND JONATHAN A. , MUSI NICOLAS 
Published: June 2018

Muscle mass declines with age (sarcopenia) in both men and women resulting in impaired physical function and altered glucose metabolism. Endurance exercise training can mitigate and even reverse some of the changes in skeletal muscle structure and function, which are observed at advanced age. To gain insight into the potential mechanisms driving sarcopenia and the adaptive response to training, we conducted deep sequencing on vastus lateralis muscle obtained from healthy, younger (n=14; age=27±0.89 y; 8 women, 6 men) and older (n=14, age=71±1.39 y; 7 women, 7 men) subjects before and after a 4 month endurance training program. We analyzed the sequencing data with bioinformatics tools to determine whether miRNAs that change with age can be reverted back to youthful levels with training. We found that skeletal muscle from women had 7 miRNAs and men had 8 miRNAs that changed with age and were reverted back to youthful levels with training, respectively. In older trained females these 7 miRNAs targeted 94 unique transcripts in the top 1000 differentially expressed genes between post-training compared to pre-training and these transcripts were involved in lipid metabolism, glycolysis, and growth. In older men the 8 miRNAs with youthful signatures after training had 146 unique targets involved in phosphoprotein and PI3K-AKT signaling, as well as cholinergic synapses. Notably, miR-29b-3p was primarily responsible for the regulation of target transcripts within the PI3K-AKT pathway in older trained men; similar family members (miR-29a-3p and miR-29c-3p) have been directly linked to insulin sensitivity in preclinical models. All miRNAs with youthful signatures in older trained subjects had opposing expression patterns to their target mRNAs. We conclude that some of the aging related changes to the skeletal muscle transcriptome are under the regulation of miRNAs and that exercise training can reverse these changes.

Disclosure
J. Valentine: None. S. Ghosh: None. B. Milholland: None. J.A. Gelfond: None. N. Musi: None.
Dietary Education via Teacher–Diabetologist Cooperation
Authors: KANEKO SHIZUKA , ONOGI YUMI , MICHIBATA RYOKO 
Published: June 2018

A workforce shortage due to a never before experienced super aged society is coming to Japan. At present, the major producers of society (40-year-olds) are suffering from an increasing incidence of diabetes. Dietary education to S is most important in helping the future labor force develop precautions against life-related diseases before entering the labor force. Student lessons focusing on sugar totals, how to calculate sugar amounts included in beverages, in addition to information on diabetic complications were provided. Problems that occur following severely reduced food intake were also covered. A D provided dietary education to 1100 junior high and high school S on disease development for 3 years in 3 schools. Surveys show, prior to lectures, over 60% of S were aware of health considerations. However, the decision to eat breakfast was not based on the S’ decision. Some breakfast content was inappropriate due to incomplete knowledge. 50%+ were aware of a health to diet link. Of most interest to S was the amount of sugar contained in sugary drinks. After, many refrained from ingestion of these. Surveys found S who had the lesson twice developed their own decision-making ability. 93.7% of S appreciated the knowledge and were pleased to receive knowledge about food intake before suffering disease. They understood why parents said not to take a lot of sugar. 50.1% reviewed food habits, and 82.4% were willing to improve dietary habits. Some students realized they must take personal responsibility for health. 19.3% indicated sharing, or were willing to share, this knowledge with others. Some S asked D to advise other S. It is important after receiving education and tracing from Ds that T become the primary interface with S in the passing on of dietary knowledge and advice. T can more consistently pass on this knowledge on an ongoing basis with a view to putting using the knowledge themselves to personal practical use, and then transferring the skills to future generations. D: diabetologist, T: teachers. S: students. This is a follow-up report.

Disclosure
S. Kaneko: Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S, Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Novartis Pharma K.K., Sanwa Kagaku Kenkyusho Co., Ltd.. Other Relationship; Self; Elsevier. Speaker's Bureau; Self; Kowa Pharmaceuticals America, Inc., Ono Pharmaceutical Co., Ltd., Astellas Pharma US, Inc., Sanofi, Nippon Boehringer Ingelheim Co. Ltd., AstraZeneca, Sumitomo Dainippon Pharma Co., Ltd.. Speaker's Bureau; Spouse/Partner; Sumitomo Dainippon Pharma Co., Ltd., Kyowa Hakko Kirin Co., Ltd., Otsuka Holdings Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Biogen, Eisai Co., Ltd., Bayer AG, Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., Nihon Pharmaceutical Co., Ltd., Fujimoto Pharmaceutical Corporation. Y. Onogi: None. R. Michibata: None.
Effects of the Novel Dual GLP-1R/GCGR Agonist SAR425899 on Postprandial Glucose Metabolism in Overweight/Obese Subjects with Type 2 Diabetes
Authors: GOEBEL BRITTA , SCHIAVON MICHELE , VISENTIN ROBERTO , RIZ MICHELA , MAN CHIARA DALLA , COBELLI CLAUDIO , KLABUNDE THOMAS 
Published: June 2018

SAR425899 (SAR) is a novel dual glucagon-like peptide-1 receptor/glucagon receptor (GLP-1R/GCGR) agonist. A randomized, double-blind, phase I multiple-ascending-dose study (NCT02411825) in 27 overweight/obese subjects with type 2 diabetes receiving SAR demonstrated decreased body weight with a safety profile comparable with GLP-1R agonists. Here, we report additional analyses of the effect of SAR on key processes in glucose metabolism. Subjects were randomized to receive daily subcutaneous administrations of low-dose SAR (30, 60, 90 µg) or high-dose SAR (60, 120, 180 µg) for 28 days; dose escalation occurred after Days 7 and 14. Mixed meal tests were conducted before treatment (Day −1) and on Days 1 and 28. Oral glucose and C-peptide minimal models were used to quantify metabolic indices of glucose absorption, insulin sensitivity, and β-cell responsiveness. Percent change in area under the curve for rate of meal glucose appearance between 0 and 120 min from Day −1 to Day 28 was −14% and −19% with low- and high-dose SAR, respectively. Change in insulin sensitivity was 104% and 262%, respectively. Change in β-cell function was 127% and 145%, respectively (Table). After 28 days of treatment, SAR improved postprandial glucose control by significantly reducing glucose absorption rate, increasing insulin sensitivity, and enhancing β-cell function.

Disclosure
B. Goebel: Employee; Self; Sanofi. M. Schiavon: None. R. Visentin: None. M. Riz: Employee; Self; Sanofi-Aventis Deutschland GmbH. C. Dalla Man: None. C. Cobelli: Research Support; Self; Sanofi-Aventis. Advisory Panel; Self; Novo Nordisk Inc. T. Klabunde: Employee; Self; Sanofi.
Examining the Association between Treatment Satisfaction and Medication Adherence among Patients with Poorly Controlled Type 2 Diabetes
Authors: EMECHEBE NNADOZIE , AGU NGOZICHUKWUKA , MALMI MARKKU , ZGIBOR JANICE C. 
Published: June 2018

Adherence to diabetes medications remains an important target for public health intervention, however, approximately 32% of people living with diabetes do not take their medications as they should. We examined the association between treatment satisfaction and medication adherence in people living with type 2 diabetes from the REdesigning MEDication Intensification Effectiveness Study for Diabetes (REMEDIES 4D) study. REMEDIES 4D was a clustered, randomized trial in which certified diabetes educators (CDEs) implemented standardized treatment protocols to intensify treatment for glucose, lipid or blood pressure control. Fifteen practices and their patients were randomized to the intervention or usual care. Eligible participants had uncontrolled HbA1c, blood pressure, or LDLc. The intervention group received diabetes self-management education in addition to treatment intensification, while the usual care group participated in monthly support groups for one year. Medication adherence and treatment satisfaction scores were measured using Morisky medication adherence scale and Medication satisfaction survey respectively. A mixed model was created to account for the cluster randomized design and included covariates for treatment status (intervention vs. usual care group), sociodemographic factors, depression, insulin use, count of comorbidities, polypharmacy, baseline clinical values, adherence score at baseline and treatment satisfaction scores 12 months post-baseline. There were 135 participants in the final study population (mean age of 60 years and 51% female). After controlling for covariates, treatment satisfaction was associated with an increase in adherence to diabetes medications (β=0.34, p=0.02). Ensuring patients with type 2 diabetes are satisfied with their treatment regimen may be a crucial step to improving adherence to diabetes medications.

Disclosure
N. Emechebe: None. N. Agu: None. M. Malmi: None. J.C. Zgibor: None.
Real-World Improvement in Above-Target Estimated A1c with Sequential Use of Professional Flash Continuous Glucose Monitoring for Individuals with Diabetes
Authors: BERGENSTAL RICHARD M. , DUNN TIMOTHY , XU YONGJIN , JANGAM SUJIT , HAYTER GARY 
Published: June 2018

Professional flash continuous glucose monitoring using the FreeStyle Libre ProTM system is recently available in the U.S. This is one of the first real-world studies evaluating glucose metrics of sequential monitoring periods using a cross-sectional observational design. Between September 2016 and January 2018, de-identified data from 2,836 users having 2 sequential sensors (at least 5 days each) were divided by the 1st sensor above and below an estimated A1c (eA1c) of 7.5%. Glucose metrics for the two sensors were compared. For those starting above an eA1c of 7.5%, the eA1c reduced from 9.6% to 8.7% (-0.9%, p&lt;0.001), and time in range (70-180 mg/dL) increased from 7.8 to 10.5 h/day (2.7 h/day, p&lt;0.001). Time above 180 mg/dL decreased from 15.7 to 12.5 h/day (-3.2 h/day, p&lt;0.001), while hypoglycemia below 70 mg/dL increased but stayed below 5.0% (29 to 59 minutes/day, 30.1 minutes/day change, p&lt;0.001). For those at an eA1c of 7.5% or lower, eA1c increased but stayed in target (6.4% to 6.9%, 0.5% change, p&lt;0.001), while time below 70 mg/dL reduced by 22%, from 115 to 91 minutes/day (-24.8 minutes/day, p&lt;0.001). Professional glucose monitoring in clinical practice aids in the reduction of hyperglycemia and increased time in range while maintaining minimal hypoglycemia for those with average levels above target. Those with average levels in target benefit by reduced exposure to hypoglycemia.

Disclosure
R.M. Bergenstal: Research Support; Self; Johnson & Johnson Services, Inc.. Consultant; Self; Johnson & Johnson Services, Inc.. Research Support; Self; Abbott. Advisory Panel; Self; Abbott. Research Support; Self; Becton, Dickinson and Company. Consultant; Self; Becton, Dickinson and Company. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., AstraZeneca, Takeda Pharmaceuticals U.S.A., Inc., Dexcom, Inc.. Stock/Shareholder; Self; Merck & Co., Inc.. Research Support; Self; Eli Lilly and Company, Sanofi. Advisory Panel; Self; Sanofi, Roche Pharma. Research Support; Self; Novo Nordisk Inc.. Advisory Panel; Self; Novo Nordisk Inc.. Research Support; Self; Medtronic. Consultant; Self; Medtronic. Research Support; Self; Hygieia. Advisory Panel; Self; Hygieia, Glooko, Inc.. Research Support; Self; JAEB Center For Health Research, JDRF, National Institute of Diabetes and Digestive and Kidney Diseases. T. Dunn: Employee; Self; Abbott. Y. Xu: Employee; Self; Abbott. S. Jangam: Employee; Self; Abbott. G. Hayter: Employee; Self; Abbott.