bluuebunny/crossref_metadata_2025_split huggingface dataset:
649-P: Making Glucose the Next Vital Sign: An Educational Intervention to Teach Clinicians How to Improve Inpatient Glycemic Control
Authors: SELEY JANE JEFFRIE , MENDELSOHN CURANAJ FELICIA A. , YEH TIFFANY , YEUNG MICHELE , FALCONE JOHN 
Published: June 2019

Background: Although the American Diabetes Association recommends avoiding hypoglycemia and hyperglycemia in the inpatient setting, there is a lack of comprehensive education offered to clinicians to learn steps to achieve these goals.
Objectives: 1) Decrease rates of malglycemia while increasing percent of patients in target BG ranges by 3% on medicine units. 2) Increase prescriber test scores post educational intervention.
Methods: We developed interactive role specific educational interventions for physicians, nurse practitioners, physician assistants and registered nurses focusing on strategies to improve glycemic control while preventing adverse events. Education was tailored to each profession with case based face-to-face and on-line educational modules. Glycemic Management pocket cards and dosing guidelines for steroids, enteral feedings and preparation for surgery were distributed as well as "Glucose: The Next Vital Sign" Buttons to create a culture of safety and shared vision.
Conclusion: Results to date indicate an improvement in target BG readings. At the end of February 2019, we will calculate overall rates of hypoglycemia and hyperglycemia as well as in target BGs for the 6 month period and compare to the same months one year earlier. We will analyze prescriber and RN test scores, revise educational intervention and offer the program to other service lines.

Disclosure
J. Seley: Advisory Panel; Self; AstraZeneca, Sanofi US. Consultant; Self; Ascensia Diabetes Care, Johnson & Johnson Diabetes Institute. F.A. Mendelsohn Curanaj: None. T. Yeh: None. M. Yeung: None. J. Falcone: None.

Funding
Weill Cornell Medicine
651-P: Validation of a Clinically Relevant Knowledge Assessment in Pediatric Type 1 Diabetes
Authors: ANASTASIA ALBANESE-O'NEILL , MACINNES JANN W. , THOMAS NICOLE T. , HALLER MICHAEL J. , SCHATZ DESMOND , SILVERSTEIN JANET , ADAMS JANEY , OYETORO REBECCA , KERSHAW BRITTANY A. , ANDERSON KIRA , BERNIER ANGELINA 
Published: June 2019

Objective assessment of diabetes knowledge is essential to providing effective diabetes education. There is currently no such resource or instrument designed for pediatric clinical use and validated in the target population. We developed and validated the Knowledge Assessment in T1D (KAT-1) for this purpose. The KAT-1 has a total of 109 multiple choice items divided into 11 subscales designed to be taken individually. Following a pilot study to optimize the KAT-1, a validation study was performed with 200 participants (60% privately insured; 70% female; mean child A1c 8.2%; 10% African American, 11% Hispanic), including 50 parents of children with T1D &lt;10 years; 50 parents of children with T1D ages 11-15 years; 50 adolescents with T1D ages 11-15 years; and fifty 16-21 year olds with T1D. All completed the KAT-1, Diabetes Knowledge Test 2 (DKT2), and a demographic survey. SPSS was used to evaluate the results. The complete KAT-1 scale demonstrated strong internal consistency (Cronbach’s α = 0.92, mean score 84.6, SD = 16.1). Nine of the 11 topical subscales demonstrated strong internal consistency and each took &lt;5 minutes to complete: Supplies/Insurance (α = 0.82, mean time = 2.3 minutes, 9 questions), Hypoglycemia (α = 0.57, time = 3.1 minutes, 8Q), Sick Days/Ketones (α = 0.73, time = 3.2 minutes, 11Q), Basic Management (α = 0.63, time = 3.7 minutes, 13Q), Insulin (α = 0.67, time = 1.7 minutes, 12Q), Pathophysiology (α = 0.66, time = 4.1 minutes, 10Q), Technology/Devices (α = 0.86, time = 2.1 minutes, 15Q), Nutrition (α = 0.51, time = 2 minutes, 7Q), and Diabetes at School (α = 0.52, time = 4.3 minutes, 9Q). Subscale scores were positively correlated with one another. Total scores were positively correlated with the DKT2 and negatively correlated with the child’s reported A1c. All correlations were significant. The validated KAT-1 facilitates objective and expedient assessment of T1D knowledge. Its subscales will be integrated into the EHR as patient-facing surveys to quickly identify individual learning needs and allow for targeted T1D education.

Disclosure
A. Albanese-O'Neill: None. J.W. MacInnes: None. N.T. Thomas: None. M.J. Haller: Advisory Panel; Self; Pancreum, SAB Biotherapeutics. D. Schatz: None. J. Silverstein: None. J. Adams: None. R. Oyetoro: None. B.A. Kershaw: None. K. Anderson: None. A. Bernier: None.
662-P: Facilitators and Barriers to Healthy Eating among American Indian/Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives
Authors: MOORE KELLY R. , STOTZ SARAH A. , BREGA ANGELA G. , GONZALES KELLY L. 
Published: June 2019

American Indian and Alaska Native (AIAN) adults have a higher rate of type 2 diabetes (T2D) and related complications than non-AIAN adults. Nutrition is the cornerstone of diabetes self-management and nutrition education is a key component of diabetes self-management education. The purpose of this research was to understand stakeholder perspectives on how to adapt the American Diabetes Association (ADA) newly developed nutrition education program entitled “What Can I Eat? Choices for People with T2D and their Families” (WCIE) for AIAN adults. Using focus group and individual interview methods, we interviewed experts in AIAN diabetes nutrition education (n=9); AIAN educators, Native elders, and tribal leaders (n=11); and AIAN adults with T2D (n=29) and their family members (n=22) at 4 geographically distinct urban and reservation sites nationwide. Focus groups and interviews were recorded and transcribed verbatim. We employed the constant comparison method for data analysis and used Atlas.ti (Mac version 8.0) to digitalize the analytical process. Qualitative analysis identified specific facilitators and barriers to healthy eating in Native communities. Facilitators included: strong community and family support systems, traditional values of balance and gratitude, Native pride, and community-based wellness goals. Barriers included: food insecurity, challenges to preparation of home-cooked meals, high consumption of fast food and sugar-sweetened beverages, and loss of access to traditional foods and food-acquisition practices. Findings will be used to culturally adapt the existing ADA WCIE diabetes nutrition education program for AIAN adults with T2D.

Disclosure
K.R. Moore: None. S.A. Stotz: None. A.G. Brega: None. K.L. Gonzales: None.

Funding
American Diabetes Association (4-18-SMSC-01 to K.R.M.)
691-P: Validation of the Diabetes Knowledge Test and the Diabetes Attitude Scale 3, in a Diabetic Population in Venezuela
Authors: MARCANO YAMILETH , VELÁSQUEZ ENMANUEL J. 
Published: June 2019

Objective: To characterize the elements that demonstrate the validity of the Spanish versions of Diabetes Knowledge Test and the Diabetes Attitude Scale 3 in Venezuela.
Design and Methods: descriptive, observational, transversal, and psychometric field study. Sample included 100 participants with DM type 1 and 2, 12 to 70 years old, assisting to the Endocrinology service of three Venezuelan centers. Content was validated based in theoretical fundamentals. Semantic adaptation of the questionnaires was performed. Corrections were made according to validation of content. The Spanish versions includes 33 questions and 5 sub-scales where the answers were measured with a point scale from 1 to 5, were 5 was “totally agree” and 1 was “totally disagree” for the Diabetes Attitude Scale 3; and 38 questions with 5 areas of knowledge for the Diabetes Knowledge Test. Data was analyzed by the Cronbach’s alpha coefficient for the reliability and by the factor analysis with varimax rotation for the validity of the construct. Data was tabulated with SPSS 11.0.
Results: Diabetes Attitude Scale 3: Cronbach’s Alpha for the global internal consistency was 0,628 guaranteeing the reliability of the scale. New sub-scales were obtained from factor analysis, 6 total. The Cronbach’s Alpha was superior to 0,700 for most of the sub-scales, meaning a good reliability, the exception was the sub-scale “Perception of the gravity of the Disease” with a null reliability. Diabetes Knowledge Test: the global test indicates an excellent internal consistency with a Cronbach’s Alpha of 0,800. New areas were obtained from factor analysis, 4 total. The Cronbach’s Alpha for each of the areas of knowledge was higher of 0,900, indicating an excellent reliability.
Conclusion: our questionnaires have been proven to be reliable, valid, being suitable for its application in future research in the described population.

Disclosure
Y. Marcano: None. E.J. Velásquez: None.
695-P: The Network of 37 Community-Based Education Centers for Diabetes Self-Management in Gyeonggi Province, Korea
Authors: KIM EUNJI 
Published: June 2019

Background and Objectives: Diabetes is complex, chronic illness requiring comprehensive risk-reduction strategy including community efforts. While Korea society is getting older and prevalence of diabetes is getting high, control rate of diabetes among treated patients is still low in Korea. Gyeonggi province, the largest province in Korea, developed the network of 37 community-based education centers for diabetes self-management (NCECD). NCECD incorporated community public health centers, diabetes education centers and primary medical clinics to improve knowledge, self-efficacy and self-management among diabetes patients in Gyeonggi province, Korea.
Methods: Standardized education and counseling program has been implemented to about 2,000 diabetes patients during 4 weeks period in 37 cities, Gyeonggi province in 2018. Standardized questionnaire was distributed to participants before and after programs to find out changes of` diabetes knowledge, self-efficacy and self-management of diabetes.
Results: 1,794 people were answered before and after programs and significant changes were seen for diabetes knowledge, self-efficacy and self-management. An average correct answer rate of diabetes knowledge was increased from 76.0% to 88.6%. Mean of diabetes knowledge increased from 7.9 to 8.7 (p=0.000) and the overall assessment of participants’ self-efficacy was increased in mean score from 16.1 to 17.4(p=0.000). Their ability to perform diabetes self-management increased in mean score from 3.4 to 3.7 (p=0.000).
Conclusions: These findings demonstrate that the network of thirty-seven community-based education centers for diabetes self-management can be successful in Gyeonggi province, Korea and important insight is provided for ways that network can be tailored to meet the needs of their populations.

Disclosure
E. Kim: None.
699-P: Assessment and Management of Falling in Type 2 Diabetic Patients with Diabetic Kidney Disease
Authors: IKEJIMA SHIN , TAKAHASHI TOMOMI , KONDO SEIYA , UMEZU JUNKO , UEMA MIKA , HIRAI AIZAN 
Published: June 2019

Background: Older type 2 diabetic patients are at an increased risk of falling. On the other hand, the risk of sarcopenia increases in patients with chronic renal disease. In the present study, we reported about the risk of falling in type 2 diabetic patients with diabetic kidney disease (DKD).
Methods: Participants were 111 outpatients with type 2 diabetes at our hospital (66.1±8.8 years old). We measured one-leg standing (OLS) time with eyes open and analyzed the date according to renal function. Participants were defined as patients with a high risk of falling, if their OLS time was less than 20s. In order to examine the cause of short OLS time, we measured the ten times sit to stand test (TTSTS) and toe grip strength test (TGST). Furthermore, we measured hand grip strength, the timed up and go test (TUG), skeletal muscle mass (Inbody S10, Biospace, Tokyo, Japan), and evaluated diabetic peripheral neuropathy (DPN) by DPN Check (HDN-1000, Omron, Tokyo, Japan). At last, we planned original physical therapy for patients.
Result: A total of 101 cases (60 males; 51 females) were included in this study. The prevalence of patients with a high risk of falling was 60.0%. In patients without renal failure (eGFR ≥ 60 ml/min/1.73 m2), with mild renal failure (30 ≤ eGFR &lt; 60), and with sever renal failure (eGFR &lt; 30), the prevalence of patients with a high risk of falling was 48.1%, 67.9%, and 81.8 % respectively. Patients with a short OLS time tended to perform the TTSTS more slowly than patients with a normal OLS time. Short OLS time is also associated with TGST. Patients with DPN did badly on the TGST. Based on this result, we provided patients with a physical therapy program and diet therapy.
Conclusion: These findings showed that the OLS time was significantly shorter in type 2 diabetic patients, especially those with advanced DKD. Therefore, exercise therapy, diet therapy including a good quality protein intake and management of complication including diabetic DPN are important for type 2 diabetic patients with DKD.

Disclosure
S. Ikejima: None. T. Takahashi: None. S. Kondo: None. J. Umezu: None. M. Uema: None. A. Hirai: None.
703-P: A Model Project of Structured Group Education Demonstrated Significant and Reproducible Effect on Good Metabolic Control
Authors: JIRKOVSKA JARMILA 
Published: June 2019

Background: A number of diabetics do not meet targets for metabolic control, with high morbidity, mortality, and costs. Prevention is of fundamental importance to reduce the burden. Various approaches are used including patient self-management education program. Aim was to assess reproducibility and homogeneity of significant effect on metabolic control improvement in pilot high-quality standardized structured group education program implemented in education centers countrywide within 2 subsequent years.
Methods: An out-patient program including 4x2 hours of structured education lessons (self-monitoring; diet; exercise; foot care) was realized in 9 centers in 2016 and 10 centers in 2017. Overall 62 type 2 diabetics on insulin in 2016 and 58 in 2017 were included (comparable in age, gender, BMI). Metabolic parameters were measured at baseline and 6 months later. Reproducibility of group education effect on diabetes control between 2016 and 2017 as well as homogeneity of outcomes among centers were assessed by standardized statistical analysis.
Results: Proportion of individuals with comparably well controlled diabetes (HbA1c&lt;60 mmol/mol) 6 months after the program increased significantly both in 2016 (26 to 45%, p=0.007) and 2017 (36 to 67%, p=0.001) in comparison with baseline. Mean HbA1c declined from 70.0±16.2 at baseline to 63.1±12.6 mmol/mol at 6 months (p=0.001) in 2016 and from 65.0±15.8 to 58.3±13.0 mmol/mol (p=0.001) in 2017. Likewise, for both years we observed significant decline in fasting plasma glucose, body weight reduction and decrease in systolic blood pressure as well as assessed homogeneity in diabetes improvement among centers.
Conclusion: Project demonstrated good reproducibility of significantly improved metabolic control and homogeneity among centers in 2 consecutive years. The model is helpful in discussion with health insurance companies on adequate reimbursement.

Disclosure
J. Jirkovska: Advisory Panel; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Research Support; Self; Sanofi. Speaker's Bureau; Self; Ascensia Diabetes Care, Lilly Diabetes, Novo Nordisk Inc.

Funding
Czech Diabetes Society
718-P: Post-exercise Enhancement of Insulin-Stimulated Glucose Uptake in Insulin-Resistant Rat Skeletal Muscle Concomitant with Greater γ3-AMPK Activity and Insulin-Stimulated AS160 Phosphorylation on Key Regulatory Phosphosites
Authors: PATAKY MARK W. , ARIAS EDWARD B. , ZHENG XIAOHUA , WANG HAIYAN , CARTEE GREGORY D. 
Published: June 2019

One exercise session can increase subsequent insulin-stimulated glucose uptake (ISGU) by healthy skeletal muscle, and recently published research linked this outcome to exercise-induced elevation in γ3-AMPK activity which leads to greater phosphorylation of Akt substrate of 160 kDa (pAS160) on an AMPK-phosphomotif (Ser704), which in turn favors greater insulin-stimulated pAS160 on a key Akt-phosphomotif (Thr642) that regulates ISGU. Studying healthy muscle is important, but a more urgent need is to understand the mechanisms for enhanced ISGU in insulin resistant muscle. Our primary goal was to determine if exercise, which increases ISGU, also increases γ3-AMPK activity and pAS160 on key regulatory sites at 3-hours post-exercise (3hPEX) in insulin resistant muscle. Rats fed a high fat diet (HFD; 2 week) known to cause muscle insulin resistance performed acute swim exercise (2 h) or remained sedentary (SED). Other chow-fed (low fat diet, LFD; 2 week) SED rats served as healthy controls. Isolated epitrochlearis muscles from 3hPEX rats (and SED controls) were used for ISGU, pAS160 and γ1- and γ3-AMPK isoform-specific activity. ISGU was lower in HFD SED muscles compared to LFD SED, but this decrement was eliminated in the HFD 3hPEX group. The γ3-AMPK activity, but not γ1-AMPK activity, was elevated in HFD 3hPEX muscles versus both SED controls. In addition, insulin-stimulated pAS160 on Thr642 and Ser704 in HFD 3hPEX muscles was elevated above HFD SED controls and equal to values in LFD SED muscles. These novel results demonstrated, for the first time in an insulin-resistant model, that the post-exercise increase in ISGU was accompanied by enhanced pAS160Ser704 and γ3-AMPK activation. Our working hypothesis is that these key signaling events are necessary for acute exercise to restore the ISGU of insulin resistant muscles to values equal to normal LFD SED controls.

Disclosure
M.W. Pataky: None. E.B. Arias: None. X. Zheng: None. H. Wang: None. G.D. Cartee: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases
721-P: Exercise Training Alters Subcutaneous Adipose Tissue Morphology in Obese Adults Even without Weight Loss
Authors: AHN CHIWOON , RYAN BENJAMIN J. , GILLEN JENNA B. , LUDZKI ALISON , SCHLEH MICHAEL W. , REINHEIMER BENJAMIN A. , HOROWITZ JEFFREY F. 
Published: June 2019

Many metabolic health complications in obese adults are linked to abnormalities within their enlarged adipose tissue mass, which include hypertrophic adipocytes, a fibrotic extracellular matrix (ECM), and suppressed capillary density. Exercise training is a first-line treatment for obesity-related diseases, but the direct effects of exercise on adipose tissue structure and metabolic function remain unclear. The purpose of this study was to determine the effects of moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) on subcutaneous adipose tissue morphology. 17 obese adults were randomly assigned to 12 weeks (4 days/week) of MICT (45 minutes at 70% HRmax, n=9) or HIIT (10 X 1 minutes at 90% HRmax, 1 minute recovery, n=8) and were required to maintain their body weight throughout. Abdominal subcutaneous adipose tissue biopsy samples were collected before and after training for histological and immunoblot measures to assess adipocyte cell size, markers of ECM remodeling and capillarization. Aerobic fitness (VO2peak) improved ∼10% in both MICT and HIIT (P&lt;0.001), while body weight and fat mass remained unchanged, as designed. However, even in the absence of weight loss, adipocyte size decreased slightly (∼10%), yet significantly after training (P=0.04). The reduction in adipocyte cell size in HIIT was accompanied by a significant increase in the protein abundance of a key adipogenic regulator, CEBPα (P=0.03). Exercise training also induced a strong trend for a reduction in the abundance of collagen 6a (P=0.07). We also found a strong trend for HIIT to increase the protein abundance of the angiogenic regulator VEGFα (P=0.06), although this did not translate to a measurable increase in capillarization.
In summary, exercise training, perhaps especially HIIT, may increase adipogenic and angiogenic capacity in adipose tissue, as well as trigger adipose ECM remodeling.

Disclosure
C. Ahn: None. B.J. Ryan: None. J.B. Gillen: None. A. Ludzki: None. M.W. Schleh: None. B.A. Reinheimer: None. J.F. Horowitz: Research Support; Self; American Diabetes Association.

Funding
National Institutes of Health (R01DK077966, P30DK089503, T32DK007245); Canadian Institutes of Health Research (DFS146190)
723-P: A Single Session of Exercise Increases Resident Macrophages in Subcutaneous Adipose Tissue from Healthy Human Subjects
Authors: LUDZKI ALISON , KRUEGER EMILY M. , BALDWIN TOREE C. , TAYLOR NATALIE M. , MUIR LINDSEY A. , LUMENG CAREY , HOROWITZ JEFFREY F. 
Published: June 2019

Infiltration of pro-inflammatory adipose tissue macrophages (ATMs) is implicated in systemic low-grade inflammation that underlies metabolic health complications in obesity. Exercise training has been linked to reduced adipose tissue and systemic inflammation, but these observations are often confounded by concomitant weight loss. Many metabolic benefits of exercise are a cumulative effect of each bout of exercise, thus the aim of this study was to determine changes in ATMs (using flow cytometry) in response to a single exercise session. We collected subcutaneous abdominal adipose tissue samples from 10 obese (BMI: 33±3kg/m2; fat mass: 41±20kg) and 14 lean (BMI: 23±13kg/m2; fat mass: 16±5kg) adults, 12 hours after exercising for 60 minutes at 70% VO2max (EX); and again 3 days after their most recent exercise session (No-EX). To characterize the cellular response to exercise without the confounding influence of exercise novelty, all subjects were habitual exercisers. The exercise session did not alter total immune cell number (OBESE: 30±7 vs. 31±7; LEAN: 27±9 vs. 28±8% live cells) or total ATM number (OBESE: 3.9±1.7 vs. 4.0±1.6; LEAN: 3.5±1.5 vs. 4.3±1.9% live cells; for No-EX and EX, respectively). However, there was a main effect for exercise to increase the number of CD11c- ATMs (OBESE: 1.3±1.4 vs. 1.5±1.5; LEAN: 1.0±0.6 vs. 2.0±1.6% live cells; P=0.03), indicating the abundance of resident ATMs increased after exercise. Surprisingly, the response to exercise was not different in lean vs. obese subjects. Although the change in resident ATM content after exercise was rather subtle in this cohort of healthy regular exercisers, these are the first single cell data to suggest each session of exercise may induce a phenotypic shift in subcutaneous ATMs. This could be a mechanism contributing to the anti-inflammatory health benefits of exercise.

Disclosure
A. Ludzki: None. E.M. Krueger: None. T.C. Baldwin: None. N.M. Taylor: None. L.A. Muir: None. C. Lumeng: None. J.F. Horowitz: Research Support; Self; American Diabetes Association.

Funding
National Institutes of Health (R01DK077966) Canadian Institutes of Health Research (DFS146190)