bluuebunny/crossref_metadata_2025_split huggingface dataset:
Results of a Culturally Tailored Multidisciplinary Intervention on Diabetes Self-Care and Glycemic Outcome in Lebanese Patients with Type 2 Diabetes
Authors: SUKKARIEH-HARATY OLA , BASSIL MAYA , EGEDE LEONARD E. 
Published: June 2018

Background: Enhancing diabetes self-care is known to improve glycemic control of patients with type 2 diabetes mellitus (T2DM). According to American Diabetes Association guidelines, a multidisciplinary and culturally appropriate intervention is needed for optimal diabetes self-care and glycemic outcomes. There is no published study that evaluated an educational intervention targeting diabetes self-care and glycemic outcomes in Lebanese patients with T2DM.
Aim: The aim of this pilot-study was to test the effect of culturally-tailored educational program targeting diabetes self-care on glycemic control of Lebanese patients with T2DM, of low socioeconomic status.
Methods: A sample of 27 adults (Age: 61±10 years, 59% males, A1C: 8.98±1.38%) diagnosed with T2DM for at least one year was recruited from two dispensaries in Beirut. Participants received culturally-tailored, multidisciplinary educational sessions based on the Information-Motivation-Behavioral model and on American Diabetes Association’s National Standards for Diabetes Self-Management Education and Support. Summary of Diabetes Self-Care Activities (SDSCA), Social Support Scale (SS), Diabetes Fatalism Scale (DFS), and Diabetes Knowledge Test (DKT), as well as blood samples (HbA1c, Fasting Plasma Glucose) were collected at baseline and three months post-intervention.
Results: Results revealed improvements in various diabetes self-care activities (Diet and Self-Monitoring Blood Glucose) after 3 months, which was reflected in a significant decrease in glycaemia (A1C: -0.6%; Fasting Plasma Glucose: -35 mg/dl; p&lt;0.05).
Conclusion: This is the first intervention study showing the effectiveness of a culturally-tailored, multidisciplinary education program in improving glycemic control and diabetes self-care behavior of Lebanese patients with T2DM. It sets the stage for larger scale implementation with more representative sample.

Disclosure
O. Sukkarieh-Haraty: None. M. Bassil: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..
Promoters of and Barriers to Engagement in Type 2 Diabetes Mellitus (T2DM) Populations with Real-World Technological Interventions
Authors: DUVALL KEVIN R. , TRASY ANJALI , MURRAY ERIN , MILAM ROBERT , SAYRE TOBIAS , BEAL ANNE C. 
Published: June 2018

Glycemic control is often complicated by patients’ lack of adherence to treatment regimens and suboptimal self-efficacy behaviors. New technological interventions can help self-management, but it is often difficult to engage patients and maintain use. A systematic literature review of Medline, Embase, Cochrane CENTRAL, and manual searching identified literature reporting on technological interventions for T2DM to evaluate patient satisfaction affecting adherence. Observational studies and pragmatic clinical trials reporting intervention adherence and patient experience were evaluated for perceived promoters or barriers of intervention. The search retrieved 329 publications. Fourteen met criteria for inclusion and were analyzed. Adherence rates varied, ranging from 32-90% in web-based programs, to 28- 90% in telemedicine programs. Shorter follow-up times generally indicated better adherence. Patient-specific feedback was reported for 1,000 patients in 11 studies. Common patient-reported promoters of initiation and adherence included high level of provider interest, motivating, encouraging and personally relevant educational messaging. Barriers for the interventions included lack of motivational messaging, educational value, redundancy, technology-related limitations and overload concern. Technological interventions such as smartphone applications and patient web portals offer an opportunity to increase self-management in T2DM, further aided by strong healthcare provider promotion, support and engagement. In developing new technological interventions, it is important to consider easy-to-use individually-tailored content that is both motivational and educational. These programs will offer the best opportunities for adoption by providers and improved self-management by patients. Further review is needed to identify which technological interventions are most efficacious.

Disclosure
K.R. Duvall: Employee; Self; Sanofi. Stock/Shareholder; Self; Insulet Corporation, Sanofi, Becton, Dickinson and Company. A. Trasy: Employee; Self; Sanofi. Employee; Spouse/Partner; Bayer US. E. Murray: Consultant; Self; Sanofi. R. Milam: Employee; Self; Doctor Evidence. T. Sayre: None. A.C. Beal: Employee; Self; Sanofi. Board Member; Self; AcademyHealth.
Type 1 Diabetes—The Comic Book
Authors: PATEL MAYANK B. , KAR PARTHA , MCLAUGHLIN DANIEL G. 
Published: June 2018

Background: Disney, Marvel and DC Comics have done much to embed their superhero creations in the public domain, through movies and art. Acquiring superpowers and learning to live differently can be associated with shock and bewilderment, whilst being viewed with suspicion, ignorance and misunderstanding by others. These issues can be extended to those who develop type 1 diabetes. These individuals often have to dispel myths and challenge ignorance from both public and healthcare professionals. Whilst there are resources available to help, it can be challenging to find appropriate educational materials that younger people with type 1 diabetes can easily relate to.
Aims: To develop a new type 1 diabetes resource for younger people.
Methods: Working with individuals living with type 1 diabetes, the project group took the current popularity of superheroes as inspiration. Based on real life experiences, ‘type 1: Origins’, the comic book, chronicles the early experiences of a young man developing type 1 diabetes and some of the challenges he faces.
Results: Since its launch in October 2016, this free to access online comic book has had over 7000 international downloads. There has been a positive response from people with diabetes, their parents and the wider public. Several key UK diabetes charities have also endorsed and championed its use as part of diabetes education. In October 2017, the comic won a UK nationally coveted ‘Diabetes: Quality in Care’ award as ‘Best Diabetes Collaboration initiative of the year’.
Discussion: The authors believe that this collaboration has produced the first diabetes educational resource of this kind. It has been centrally recognized by NHS England as an innovative way for raising the profile of type 1 diabetes. Following its successful launch, there are plans to translate the story into different languages. A sequel is in development, in which safety in hospitals around type 1 diabetes will be a theme. Comic link: https://revolvecomics.com/diabetes-type-1-origins-comic/.

Disclosure
M.B. Patel: None. P. Kar: None. D.G. McLaughlin: None.
The Use of Quality Improvement Continuing Medical Education to Improve the Evaluation of Diabetic Retinopathy
Authors: ROBINSON KATIE , ESGRO ROBERT A. 
Published: June 2018

Rationale: Diabetic Retinopathy (DR) is a leading cause of vision loss worldwide. While regular screening can lead to earlier interventions, reduce vision loss, and improve patient outcomes, baseline screening in patients at risk for DR has traditionally been low.
Methods: To improve screening rates for DR, Vindico Medical Education and staff from the Cole Eye Institute at the Cleveland Clinic (CC) developed and executed a quality improvement CME (QI-CME) initiative within a closed network of endocrinologists and primary care physicians (PCPs) who see patients with diabetes. Interventions included a series of live, print, and web-based CME activities focused on the timely referral of patients with diabetes for ophthalmic evaluation.
Results: At baseline, 95.5% and 71% of endocrinologists and PCPs, respectively, asked their patients about ophthalmologic signs and symptoms, though there was significant delay in the time between initial patient visit and follow-up with ophthalmology among the providers (173.2 days for endocrinologists and 184.8 days for PCPs). After delivery of the QI-CME within the closed system, there were significant gains in knowledge and competence as well as a 125-day and 130-day reduction in time between initial patient visit and ophthalmology follow-up, among endocrinologists and PCPs, respectively.
Conclusion: This program demonstrated that the sequential delivery of targeted CME coupled with patient chart reviews within a closed health system is a relatively simplistic, yet powerful model to address this practice gap toward improved patient outcomes by avoided vision loss. Notably, this model may be easily adopted to engage additional pertinent audiences, such as ophthalmologists, or to different therapeutic areas that rely on timely referral to a specialist for appropriate care.

Disclosure
K. Robinson: None. R.A. Esgro: None.
An Evaluation of the Diabetes Conversation Map™ Program—Are Program Factors Associated with Health Outcomes and Health Care Utilization at 12 Months Post-Enrollment?
Authors: SRULOVICI EINAV , LEVENTER-ROBERTS MAYA , CURTIS BRADLEY , HE XUANYAO , AKRIV AMICHAY , HOSHEN MOSHE B. , ROTEM MINA , GOFER ILAN , SHADMI EFRAT , KEY CALANIT , LEVIN-IAINA NOMY , STRIZEK ALENA , FELDMAN BECCA S. 
Published: June 2018

Background: The Diabetes Conversation Mapࡊ Program serves Clalit Health Services members with type 2 diabetes Mellitus (T2DM) for over 7 years, administered by over400 trained certified nurses. A formal evaluation of the programmatic factors of Mapࡊ has not yet been performed.
Methods: This was a retrospective cohort study of 5,597 participants with T2DM who enrolled in the Map™ program between 1.1.2010 and 4.1.2015. Using Gamma and Poisson regression models and testing for hierarchical regression with random effects, we assessed the association between program factors (nurse instructor, enrollment year, and number of Map™ sessions attended), and outcomes (laboratory test results, adherence, and healthcare utilization) during a 12 month follow-up period.
Results: Introducing the random effect of nurses who conducted the sessions yielded a low explained variance. Similarly, there were no significant differences in the outcomes across year of enrollment. However, Map™ participants who attended at least one session had on average a 2.1% reduction in HbA1c levels compared to those who enrolled but did not attend any sessions. Among participants who attended 1 session, the frequency of hospital admissions decreased by 55%, a decreased that did not change up to 4 sessions, compared to those who attended 0 sessions. There was no increased benefit in attending more than 4 sessions on frequency of hospital admissions within the follow-up period. The number of sessions was not associated with any other outcomes.
Conclusions: Our results suggest that attending up to four sessions in the Map™ program is associated with improved HbA1c and decreased hospitalizations, and this does not vary by enrollment year or instructor. We suggest that nurses who instruct the Map™ program should try to improve participants' attendance to at least four sessions in order to maximize reductions in these two outcomes.

Disclosure
E. Srulovici: None. M. Leventer-Roberts: None. B. Curtis: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. X. He: None. A. Akriv: None. M.B. Hoshen: None. M. Rotem: None. I. Gofer: None. E. Shadmi: None. C. Key: None. N. Levin-Iaina: Employee; Self; Eli Lilly and Company. A. Strizek: None. B.S. Feldman: None.
Combining Insulin and Incretins in T2DM Management—Effect of Online Education on Physician Knowledge and Competence
Authors: TRIER JOACHIM , MCCARTHY ROBERT F. , COLAGIURI STEPHEN 
Published: June 2018

Purpose: To determine if online medical education for diabetologists/endocrinologists (diabs/endos) and primary care physicians (PCPs) can improve knowledge regarding treatment options for intensification of insulin in patients with T2DM, the rationale, clinical evidence, and benefits of novel basal insulins/GLP-1 receptor agonist (GLP-1 RA) fixed-ratio combinations (FRCs) and competence related to the practical aspects of initiating and titrating such FRCs.
Methods: The educational activity consisted of a 30-min online video panel discussion with synchronized slides. Educational effect was assessed with a repeated pairs pre- and post-assessment study with a 3-item, multiple-choice, knowledge and competence questionnaire and a confidence assessment. For all questions, each participant acts as his/her own control. A χi-squared test assessed statistical significance at the P &lt;.level. The activity launched November 30, 2016; data were collected until January 23, 2017.
Results: Participation in the activity significantly (P &lt;.05) improved knowledge/competence of diabs/endos (average from 28% to 55%, n=99) and PCPs (average from 24% to 52%, n=129) with respect to initiating novel insulin FRCs in patients with T2DM, in particular understanding the benefits of novel short- and long-acting FRCs, how a basal insulin/GLP-1 RA FRC is effective in HbA1c reduction whilst offering better tolerability compared to monotherapy. Confidence levels in starting and titrating such FRCs in patients with T2DM uncontrolled on basal insulin also improved (57% in diabs/endos, 67% in PCPs).
Conclusions: Participation in an online video panel discussion improved knowledge, competence and confidence regarding the clinical benefits and use of novel insulin FRCs in appropriate patients with T2DM. Further education is warranted on these topics and for selecting the correct titration scheme for transitioning patients with uncontrolled T2DM receiving basal insulin.

Disclosure
J. Trier: None. R.F. McCarthy: None. S. Colagiuri: Advisory Panel; Self; AstraZeneca, Elsevier, Medscape, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi, Servier.
Ocho Pasos a la Buena Salud (Eight Steps to Better Health)—A Diabetes Education Program for Low-Literacy Latinos With or at Risk for Type 2 Diabetes (T2D)
Authors: CREASON JAMIE , CONNEELY MARY M. , AXELROD CEARA , BEVIER WENDY C. , SWARTZENTRUBER JENIFER , KERR DAVID 
Published: June 2018

Ocho Pasos (Eight Steps) is a culturally relevant diabetes education program designed for low-income, low literacy Latino adults. The main focus is to improve health for those challenged with multiple socio-economic barriers. Classes are taught in Spanish over 8 weeks in a community setting. Diabetes-friendly diet modifications, compatible with culturally appropriate food traditions (e.g., reducing Tortilla consumption), are emphasized. Education, covering T2D risk factors, self-monitoring, stress management, and physical activity, is delivered using images, food models, and visual and tactile teaching aids. HBA1C [A1C Now® (PTS Diagnostics, Indianapolis, IN)], BMI, and waist circumference (WC), are measured at first and last classes.
Between July 2015- Dec 2017, 478 adults were enrolled with complete pre- and post-class data available for 127 [77% women]. Of these 38 had HBA1C ≥6.5%, 43 between 5.7-6.4%, and 46 &lt;5.7% at entry. For those with initial HBA1C≥6.5%, this decreased 0.74% [p&lt;0.01]. For those between 5.7-6.4%, HBA1C fell 0.13% vs. entry, [p&lt;0.05]. BMI decreased from 30.7±6.2 to 30.2±6.1 kg.m2 (p&lt;0.01) and WC from 39.5±5.5 to 38.6±5.1 in, [p&lt;0.01]. Daily average Tortilla consumption decreased from 5.1±2.7 to 2.4±2.7 tortillas/day [p&lt;0.01]. Participants who decreased daily tortilla consumption showed a significant reduction in their HBA1C (p&lt;0.05), and 52% also reported more exercise after attending. Participants with HBA1C ≥6.5% had the greatest class attendance; 55% attended &gt;5 classes.
Ocho Pasos a la Buena Salud is an effective diabetes education program for Latinos who face serious health care challenges for achieving optimal glycemic control or prevention of T2D.

Disclosure
J. Creason: None. M.M. Conneely: None. C. Axelrod: None. W.C. Bevier: None. J. Swartzentruber: None. D. Kerr: Advisory Panel; Self; Glooko, Inc.. Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Sanofi-Aventis. Stock/Shareholder; Self; Cellnovo. Advisory Panel; Self; Novo Nordisk Inc..
Marketing and Communication Strategies to Increase Enrollment in National Diabetes Prevention Program—Implications for Evaluation of Technical Assistance
Authors: MENSA-WILMOT YVONNE , BOWEN SHELLY-ANN , THUMMALAPALLY SHARANYA , MURPHY MONICA D. , RUTLEDGE GIA E. 
Published: June 2018

Under a 4-year federally funded program, states (18) and large cities (4) are implementing approaches to scale and sustain the National Diabetes Prevention Program (National DPP) a structured, evidence-based, year-long lifestyle change program to prevent or delay onset of type 2 diabetes in people with prediabetes or at risk of developing the disease. This study examines grantee utilization of health marketing strategies to increase enrollment in the National DPP, targeting both general and high-risk populations experiencing health or socioeconomic disparities, and the technical assistance (TA) provided to grantees to implement and evaluate their marketing strategies. Analysis of Yr2 annual performance measure reports indicated that 2.2 million people were reached through traditional (print, television, radio, etc.) and social media (Facebook, Wiggio, YouTube, etc.). Over 17,000 new participants enrolled in National DPP with more than 2,000 from high-risk populations. Qualitative analysis of grantee evaluation reports and TA records revealed barriers and facilitators, such as unavailability of National DPP programs and consistent provider referrals, respectively. TA to assist grantees with program activity and performance measure alignment helped grantees improve data collection and reporting. However, gaps continue to exist between activities implemented and data reported. Recommendations for future TA include 1) providing early guidance on marketing strategies, 2) assisting grantees with outcome assessment, and 3) demonstrating linkages between marketing efforts and performance measures.

Disclosure
Y. Mensa-Wilmot: None. S. Bowen: None. S. Thummalapally: None. M.D. Murphy: None. G.E. Rutledge: None.
The Alarming Inadequacy of Adult Vaccination—Vaccination Rates in Diabetic Patients
Authors: FEYIZOğLU GÜNEş , KARSLI ASLI , OGUZ AYTEKIN 
Published: June 2018

Aim: DM is a disease that causes immune incompetence due to various reasons. Therefore, the risk of infectious disease and the risk of complications, morbidity and mortality related to infectious disease in diabetic patients are increased compared to healthy adults. Patients with DM are advised to get vaccinated for
influenza once every year, tetanus every 10 years, hepatitis B if they did not complete their routine vaccinations and pneumococcus for once. Researches reveal the lack of adult vaccination awareness, even in high risk group of patients. This study is designed to determine the adult vaccination rates (VR) in diabetic patients who are in routine follow-up in our outpatient diabetes clinic.
Methods and Findings: Diabetic patients that applied to Istanbul Medeniyet University Goztepe Training and Research Hospital Diabetes Outpatient Clinic between January and July 2017 were included in the study. Patients were selected by simple random sampling and their demographic data were recorded. Patients were asked if they were vaccinated for influenza in last year, tetanus in last 10 years, hepatitis B and pneumococcus. In the 846 (535 female, 311 male) type 2 DM patients that were included in the study, the average age was 58.7(32-86) and the average years with diabetes was 11,2(1-50). VR were 17.6% (n=149) for influenza, 18.6% (n=157) for tetanus, 8.6% (n=73) for hepatitis B and 5.4% (n=46) for pneumococcus.
Results and Discussion: This study demonstrates that adult VR in our diabetic patients are inadequate. Adult vaccination policy programs recommend the aim of 90% influenza and 60% pneumococcus VR. Even though our population consists of diabetes patients with seemingly high consciousness levels, attending their regular doctor appointments, their VR are far below the targeted rates. The fact that unvaccination rates are exceeding 80% for influenza and 90% for pneumococcus points out to the significance of increasing adult VR as a health issue of priority and urgency in diabetic patients.

Disclosure
G. Feyizoğlu: None. A. Karsli: None. A. Oguz: None.
Results from the First Culturally-Tailored, Multidisciplinary Diabetes Education in Lebanon—Effect on Cardiovascular Risk Factors
Authors: BASSIL MAYA , SUKKARIEH-HARATY OLA , ABI KHARMA JOELLE L. , EGEDE LEONARD E. 
Published: June 2018

Background: Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care, and is known to reduce cardiovascular risk factors of patients with type 2 diabetes (T2D) (American Diabetes Association [ADA], 2017). According to ADA, effective DSME is multidisciplinary, patient-centered, as well as age and culturally appropriate (ADA, 2017). Despite ranking second in the world in the prevalence of diabetes, there is no reported intervention addressing diabetes self-care in the Arab world.
Aims: The aim of this pilot-study was to test the effect of the first culturally-tailored educational program targeting diabetes self-care on cardiovascular risk factors of Lebanese patients with T2D.
Methods: A sample of 27 adults (Age: 61±10 years, 59% M, A1C: 8.98±1.38%) diagnosed with T2D for at least one year was recruited from two dispensaries in Beirut. Participants received culturally-tailored, multidisciplinary educational sessions based on the Information-Motivation-Behavioral model and on ADA’s National Standards for Diabetes Self-Management Education and Support. Anthropometric measures (weight, height, BMI, waist circumference, body fat mass and fat-free mass) and blood samples (Triglycerides, Total, LDL and HDL cholesterol) were collected at baseline, 3 months and 6 months post-intervention.
Results: Waist circumference (107.52±12.91 vs. 106.59±12.01) and cholesterol/HDL ratio (4.45±1.39 vs. 4.06±1.29) decreased at 6 months post-intervention (p=0.02).
Discussion and Conclusion: This is the first intervention study showing the effectiveness of a culturally-tailored, multidisciplinary education program in improving body adiposity and blood lipids of Lebanese patients with T2D, and thus reducing their cardiovascular risk factors. It sets the stage for larger scale implementation with more representative sample.

Disclosure
M. Bassil: None. O. Sukkarieh-Haraty: None. J.L. Abi Kharma: None. L.E. Egede: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases. Advisory Panel; Self; Novo Nordisk Inc..