bluuebunny/crossref_metadata_2025_split huggingface dataset:
672-P: Diabetes Education Model for Primary Care Physicians (PCPs)
Authors: BHALLA SANDEEP , KUMAR PUSHKAR , MEHRA RAKESH 
Published: June 2019

India is home to over 72.9 million individuals with diabetes which is expected to rise to 134.3 million by 2045. Given the low doctor population ratio, maldistribution of specialists with an urban preference and initial diagnosis being made by non-specialists, strengthening primary health care is the key in effectively addressing this challenge. Considering the burden, Public Health Foundation of India in 2010 launched pan-India capacity building programs for PCPs. The aim of these programs is to enhance knowledge, skills and core competencies of PCPs in managing diabetes and comorbidities. The program is conceptualized and built on a PPP model with the involvement of various stakeholders including implementing, academic, funding partners, national experts (33), faculty (428), observers (150) and PCPs. Every stakeholder has unique role and responsibilities (Figure). A total 16878 PCPs have been trained under these programs in 101 cities across 27 states/UTs. Passing percentages ranged from 88 to 92 with an average score of 39 out of 50. PCPs reported a significant increase in knowledge (p&lt;0.05) and confidence in managing diabetes in end line evaluation and establishing a referral linkage in an organic manner. The learning from the model is now adopted by other LMICs including Bangladesh, Nepal, Myanmar, Afghanistan and East African countries that are in throes of an alarming burden of diabetes and shortage of trained physicians.

Disclosure
S. Bhalla: None. P. Kumar: None. R. Mehra: None.
673-P: Certificate Course in Evidence-Based Management of Diabetic Retinopathy: A Unique Partnership Model for Capacity Building of Primary Care Physicians in India
Authors: BHALLA SANDEEP , KUMAR PUSHKAR , CHANDWANI HARESH , JOSHI MANOJ 
Published: June 2019

Background: In India, 72 million people are suffering from diabetes. Studies showed that every fifth person in India with diabetes could have Diabetic Retinopathy (DR) causing a significant impact on health system. To address this burden, a capacity-building model was initiated with an objective to build the skills and core competencies of physicians for evidence based management of DR.
Methodology: Certificate Course in Evidence Based Management of Diabetic Retinopathy (CCDR) is a joint partnership program implemented via a robust curriculum developed by leading academic partners, vetted by 8 renowned Diabetologists/Retina specialists, delivered by 40 Regional Faculty in 20 centers across India, comprised of didactic lectures, case studies and instructional videos. The four modular course conducted as once a month contact session and one session as hands-on-training at premier retina institute with an integral monitoring and supervision mechanism.
Results: Over 3 cycles; 445 participants have been trained from 100 districts (159 cities, 22 states and 2 UTs); 42% affiliated to public sector and 51% are postgraduates. Pre/Post-test knowledge score revealed a significant change (p&lt; 0.05). Participants rated overall course as an ‘excellent’ (9.1/10). The course is endorsed by UKRI Council GCRF through Ornate-India and has been adopted by various state government and international organizations. The fourth cycle of the course will train another 100 physicians. To ensure sustainability and expand the reach of the course, it has also been developed into an e-learning platform.
Conclusion: This unique educational model has met an excellent response from physicians, which probably reflects the felt need of physician community in India for skill improvement in DR management.

Disclosure
S. Bhalla: None. P. Kumar: None. H. Chandwani: None. M. Joshi: None.
679-P: Learner Preferences Related to Diabetes Medical Education
Authors: LARKIN AMY , LACOUTURE MICHAEL 
Published: June 2019

Introduction: Understanding how clinicians prefer to learn and participate in continuing medical education (CME) and continuing education (CE) for certified diabetes educators (CDEs) can help providers of such education design more engaging and effective activities that can potentially further improve diabetes management in practice.
Methods: Medscape conducted a 10 question, online, incentivized survey in May 2018. Respondents’ confidentiality was maintained and responses were de-identified and aggregated prior to analyses.
Results: Most preferred duration for a CME activity: 30 minutes (33% PCP, 42% D/Es, and 41% CDEs). Most preferred format for a CME activity: online (52% PCP, 58% D/Es, and 63% CDEs), followed by live events at a medical conference (38% PCP, 30% D/Es, and 18% CDEs). Most preferred format for an online CME activity: video (60% PCP, 48% D/Es, and 51% CDEs), followed by text (37% PCP, 43% D/Es, and 41% CDEs). For online CME/CE, most preferred instructional design format: case-based (54% PCP, 56% D/Es, and 57% CDEs). Most important factors in selecting online CME/CE activities: content description (58% PCP, 52% D/Es, and 61% CDEs), credit hours for D/Es (40%) and CDEs (49%), and credit hours and title for PCPs (both 36%). The most important factors in selecting which symposia to attend at a scientific congress were content agenda for all groups (62% PCP, 64% D/Es, and 63% CDEs), learning objectives for D/E (29%) and CDEs (41%), and faculty for PCPs (44%). Most common ways of becoming aware of available professional education activities: invitation from online providers (PCPs 60%, D/Es 60%, CDEs 67%) and societies (PCPs 50%, D/Es 70%, CDEs 63%). The majority of participants reported that in the past 12 months they have learned something from CME/CE that changed their practice (88% PCP, 92% D/Es, and 82% CDEs).
Conclusion: Learner preferences for diabetes-related to live and online CME/CE were identified. These data should inform development of future CME/CE activities that are engaging and impactful.

Disclosure
A. Larkin: None. M. LaCouture: None.
681-P: Survey of Medical Staff on Use of Glucagon Injection in the Event of Serious Hypoglycemia in Japanese Diabetic Patients—Reason for Poor Spread of Glucagon Use in Japan
Authors: SAITO NOBUMICHI , TOYODA MASAO , KIMURA MORITSUGU , FUKAGAWA MASAFUMI 
Published: June 2019

Glucagon injection is effective in the event of serious hypoglycemia, especially in unconscious patients who cannot swallow their medications. However, recent surveys in Japan found that only 15.9% of patients have glucagon injections in their possession, and both the adoption rate and the level of awareness in Japan lag behind those of Western countries. This suggests that the medical care and education system for diabetes patients in Japan should deal with this issue not only with patients and their families, but also with healthcare professionals engaged in patient guidance. We carried out a questionnaire survey of the staff at our hospital to determine the state of awareness and provision of glucagon injections by the medical staff in the event of serious hypoglycemia. A questionnaire was distributed to 100 medical staff at our hospital who were engaged in treatment of diabetes, requesting information about the state of knowledge and awareness on glucagon injections. All physicians and about 30% of nurses provided guidance on glucagon injection. In contrast, only a few nutritionists, pharmacists, clinical technologists, and other professionals, who were Certified Diabetes Educators of Japan, had ever done so. We concluded that the lack of knowledge among the medical staff about the technique of glucagon injection and related specific instructions may be one reason for the low rate of glucagon possession and use among the Japanese diabetics. The results suggested that the medical staff have poor knowledge about the technique of injection of glucagon and related instructions, and that a procedure has yet to be established for collection of expired unused dispensed glucagon vials and for re-prescription. Our results highlighted the need for educational programs for a sizeable proportion of healthcare professionals who are involved in the management of diabetes but lack specific information on glucagon injection.

Disclosure
N. Saito: None. M. Toyoda: Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kyowa Hakko Kirin Co., Ltd., Medtronic Japan Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk Inc., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. M. Kimura: None. M. Fukagawa: Research Support; Self; Kyowa Hakko Kirin Co., Ltd. Speaker's Bureau; Self; Bayer Yakuhin, Ltd., Kissei Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Torii Pharmaceutical Co., Ltd.
683-P: Multidisciplinary Predialysis Team Education for Patients with Diabetic Nephropathy May Prolong Survival and Decrease the Mortality after the Induction of Dialysis
Authors: HITOMI MAMIKO , SATO TERUKO , MORIYA TATSUMI 
Published: June 2019

Although a multidisciplinary individual team approach (MTA) has been thought to help prevent the progression of diabetic nephropathy (DN), its efficacy on patient survival has not been fully examined. We compared the effect of an MTA on the hemodialysis (HD) course of 60 DN patients with that of 40 DN patients managed via a dietitian approach (DA) alone (total patients, n=100; 68 male, age, 61±12 years; 95 T2DM). In all cases, HD was initiated between January 2010 and June 2017. MTA staff members were doctors, dietitians, nurses, laboratory technologists, and pharmacists. The team provided broad education such as advice on nutrition, medication, medical exam, and foot care. In the MTA group, the hematocrit value was significantly better, and the difference between real body weight at the initiation HD and dry weight was significantly smaller (vs. DA group: 28.3±4.8% vs. 26.6±4.1% p=0.033, 6.4±5.6kg vs. 8.9±7.1kg p=0.036, respectively). The MTA group tended to have a lower CTR, lower cost per admission for HD induction and lower urinary sodium excretion in 24h urine collection (vs. DA group: 53.4±6.6% vs. 55.5±8.2% p=0.095, $14,861±8,222 vs. $18,693±14,149 p=0.064, 8.2±2.2g/day vs. 13.0±6.9g/day p=0.095, respectively). The number of rehospitalizations due to macroangiopathy after HD induction was smaller in the MTA group (Pearson 3.444, p=0.064). The frequency of death after HD was significantly lower in the MTA group (Pearson 4.575, p=0.032). A Kaplan-Meier survival analysis showed that the MTA group had superior patient survival (log rank 5.727, p=0.017).
In conclusion, the MTA provided prolonged survival and might prevent rehospitalization. Both might be resulted from predominant and non-inferior effects of an MTA on DN patients with HD; thus, further study is warranted to examine the combined effects of the predominant or non-inferior advantages of MTA in providing longer life expectancy in comparison to DA.

Disclosure
M. Hitomi: None. T. Sato: None. T. Moriya: None.
69-OR: Mobility, Satisfaction, and Quality of Life among Long-Term Dysvascular/Diabetic Prosthesis Users: Results of a National Cross-Sectional Survey
Authors: STEVENS PHILLIP , WURDEMAN SHANE R. 
Published: June 2019

Objective: To establish the mobility, satisfaction and quality of life among prosthesis users with major lower limb dysvascular/diabetic amputation (transtibial or proximal) at various long-term phases of prosthetic rehabilitation.
Methods: A multi-site, cross-sectional outcomes analysis. A total of 341 individuals met inclusion/exclusion criteria. Individuals were grouped in acute phases (0-3 mos (n=24); 4-6 mos (n=72)) and chronic phases (24-36 mos (n=91), 37-48 mos (n=53), 49-60 mos (n=47) and 60-84 mos (n=54)) post-amputation. Mobility was measured with the Prosthetic Limb Users Survey of Mobility (PLUS-M) while quality of life (Qol) and satisfaction (Sat) were reported using 10-point scales adapted from the Prosthesis Evaluation Questionnaire-Well Being (PEQ-WB).
Results: The average mobility, Qol and Sat among prosthesis users was, respectively, 44.8±10.6, 7.6±2.2 and 7.6±2.2. There were no observed differences in mobility (F5,330=1.52, p=0.18) or Qol (F5,333=0.78, p=0.57) between any groups. For Sat, there was a group difference (F5,334=2.44, p=0.03) as individuals who receive a prosthesis 0-3 mos experience initial higher Sat values compared to those 25-36 mos (p=0.005), 49-60 mos (p=0.008), and 61-84 mos (p=0.009).
Conclusion: Those individuals with amputation secondary to dysvascular disease and diabetes who continue to participate in prosthetic rehabilitation appear to maintain reasonable levels of mobility, satisfaction and quality of life as much as 7 years post amputation. There may be a modest initial increase in satisfaction with the early receipt of a prosthesis. However, transfemoral amputations were under represented in this cohort of individuals fitted shortly after amputation. Notably, the mobility levels observed in the dysvascular population through a range of extended post-amputation durations remain within a single standard deviation of the amputee population mean for mobility.

Disclosure
P. Stevens: Employee; Self; Hanger Clinic. S.R. Wurdeman: None.

Funding
American Orthotics & Prosthetics Association (EB-043016)
70-OR: Are Surrogate Markers for Osteomyelitis Remission Reliable?
Authors: CRISOLOGO PETER A. , FONTAINE JAVIER LA , DAVIS KATHRYN , WUKICH DANE , LAVERY LAWRENCE A. 
Published: June 2019

Aim: To evaluate surrogate markers commonly used in the literature for osteomyelitis remission after initial treatment for diabetic foot infections (DFIs).
Methods: 35 patients with DFIs were prospectively enrolled and followed for 12 months. Osteomyelitis (OM) was determined from bone culture and histology initially and for recurrence. We used X2 test for dichotomous variables and ANOVA for continuous variables.
Results: 24 patients were diagnosed with OM and 11 with soft-tissue infections (STI). There was no difference between the two groups for OM re-infection, healed ulcers, re-ulceration, re-admission for DFI at the same site, amputation at the same site after discharge. There were more surgeries after discharge in the STI group (p=0.02, Table 1).
Conclusions: OM at the same site based on bone biopsy indicated that 16.7% failed therapy; this was the only direct measure of OM. Indirect markers demonstrated a higher rate of failure. Failure ranged from 8.3-20.8% with surrogate markers. Most OM markers were similar to markers in STI subjects. Surrogate markers should not be the sole criteria used in place of more accurate measures such as advanced imaging or the gold standard of a bone culture and histopathology.

Disclosure
P.A. Crisologo: None. J. La Fontaine: None. K. Davis: None. D. Wukich: Consultant; Self; Orthofix. Other Relationship; Self; Arthrex. L.A. Lavery: Consultant; Self; Bayer US, Boehringer Ingelheim Pharmaceuticals, Inc., Medline Industries, Inc. Research Support; Self; Cardinal Health, EO2 Concepts, Integra LifeSciences, MedImmune, Osiris Therapeutics, Inc.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (3U24DK076169-08S4)
701-P: Predictors of Engagement and Weight Loss in Real-World Diabetes Prevention Program (DPP)
Authors: AUYOUNG MONA , LUU KIMBERLY , RUIZ MONICA , WALKER CHRIS , PHILIS-TSIMIKAS ATHENA , FORTMANN ADDIE L. 
Published: June 2019

Weight loss can significantly reduce an individual’s risk for T2D. However, it can be challenging to engage participants in the DPP long enough to lose weight. This analysis examines sociodemographic characteristics and health behaviors as predictors of participant engagement and weight loss/gain. Participants were recruited into the DPP through a referral from a provider, family/friend, or other. Classes were conducted through local ambulatory clinics and community settings in San Diego, CA. Baseline self-report surveys were administered prior to program start, and weight was assessed at every session. Participants (N=290) were mostly female (81%) with a mean age of 57 (±14), diverse [51% Hispanic, 9% Asian/Native Hawaiian or Pacific Islander (ANHPI), 4% Other], and reported household incomes &lt;$24,000 (77%). Regression models also controlled for age, baseline BMI, education, and employment. Baseline healthful eating was a significant predictor of DPP engagement; each 1-point increase on the Towsend Food Behavior Checklist was associated with an average of 0.25 fewer sessions (p=0.016) attended (out of 34 possible sessions). Participants of Other race/ethnicity averaged significantly fewer sessions (11.5±8.5) than whites (17.40±8.6, p=0.004), Hispanics (17.36±7.7, p=0.009), and ANHPIs (16.16±8.9, p=0.01). There were significant differences in weight loss for men (-8.07±9.5) vs. women (-6.30±9.4, p=0.04) and for retirees (-6.50±7.59) vs. the employed (-8.14±10.87, p=0.023) and self-employed (-5.48 ±10.64, p=0.04), and retirees. Participants with healthier eating behaviors may not feel the need to attend as many sessions as others, although the difference in attendance is relatively small. The racial/ethnic differences in engagement should be interpreted with caution since there may be differences within the different racial/ethnic groups in this category. The weight loss differences by work status suggest more tailored approaches and strategies to lifestyle management.

Disclosure
M. AuYoung: None. K. Luu: None. M. Ruiz: None. C. Walker: None. A. Philis-Tsimikas: Advisory Panel; Self; AstraZeneca, Lilly Diabetes, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Dexcom, Inc., Glooko, Inc., National Institute of Diabetes and Digestive and Kidney Diseases. Stock/Shareholder; Spouse/Partner; Ionis Pharmaceuticals, Inc., Novo Nordisk Inc. A.L. Fortmann: None.
707-P: Diabetes Education through Shared Medical Appointment: Utilizing Digital Health—A Comparison of Platforms and Integrating Devices with Result Review
Authors: FAIMAN MATTHEW , HUSTAK LEIGHANNE KRAMER , MAGGIORE ANNE J. , SUMEGO MARIANNE 
Published: June 2019

Chronic disease management is over whelming the Unites States Healthcare System. Often the barriers to care in chronic disease include limited access, inadequately trained caregivers, travel costs, lack of real time data, and the limitations of office time for education. The novel use of digital health seeks to optimize care and address many of the social barriers to quality care. At the same time, the new requirements of health care regulation in the United States, challenge health care organizations to improve population management. The Distance Health team and Shared Medical Appointment (SMA) team, in an effort to positively affect population management of type 2 diabetics across practices, developed a work effort to compare two telehealth platforms for the delivery of group education and medication management. The utilization of smart devices for real time data collection in the management of diabetes and associated chronic diseases was also implemented. The team sought to compare the American Well platform with the TruClinic platform for delivery of group education translating traditional SMA in office visits to virtual delivery engaging multiple patients. The participants were identified through care gap registries, internal medicine provider referrals for diabetes education and patient self-referral. The patients were randomly assigned. A family nurse practitioner with CDE certification followed and engaged the patients monthly in SMA education sessions through one of the digital platforms, over a 4 month period using change in A1C and qualitative patient satisfaction data to review SMA engagement, improved disease state and platform usability. The process from patient identification, digital consent, appointment invitation, and qualitative data review of provider satisfaction, patient engagement, and A1C improvement is described in detail comparing the two platforms’ usability.

Disclosure
M. Faiman: None. L.K. Hustak: None. A.J. Maggiore: None. M. Sumego: None.
717-P: Effect of Telephone Coaching Support on Glycemic Control in Type 2 Diabetes Treated with Glargine U300 Insulin
Authors: GUERRERO DIEGO BELLIDO , BELLIDO VIRGINIA , MORALES CRISTOBAL , GARCÍA JOSÉ , MUÑOZ-GARACH ARACELI , FERNANDEZ MORERA JUAN LUIS , AGUILERA BEATRIZ GONZALEZ , LÓPEZ DE LA TORRE MARTÍN , FUENTEALBA PAULINA 
Published: June 2019

Background and Aims: “T-Coach® program” is a telephone support platform for type 2 diabetes (T2D) on glargine U300 insulin. This study aimed to evaluate whether this program was effective in helping patients reach their optimal insulin dose.
Materials and Methods: Both T2D patients who were initiating glargine U300 or requiring dose titration, enrolled in T-Coach® program, were included in the study. Telephone intervention was delivered by diabetes nurse educators and consisted of regular telephone sessions, aimed at achievement of target fasting blood glucose (FBG) and reinforce diabetes education. The optimal insulin dose (OID) was defined as the dose of Glargine U300 required to achieve target FBG. The primary outcome was whether a patient reached the OID dose within 6 months.
Results: A total of 589 patients consented and were included in TCoach program®. Median age was 65.4±11.2 years; 51.8% men; BMI 30.3±6 kg/m2. Of them, 65.9% were already on basal insulin (17.7% on Glargine U300). Mean glargine U300 dose was 27.4±15.9 UI. Mean baseline HbA1c was 9.4±1.8%, and basal FBG was 215.2±66.2 mg/dL. Mean FBG target was 88.7-132.3 mg/dl. Of them, 77.6% reached their OID at 6 months (75.7% at 3 months, and 41.2% at 1 month), and they did so in an average of 2.2±1.8 months. Mean FBG levels fell from 215.2 mg/dL to 137.9 mg/dL, 117.9 mg/dL and 115.9 mg/dL at months 1,3 and 6, respectively. Mean glargine U300 dose increased from 27.4 UI to 30.4 UI at month 6. Knowledge and adherence questionnaires were given to the patients. Mean score in knowledge questionnaire increased from 4.8 to 7.6 after the program. Moreover, a satisfaction survey was completed by 208 patients. The program was very well graded, with an average score of 9.1 out of 10.
Conclusion: The T-Coach® program is an effective way to help patients reach their optimal insulin glargine U300 dose, improves glycemic control and can be an effective support for diabetes education.

Disclosure
D. Bellido Guerrero: None. V. Bellido: None. C. Morales: Other Relationship; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. J. García: None. A. Muñoz-Garach: Speaker's Bureau; Self; Lilly Diabetes, Novo Nordisk A/S, Sanofi-Aventis. J.L. Fernandez Morera: None. B. Gonzalez Aguilera: None. M. López de la Torre: None. P. Fuentealba: Employee; Self; Sanofi.