bluuebunny/crossref_metadata_2025_split huggingface dataset:
618-P: Development of a New Index Based on 24-Hour Urinary Creatinine to Predict Improvement of Lumbar Spine BMD after One Year of Zoledronic Acid Treatment for Osteoporosis
Authors: ZENG JIANGPING , JING YUJIE , LI NANNAN , SHENG HUI 
Published: June 2024

Introduction & Objective: Muscle and bone can interact with each other, but the effect of muscle on osteoporosis treatment is not clear. This study aims to study the correlation between 24 h Ucr (24-hour urinary creatinine excretion, an indicator of muscle mass) and the change of lumbar spine bone mineral density (BMD) after treatment with Zoledronic Acid (ZOL), and develop an effective model for BMD improvement prediction.
Patients and Methods: A total of 169 adults with primary osteoporosis receiving ZOL (5 mg once year) were included. BMD was measured at baseline and 1 year after treatment. BMD improvement was defined as a percentage increase greater than the minimum BMD change (2.78%).
Results: 24 h Ucr was negatively correlated with 1 year lumbar BMD changes (r = -0.208, p = 0.007) after treatment with ZOL. Binary logistic regression analysis showed that after adjusting for sex, age, height, weight, diabetes mellitus, baseline lumbar BMD and serum creatinine, 24 h Ucr was an independent predictor of improvement in lumbar BMD after 1 year of ZOL treatment (odds ratio 0.580, 95% confidence interval 0.456 - 0.738, p &lt; 0.001). A new model logit (P) ( -1.321 + 1.864 × gender (female = 1, male = 2) + 9.8 × height (m) - 1.038 × T2DM (yes = 1, no = 0) - 0.582 × 24h Ucr (mmol/d) + 0.061 × creatinine (umol/L) - 16.958 × lumbar BMD (baseline) (g/cm2)) constructed by binary logistic regression analysis with backward selection predicted that the area under the curve (AUC) of lumbar BMD improvement was 0.871. With P = 0.739 as the cutoff value, the specificity was 89.3%, and the sensitivity was 73.5%. The final predictive model was internally validated using the bootstrap re-sampling procedure that calculated small AUC optimisms of -0.001 (95% CI -0.005-0.003).
Conclusion: 24 h Ucr was negatively correlated with 1 year change in lumbar BMD after treatment with ZOL and the index P showed good predictive value for 1 year lumbar BMD improvement after treatment with ZOL.

Disclosure
J. Zeng: None. Y. Jing: None. N. Li: None. H. Sheng: None.

Funding
Grants from National Natural Science Foundation of China (No. 82170894); Program of Shanghai Science and Technology Committee (21S11901100); The Research Physician Project of Shanghai Tenth People's Hospital (2023YJXYSA014).
630-P: Vitamin D Deficiency and Its Association with Clinical Parameters in Type 2 Diabetes—Findings from a Cross- Sectional Study in India
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , KATHRIKOLLY THEJAS , TIWARI DIPTIKA , SHARMA BABY , VYAWAHARE ANAGHA R. , GANLA MALHAR H. , HIREMATH MAMATA , SABOO BANSHI D. 
Published: June 2024

Introduction & Objective: The interplay between vitamin D deficiency and type 2 diabetes (T2D) has gained significant attention, with studies indicating that vitamin D deficiency is a potential risk factor for T2D. This study aimed to explore the association between vitamin D deficiency and key clinical parameters in individuals diagnosed with T2D.
Methods: A cross-sectional study was conducted on 2787 T2D-diagnosed patients enrolled in a one-year online lifestyle intervention program at the Freedom from Diabetes Clinic, India, from January to September 2023. The intervention comprised a customized plant-based diet, exercise, stress management, and medical support. Demographic, clinical, and anthropometric data were collected. Serum vitamin D levels were assessed using standardized assays; levels &lt;20 ng/ml indicated deficiency.
Results: The mean age of the study population was 49±10 years (62% male), and 43% had vitamin D deficiency. There was a statistically significant relationship between poor glycemic control (HbA1c&gt;7%) and vitamin D deficiency (p&lt;0.05). Vitamin D deficiency was associated with increased levels of LDL-C, triglycerides, and total cholesterol, and decreased HDL-C levels (p&lt;0.05). Vitamin D deficiency was significantly higher in patients with elevated hsCRP levels (47%) than in those with normal hsCRP levels (42%) (p&lt;0.05), highlighting the role of vitamin D in inflammatory processes. Additionally, vitamin D deficiency was associated with shorter disease duration (&lt;6 years), younger age (&lt;40 years), and male sex (p&lt;0.05).
Conclusion: Our study highlights significant links between vitamin D deficiency and metabolic markers, notably poor glycemic control, lipid abnormalities, and inflammation. Further investigations to determine the causal relationships between these factors and develop targeted interventions for managing vitamin D deficiency in individuals with type 2 diabetes are warranted.

Disclosure
P. Tripathi: None. N.S. Kadam: None. T. Kathrikolly: None. D. Tiwari: None. B. Sharma: None. A.R. Vyawahare: None. M.H. Ganla: None. M. Hiremath: None. B.D. Saboo: None.
643-P: Exploring Eating Styles of Older Adults with Type 1 Diabetes (T1D)
Authors: CRISTELLO SARTEAU ANGELICA , GOPISETTY NIKHITA R. , SPRINKLES JESSICA , ERCOLINO GABRIELLA , FRUIK ANGELA , MUTHUKKUMAR RASHMI , QU XIAORUI , MAYER-DAVIS ELIZABETH J. , KAHKOSKA ANNA 
Published: June 2024

Introduction & Objective: Emotional, external, and restricted eating styles may shape diet, glycemic levels, and other cardiovascular risk factors in T1D. We characterized eating styles among older adults with T1D given scant knowledge to guide dietary counseling in this growing population.
Methods: Older adults with T1D seeking care at an academic endocrinology clinic completed an online survey (Sep-Nov 2023) with the Dutch Eating Behaviour Questionnaire (DEBQ). We calculated mean and median restrained, external, and emotional eating style scores and examined relationships between scores, BMI, and HbA1c.
Results: The DEBQ was completed by 77 older adults (age 71.3 ± 4.1, 93.5% non-Hispanic White) with T1D (duration 33.5± 18.1, Hba1c 6.8 ± 1.1, BMI 27.3 ± 4.7). Scores for restrained eating (M: 1.54, Range: 0.0 - 3.4), emotional eating (M: 0.94, Range: 0.0 - 3.8), and external eating (M: 1.51, Range: 0.0 - 3.2) were lower than estimates in extant studies. Results suggest a positive relationship between emotional and external eating, between emotional eating and BMI, as well as a negative relationship between restrained eating and HbA1c (Figure 1).
Conclusion: This is the first study to characterize eating styles among older adults with T1D. Results suggest distinct eating styles in this population that may correlate with key clinical outcomes. Research must further evaluate validity of the DEBQ and identify clinically relevant cut points.

Disclosure
A. Cristello Sarteau: None. N.R. Gopisetty: None. J. Sprinkles: None. G. Ercolino: None. A. Fruik: None. R. Muthukkumar: None. X. Qu: None. E.J. Mayer-Davis: None. A. Kahkoska: None.

Funding
K12TR004416
644-P: Racial Ethnic Disparities in Prescription of GLP-1 Receptor Agonists for People at High Risk for Diabetes on Atypical Antipsychotics
Authors: SAM VARGHESE JITHIN , GOLDSMITH DAVID , WAFORD RACHEL , CHAKKALAKAL ROSETTE , ALI MOHAMMED K. , PASQUEL FRANCISCO J. , COTES ROBERT O. 
Published: June 2024

Introduction: Atypical antipsychotics (AAP) significantly increase the risk of obesity and type 2 diabetes (T2D). GLP-1 receptor agonists (GLP-1 RA) are weight-loss medications which may be beneficial in treating AAP-induced weight gain. We evaluated trends in prescriptions of GLP-1 RA among patients at high risk of T2D using AAP stratified by race-ethnicity.
Methods: We modeled covariate-adjusted trends in GLP-1 RA (liraglutide, semaglutide) prescriptions between January 2019-November 2023 from the Epic Cosmos dataset among a real-world cohort at high risk of T2D on AAP. We included 121,493 adults (18-99 years) with obesity or overweight (BMI ≥ 27kg/m2) and weight-related comorbidity (hypertension or hypercholesterolemia). We report trends in GLP-1 RA prescriptions by race-ethnicity (Hispanic, Non-Hispanic [NH] White, NH Black, NH Other).
Results: The analytic sample was 59.0% female, 72.2% NH White, 16.2% NH Black, and 5.8% Hispanic with mean age of 51.4 (SD: 19.2) years. There were no differences by race-ethnicity in 2019. However, in 2023 relative to NH White patients (2.2% [95% CI: 1.4, 3.1]), prescriptions were lower for NH Black (-1.1% [-2.8, 0.1]), Hispanic (-1.5% [-2.7, 0.0]) and NH Other (-1.2% [-2.7, 0.0]), Figure.
Conclusion: There are emerging racial-ethnic disparities and underuse of effective weight loss medications among patients treated with AAP.

Disclosure
J. Varghese: None. D. Goldsmith: None. R. Waford: None. R. Chakkalakal: None. M.K. Ali: Advisory Panel; Eli Lilly and Company. F.J. Pasquel: Research Support; Tandem Diabetes Care, Inc., Insulet Corporation, Dexcom, Inc., Ideal Medical Technologies, Novo Nordisk. Consultant; Dexcom, Inc., Medscape. R.O. Cotes: Research Support; Roche Pharmaceuticals, Alkermes, Otsuka America Pharmaceutical, Inc., Karuna Therapeutics. Consultant; Saladax Biomedical. Speaker's Bureau; Saldax Biomedical, Clinical Care Options (CME company).
646-P: Improved Outcomes with Intensive Follow-up in Pediatric Diabetes Patients with Care Concerns
Authors: MCCAULEY MARY , FULTON CAROLINE , MORELOS CELIA 
Published: June 2024

Introduction: Standards of pediatric diabetes care recommend routine clinic visits quarterly, but in some cases more frequent visits may aid in improving hyperglycemia. This study aimed to determine if intensive follow-up affected DM outcomes.
Methods: EHR data was reviewed (2020-23) to identify subjects with a prior diagnosis of T1D or T2D on insulin therapy at start of intervention. Increased follow-up was initiated for hyperglycemia (84%), education needs (64%), DM burnout (42%), behavioral health (BH) concern (42%), family dynamics (34%), recent onset (32%), pump start (32%), or young age (10%). BH interventions targeted coping, problem-solving, and communication. Data analyzed with SPSS. Primary outcomes were A1c, time-in-range (TIR); secondary outcomes included medications, technology use, and ED/hospital visits.
Results: Cohort (n=50) included subjects with T1D (66%) and T2D (32%). Intervention occurred 2.4 years post-diagnosis with a mean duration of 6 months or 5 clinic visits. Initial A1c (n=50) was 10.85% (95% CI 10.23-11.48, SD 2.18); post-A1c (n=50) was 8.35% (95% CI 7.87-8.92, SD 1.93); mean decrease in A1c was 2.5% (95% CI 1.89-3.10, SD 2.13, p&lt;0.001). Initial TIR (n=17) was 31.47% (95% CI 17.21-45.72, SD 27.72); post-TIR was 47.35% (95% CI 37.39-57.31, SD 19.37); mean increase was15.88% (95% CI 8.71-21.8, SD 3.467, p=0.007). Subjects with identified DM burnout, BH concerns, DSM-5 TR diagnosis, or IEP were just as successful in achieving A1c improvement. There was a reduction in MDI therapy (p&lt;0.001) and an increase in hybrid closed-loop pump use (p&lt;0.001). There was an increase in CGM use (p&lt;0.001) and a reduction in ED visits/hospitalizations (p&lt;0.001).
Conclusion: In a pediatric diabetes cohort with identified care concerns, significant improvement in mean A1c/TIR and increased diabetes technology utilization were seen following brief intensive intervention. These findings strongly support short-term increased follow-up to improve diabetes outcomes.

Disclosure
M. McCauley: None. C. Fulton: None. C. Morelos: None.
653-P: Do Specific Fears or General Anxiety Mediate the Relationship between Child Nighttime Glucose Levels and Parent Sleep Quality?
Authors: MONZON ALEXANDRA , PIERCE JESSICA S. , WASSERMAN RACHEL M. , MCDONOUGH RYAN , PATTON SUSANA R. 
Published: June 2024

Introduction: Many caregivers of youth with type 1 diabetes (T1D) report reduced sleep at night and sleep disruptions due to overnight diabetes care and fear of nighttime hypoglycemia (FoNH). Data suggests that child nighttime glycemic variability is associated with increased FoNH, and increased nighttime caregiving due to out-of-range glucose levels may also impact parent sleep, but no studies have examined relations among these variables in a single model. The current study examines if parent FoNH or general anxiety mediates the relationship between child nighttime glycemic variability and parent sleep quality.
Methods: We recruited 165 parents/caregivers of youth with T1D. We administered the Pittsburg Sleep Quality Scale, State-Trait Anxiety Inventory, and the Hypoglycemia Fear Survey for Parents, along with new items that assessed additional nighttime fears more comprehensively. Youth provided 14 days of glucose data from their personal continuous glucose monitor. We conducted mediation analysis in R using the Lavaan package.
Results: Most caregivers (89%) self-identified as mothers with a Mage= 41.76+6.52 years. For youth, 49% were female, Mage= 13.41+2.59 years, MT1D duration= 3.97+3.14 years, and MHbA1C= 7.81 + 1.43. Mediation analyses revealed a direct effect of glycemic variability on parent sleep quality (b=0.04, p&gt;0.05), and parent FoNH mediated this effect (b=2.9, p&gt;0.05). Neither state (p=0.29) nor trait anxiety (p=0.28) mediated this effect.
Conclusions: It is important to consider how child glucose levels at night relate to parents' sleep quality to reduce the risk that parental fatigue may impact their functioning the following day. The results of this study suggest that parental FoNH is an important factor that relates to parent sleep quality. Clinicians may consider providing strategies that may help parents manage their specific worries related to hypoglycemia to potentially help parents improve sleep.

Disclosure
A. Monzon: None. J.S. Pierce: None. R.M. Wasserman: None. R. McDonough: Speaker's Bureau; Provention Bio, Inc. S.R. Patton: None.
663-P: Acceptability and Preferences for Features of a Family Module in an Artificial Intelligence–Enabled Empower Mobile App to Support Type 2 Diabetes Self-Management—A Formative Study
Authors: LING RENA LAU RUI , LIU HUIYI , KIE PHANG JIE , HENG KWAN YU , LENG LOW LIAN , YOON SUNGWON 
Published: June 2024

Despite the pivotal role of family support for type 2 diabetes (T2DM) management, research on family-based intervention that leverages AI-enabled mobile apps is limited. This study aims to explore perceptions of T2DM patients and family members on the acceptability of a FAMILY module in the EMPOWER mobile app and their feedback on specific FAMILY module features to inform future EMPOWER-FAMILY intervention.
We conducted semi-structured interviews with 25 T2DM patients and 25 family members. All interviews were audio-recorded and transcribed verbatim. The transcripts were analyzed using NVivo.
The FAMILY module was seen as an opportunity to cultivate shared decision making by both patients and family members. However, concerns evolved around increased family burden and diminished sense of patient autonomy, leading to potential patient-family conflicts. Leveraging on AI technology, the FAMILY module sends tailored nudges to a family member based on patient’s lifestyle behaviors. While participants acknowledged its benefits, some expressed a desire for greater customization in both frequency and content. Participants appreciated user-friendly meal logging using AI-powered food detection. Nevertheless, app feedback on dietary choices and healthier alternatives is desired, which is particularly relevant for family members involved in preparing patients’ meals. The inclusion of patient-family collaborative goal setting and achievement tracking features via wearable devices was viewed as beneficial, fostering motivation and dedicated family time. Other proposed enhancements include a platform for sharing experiences and incorporate telemedicine functionality.
Both patients and family members indicated their willingness to engage in the FAMILY module. The feedback collected from the study will be used to inform the development of the EMPOWER-FAMILY module and future intervention.

Disclosure
R. Lau: None. H. Liu: None. J. Phang: None. Y. Kwan: None. L. Low: None. S. Yoon: None.

Funding
Ministry of Education Tier 1 grant (2022-MOET1-0005)
671-P: Development of Novel Infrastructure for Diabetes Distress Screening in the Electronic Health Record
Authors: FRUIK ANGELA , YOUNG LAURA A. , GOEKE-AUSTIN KAREN K. , BEEZLEY LISA R. , THOMAS AARON , KAHKOSKA ANNA 
Published: June 2024

Introduction & Objective: Though clinical guidelines recommend diabetes distress (DD) screening, real-world screening is hindered by the burden of implementing screening regimens into clinical workflow. Our objective was to automate DD screening for people with type 1 diabetes (T1D) at a university-affiliated outpatient endocrinology clinic by building it into the EHR system.
Methods: We undertook an EPIC build to screen patients with T1D using the T1-DDAS Core Distress Scale (“screener”) and equip providers with the language to address DD. We developed and iterated the (1) eligibility criteria for distribution; (2) the patient-view of the screener; (3) scoring and storing of results; and (4) infrastructure for providers to be notified and research personnel to receive lists of patients with elevated DD.
Results: Our EHR now supports delivery of a DD screener with built-in scoring in MyChart (Figure 1); a Flowsheet showing current and past results; a front desk view to identify patients who had not yet completed the screener; a BPA (Best Practice Advisory) for the provider to address DD; and a research view.
Conclusion: This project provides proof of concept that DD screening can be integrated into the EHR to promote guidelines-aligned screening and increased clinical attention to DD. Future work involves clinic-level implementation and evaluation with patients, providers, and staff feedback.

Disclosure
A. Fruik: None. L.A. Young: Research Support; Novo Nordisk, Eli Lilly and Company, vTv Therapeutics, Beta Bionics, Inc., Corcept Therapeutics, Rhythm Pharmaceuticals, Inc., Bayer Inc., Jaeb Center for Health Research. K.K. Goeke-Austin: None. L.R. Beezley: None. A. Thomas: None. A. Kahkoska: None.

Funding
American Diabetes Association (12-22-ACE-18)
673-P: Impact of Language in Clinical Discussions of Diabetes-Related Complications in a Predominantly Non-White Sample
Authors: GARZA MATTHEW , COX EVELYN , WILSON KAREN , MORGAN ALICE J. 
Published: June 2024

The language used to talk about diabetes impacts the mental, physical, and emotional health of people with diabetes (PWD) and others’ perception of PWD. While general language recommendations for healthcare professionals (HCPs) exist, less is known about the language surrounding diabetes-related complications. This qualitative study aimed to examine how diabetes-related complications are discussed in clinics, the language used, and the emotional impact of these conversations on PWD. In October 2023, 42 PWD were recruited through the dQ&A US Patient Panel to participate in a 5-day asynchronous online discussion board via QualBoard®. Participants submitted written and video responses to a structured discussion guide and data were transcribed and analyzed using thematic analysis. The resulting participants were 57% women, 81% non-white, and included those with type 1 (21%), type 2 on insulin therapy (38%), and type 2 diabetes not on insulin therapy (41%). Discussions of diabetes-related complications varied by race and ethnicity, diabetes type, and duration of diabetes. Thematic analysis revealed three types of diabetes-related complications that struck the most fear among PWD: eye and kidney complications, and amputation. When addressing these, some HCPs used fear-based approaches, emphasizing outcomes such as blindness, dialysis, and amputation. Language depicting 'loss,' such as 'loss of limbs' or 'loss of eyesight,' used by some HCPs contributed to heightened emotional distress among PWD, and invoked a fear of lost independence or normalcy. Furthermore, framing these complications as 'end stage' prompted reflections on mortality, while the phrase 'kidney failure' led to feelings of personal failure in diabetes management. These findings highlight the use of loss-framing communication and stigmatizing, fear-based language in these conversations, as well as the negative impact this can have on the emotional state of PWD.

Disclosure
M. Garza: Other Relationship; Sanofi. E. Cox: Employee; dQ&A. K. Wilson: Employee; dQ&A. A.J. Morgan: Employee; dQ&A.

Funding
This research was funded, in part, by support from Genentech and Abbott.
687-P: Effectiveness of a Hybrid Care Model on Mental Health in a Type 2 Diabetic Population
Authors: ZAKARIA HALA , CACCELLI MILENA , OZKAN CIGDEM , DEBS JOELLE , DAHLSTROM NICOLE C. , DE LOS RIOS CELESTE , BANGAYAN JESTONI , JANE DIVINO DIANNE , SAID YOUSEF , HASHEMI ALI , ALMARZOOQI IHSAN 
Published: June 2024

Diabetes necessitates continuous self-regulation and behavioral management. Individuals with diabetes usually navigate disjointed care systems, manage stress, and need to maintain emotional balance. This often-invisible workload, overlooked by professionals fixated on numerical data, contributes to emotional distress in one-third of diabetes patients. Mental health scores are not reported by the majority of providers.This study aims to evaluate mental health and glycemic control in Type 2 Diabetes (T2D) patients through a hybrid care model (physical and digital engagement) to address challenges and guide multidisciplinary interventions.In a retrospective study of 89 patients with T2D who were managed by GluCare.Health for a year, coaches and a wider healthcare team (physicians, educators, dietitians) provided continuous engagement and support) both in-clinic and remotely (via an app). Three mental health measures were used: the World Health Organization-5 score (WHO-5), a self-reporting measure of mental well-being and quality of life, the Problem Areas in Diabetes Questionnaire (PAID) and the Patient Health Questionnaire-9 (PHQ9), which detects mental illnesses. Paired sample t-test was performed for annual improvements. Significant improvements were observed across various parameters. Patients showed weight loss (-4.0 ± 5.3, p&lt;0.001), reduced waist circumference (-4.74 ± 7.8, p&lt;0.001), and lowered HbA1c levels (-1.00 ± 1.3, p&lt;0.001). Importantly, WHO-5 scores improved from 23.56 ± 1.1 at baseline to 24.60 ± 0.7 annually (+4%) (p &lt; 0.0001). Similarly, PAID score decreased from 17.46 ± 13.6 to 12.65 ± 9.2 (-28%) (p &lt; 0.0001), and PHQ9 decreased from 1.67 ± 1.4 to 1.18 ± 1.2 (-29%) (0.005). Hybrid care models for T2D patients can potentially improve biomarkers and overall quality of life. The potential of such continuous models can address the long standing mental health issues suffered by T2D patients that are usually not addressed under traditional, episodic care.

Disclosure
H. Zakaria: None. M. Caccelli: None. C. Ozkan: None. J. Debs: None. N.C. Dahlstrom: None. C. Rios: None. J. Bangayan: None. D. Divino: None. Y. Said: None. A. Hashemi: None. I. Almarzooqi: None.