bluuebunny/crossref_metadata_2025_split huggingface dataset:
559-P: Evaluating the Feasibility and Preliminary Effectiveness of a Tailored Diabetes Education Program for Rural Residents
Authors: SMALLS BRITTANY L. , SETSER BETHANY M. , GONZABATO NELSON 
Published: June 2024

Background: Limited access to healthy foods, exercise facilities, and behavior modification skills in rural-dwelling individuals may impact the ability to appropriately manage type 2 diabetes (T2D). We tailored a 6-week diabetes education for a diverse rural Appalachia Kentucky population to determine the effects of the intervention on diabetes knowledge, self-care, and glycemic control.
Methods: A culturally tailored diabetes education was administered to study participants (N=18) with three- and six-month follow-up. The diabetes self-management questionnaire (DSMQ) and the Diabetes Knowledge Questionnaire (DKQ) were used to assess diabetes self-management and knowledge. DKQ scores were expressed as a sum of all 24 items, scaled to 10. A linear mixed effects model was used to measure DSMQ, DKQ, and A1c associations.
Results: Participants were majority white (72%). Mean A1c values decreased from 7.68 to 7.28 at follow-up. Mean DKQ scores increased from 10.50 to 11.25. There was a 0.06 difference between baseline and follow-up mean sum-scale DSMQ). Sum-scale DSMQ was negatively associated with A1c (β=-0.098; 95% CI: -0.356 to 0.161). DKQ scores were positively associated with A1c (β=0.009; 95% CI: -0.054 to 0.071). Six months of the intervention was negatively associated with A1c (β=-0.112, 95% CI: -0.462 to 0.237).
Conclusion: Findings from this pilot and feasibility study suggest that the tailored diabetes education improved diabetes knowledge and glycemic control in rural Appalachia residents living with T2D. A larger study using the tailored education is needed to provide further insight into the intervention's effectiveness.

Disclosure
B.L. Smalls: None. B.M. Setser: None. N. Gonzabato: None.

Funding
National Institutes of Diabetes and Digestion and Kidney Disease (P30 DK020579)
560-P: Optimizing Vision Care for Diabetes Patients—Interprofessional Initiatives to Combat Clinical Inertia in the Management of Diabetic Retinopathy and Diabetic Macular Edema
Authors: TAMAS MARGERY J. , BEYER MICHAEL , BEASER RICHARD S. , FONSECA VIVIAN , MOSHFEGHI ANDREW A. , DREW HEATHER N. 
Published: June 2024

Introduction and Objectives: Diabetes specialists (DSs) and primary care professionals (PCPs) play pivotal roles in the screening and referral process for diabetic retinopathy (DR) and diabetic macular edema (DME). Timely screenings and referrals to eye care specialists (ECSs) are critical in preventing vision-threatening complications for patients with diabetes (PWD). Two related activities sought to educate DSs and PCPs on appropriate ECS referrals to directly benefit and improve outcomes for PWD with, or at risk for, DR/DME.
Methods: The activities focused on interprofessional and multidisciplinary strategies to overcome referral barriers. Realistic patient cases with varying degrees of urgency were presented to engage learners and demonstrate the impact of decisions made by DSs/PCPs on patient outcomes. Multiple choice questions pre- and post-activity and intent to change questions post-activity measured the effect of the education.
Results: Total learners: 3,847, including 661 Endocrinologists and 1,726 PCPs
&lt;ul&gt;30% absolute improvement in knowledge of their role in the screening and referral process for DR/DME (51% to 81%)&lt;/ul&gt;&lt;ul&gt;27% absolute improvement in skills coordinating timely and appropriate referrals to eye care specialists (59% to 86%)&lt;/ul&gt;When learners return to practice, most intend to:&lt;ul&gt;Refer PWD to ECSs for comprehensive annual exams (89%) and follow up to ensure the exam is performed (92%)&lt;/ul&gt;&lt;ul&gt;Incorporate strategies to overcome barriers to timely and appropriate referral to ECSs (90%)&lt;/ul&gt;Conclusion: The activities resulted in significant gains in participants' knowledge related to their role in the screening and referral process for DR/DME and their ability to make referrals consistent with current guidelines. As confidence is a key component for effective clinical performance, these and similar initiatives may directly benefit and improve outcomes for PWD with, or at risk for, DR/DME.

Disclosure
M.J. Tamas: None. M. Beyer: None. R.S. Beaser: None. V. Fonseca: Consultant; Abbott, Bayer Inc. Stock/Shareholder; BRAVO4HEALTH, LLC. Consultant; Corcept Therapeutics. Speaker's Bureau; Eli Lilly and Company. Research Support; Fractyl Health, Inc. Consultant; Sun Pharmaceutical Industries Ltd. Stock/Shareholder; Amgen Inc. A.A. Moshfeghi: Research Support; Novartis Pharmaceuticals Corporation. Consultant; Alimera Sciences, Genentech, Inc. Research Support; Genentech, Inc. Consultant; Regeneron Pharmaceuticals Inc. Research Support; Regeneron Pharmaceuticals Inc. Consultant; Ocular Therapeutix. Stock/Shareholder; Ocular Therapeutix. H.N. Drew: None.

Funding
Regeneron (MED-OPT-7842, MED-OPT-7846)
569-P: A CME Webcast Series’ Impact on Clinicians’ Knowledge and Competence of Long-Term Obesity Management in Patients with Type 2 Diabetes Mellitus
Authors: AGARWAL NEHA , CAMPANO JENNY 
Published: June 2024

Obesity is one of the main modifiable risk factors for diabetes and adverse cardiovascular events, the latter being the leading cause of mortality in patients with T2D. However, clinicians who treat T2D patients often inadequately address obesity in terms of suboptimal selection of antiglycemic therapies that promote weight loss and fail to recommend comprehensive treatment strategies for long-term obesity management. They also may be unaware of advances in obesity management in high-risk patients. These gaps posed a need for developing activities to educate clinicians regarding the significance of addressing obesity in T2D patients. To address these gaps, we developed and launched a 6-part CME webcast series to assess knowledge/competence changes using pre-/post assessment questions. The series launched in Nov. 2023 with the participation of 7,867 healthcare professionals and 3,538 learners (MD/DO, PAs, RNs, NPs, PharmDs). A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p &lt;0.05). There was a significant increase in knowledge regarding the mechanism of action of novel weight management therapies and key aspects of glycemic management (57% and 59% relative increase in knowledge compared to baseline, p &lt;0.0001). Additionally, a significant increase in competency regarding selecting appropriate treatment for long-term obesity management (52% relative increased to baseline, p&lt;0.0001) was noted. At the post-activity evaluation, an average of 75% of learners indicated that they plan to make changes based on information received, including utilizing patient-first language, encouraging lifestyle modifications, and utilizing weight-neutral /lowering medications to manage glycemic control in their patients.

Disclosure
N. Agarwal: None. J. Campano: None.

Funding
Lilly USA, LLC.Grant ID A-31055
574-P: Intersectional Effects of Language and Education on Prediabetes Inequities in U.S. Latinos
Authors: CAMACHO EUGENIA , ECHEVERRIA SANDRA 
Published: June 2024

Introduction: Prediabetes presents a unique opportunity to identify risk factors that can delay or prevent the development of diabetes. Latinos experience a high prevalence of prediabetes and identifying the combined risk of multiple, interconnected sources of social disadvantage can lead to more effective prevention strategies.
Objective: Examine the joint effect/ intersection of language spoken and educational attainment on prediabetes prevalence in US Latinos.
Methods: We combined data from the 2011-2018 National Health and Nutrition Examination Survey restricting the sample to those 18+ years of age, Latino ethnicity, and no diabetes diagnosis (n=4,294). We created a four-level variable measuring the language spoken at home (English only/mostly vs Spanish only/mostly) and educational attainment (&lt;high school="" vs.="" high="" school+),="" with="" english="" only="" and="" education="" as="" the="" referent.="" prediabetes="" was="" based="" on="" laboratory="" confirmed="" a1c="" levels="" of="" 5.7-6.4.="" we="" generated="" weighted="" odds="" ratios="" (or)="" 95%="" confidence="" intervals="" (ci)="" adjusting="" for="" age,="" sex,="" poverty="" income="" ratio="" body="" mass="" index.="" all="" models="" accounted="" complex="" sampling="" design="" significance="" set="" to="" (p &lt;.05) using SAS v9.4.
Results: The prevalence of prediabetes among Latinos was 24.4%. The odds of prediabetes among Spanish only and low education was 1.8 (95% CI: 1.5,2.2) compared to the referent group in fully adjusted models. All other combinations of exposure had significant odds ratios of 1.33-1.38.
Conclusion: This study highlights the added disadvantage of limited English proficiency and education on prediabetes prevalence and suggests the need for more complex interventions addressing multiple sources of disadvantage in Latino adults.

Disclosure
E. Camacho: None. S. Echeverria: None.
58-OR: Screening for Diabetic Retinopathy Increases by 32% with Education and Intervention Program in Primary Care
Authors: SIMON LESLEY , BEALS DEAN , POGROSZEWSKI STAN J. , DEERR RACHEL , HAIMOWITZ STEVEN , HERMANSEN CHRISTIAN 
Published: June 2024

Introduction: Despite recommendations by the ADA and other medical societies, screening for diabetic retinopathy (DR) is suboptimal. We introduced an initiative at Penn Medicine Lancaster General Health (LGH) that included education of primary care providers (PCPs) and their patients with diabetes and installation of tele-retinal imaging service at the LGH PCP’s office.
Methods: PCPs at LGH and nationally were invited to participate in an online education program to reinforce knowledge of DR risk factors, screening recommendations, and treatments. Simultaneously, an order set for all patients with T2D presenting to the clinic was added to the EMR and retinal cameras fitted with technology for remote reading by retina specialists were installed in 34 LGH PCP clinics where staff was instructed on the use of these cameras and advised to recommend screening for patients with diabetes who did not have a diagnosis of retinopathy and were not screened in the past two years. Designated referral coordinators were assigned in each office to facilitate referrals to retina specialists when indicated by the reading retina specialist.
Results: Screening for DR increased by 32%, from 37.7% to 50.1%, with greater increases in people who were Hispanic (75.2% vs 25.6% for non-Hispanic), younger (55.6% for 18-54 yrs vs 21.4% for &gt; 77 yrs), and with lowest and highest initial A1C (38.5% and 38.7% vs 25.3% for &lt;6.3, &gt;8.4, and 6.9-7.4, respectively). Overall, 760 people were screened with the camera; DR was identified in 40.1%, with other abnormalities (eg, glaucoma) identified in additional 12%. Inadequate images were captured in 19%. In addition, PCP knowledge increased significantly by 40%.
Conclusion: Installation of cameras equipped with technology to securely send images to retina specialists, along with patient and clinician education, enabled patients with diabetes to undergo guideline-recommended screening in the office of their PCP, overcoming barriers to care.

Disclosure
L. Simon: None. D. Beals: None. S.J. Pogroszewski: None. R. Deerr: None. S. haimowitz: None. C. Hermansen: None.

Funding
Regeneron Pharmaceuticals, Inc
583-P: Perspectives on Stringent Glycemic Control and Weight Loss among People with Type 2 Diabetes Mellitus (T2DM) in China
Authors: ZHANG JIAN , LI ANG , QUAN JINXING , WU JUN , CAI HANQING , DING YUCHEN , TANG JIANI , MA XIAO , ZHANG JUNQING 
Published: June 2024

Introduction & Objective: While current guidelines for T2DM emphasize the importance of achieving glycemic control and weight management goals, it’s worth noting that the perspectives of people with T2DM (PWD) on achieving these goals remain unclear in China. This study aims to describe demographics and clinical experiences of PWD in China and to understand their perspectives on stringent glycemic control (HbA1c ≤ 6.5%) and weight loss (≥ 10%).
Methods: This cross-sectional mobile web survey was conducted in a representative sample of PWD across China from July to August 2023. Participants aged ≥ 18 years with diagnosed T2DM and aware of their latest HbA1c within past 6 months were enrolled as the study sample. Descriptive statistics were performed.
Results: The study sample comprised of 495 participants with the mean (SD) age 58.02 (12.44) years and the majority being male (60.20%), overweight/obese (56.37%) and having the latest HbA1c &gt; 6.5% (71.31%). This sample indicated that achieving stringent glycemic control would be extremely (82.83%) or moderately (12.12%) important. Most of the study sample (90.10%) perceived achieving stringent glycemic control could bring positive impact to physical health. More than half of the sample (62.83%) perceived ≥ 10% weight loss as beneficial or neutral. Out of 231 participants who perceived beneficial, 117 (50.65%) and 84 (36.36%) indicated that ≥ 10% weight loss was extremely or moderately important, respectively. Moreover, around 70% of the study sample preferred treatments with higher rates of achieving both stringent glycemic control and weight loss, when safety profiles were similar.
Conclusion: This study underscored that the majority of PWD recognized paramount importance of stringent glycemic control and weight loss in China. Their treatment preferences, which reflected their perceptions, may have implications for decision-making of diabetes treatments in clinical practice.

Disclosure
J. Zhang: None. A. Li: None. J. Quan: None. J. Wu: None. H. Cai: None. Y. Ding: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. J. Tang: Employee; Lilly Diabetes. X. Ma: Employee; Eli Lilly and Company. J. Zhang: None.

Funding
Eli Lilly and Company, Shanghai, China
588-P: Knowledge and Attitudes about Diabetes in San Antonio Based on Educational Attainment
Authors: GEDALA AARAV , MADAN SHREYA , VENKATESH ARUNA 
Published: June 2024

Introduction & Objective:A previous study aimed to assess the awareness levels of diabetes risk factors and complications within the San Antonio population. Now, using the same data, we aimed to stratify the data based on educational attainment to determine whether or not there is a correlation between educational attainment and awareness levels of diabetes risk factors and complications within the Bexar County population.
Methods: The previous study conducted a community-based study by administering surveys to individuals outside retail stores such as HEB and Walmart and at a health fair where participants received complimentary health check-ups. Direct emails to complete the survey were also sent.
Results: A total of 273 individuals were included in the survey, of whom 33.3% had a college degree as their highest level of education, 24.2% had a professional degree, 26.4% had a high school degree, and 16.1% had a high school diploma. When asked about the prevalence of diabetes in the San Antonio community, there was a definite correlation between educational attainment and knowledge about the prevalence of diabetes in San Antonio-44.4% of those with a professional degree were able to correctly identify that less than 25% of the San Antonio population had diabetes, while this statistic was 38.5% for those with associates, 30.5% for those with a college degree, and 25.5% for those with a high school diploma. However, this is not a perfect correlation as those with an associate degree were more accurate than those with college degrees. There was also a direct correlation between educational attainment and preventability perception in San Antonio, as 75% of those with a professional degree knew that diabetes could be prevented, as opposed to those with a high school diploma (64.8%).
Conclusion:Higher education correlates with increased diabetes knowledge in San Antonio. Further research should consider geographic location to identify awareness patterns.

Disclosure
A. Gedala: None. S. Madan: None. A. Venkatesh: None.
589-P: Diabetes Training for Deaf and Hard-of-Hearing Community Health Workers
Authors: LITCHMAN MICHELLE L. , MIRUS KARISSA A. , LEE SHINDUK , ALLEN NANCY A. 
Published: June 2024

Introduction & Objective: Deaf Diabetes Can Together (DDCT) is a diabetes self-management education and support intervention for individuals who communicate using American Sign Language (ASL). The Deaf and hard of hearing (DHH) community indicated the need for DHH Community Health Workers (CHW) to co-deliver DDCT. The purpose of this pilot was to describe an adapted CHW training for DHH and its feasibility.
Methods: Participants were those who had previously completed DDCT and self-identified interest in becoming a CHW (N=3). The CHW training included eleven 2-hour sessions, during which CHWs trainees watched the videos together on zoom with 2 rotating ASL interpreters. Existing CHW training videos were adapted by adding closed captioning as appropriate. Concurrently, participants had their training videos running on a personal computer. Quizzes were signed in ASL and completed individually. CHW trainees were asked to evaluate the training via interview.
Results: Participants completed the CHW training in 22 hours, longer than the standard CHW training lasting 11-14 hours, due to deaf culture adaptations. According to participants, helpful components included diabetes-specialty nurse practitioners in attendance to clarify content and downloadable resources. One complaint was that despite the videos having closed captioning added, the font size was too small to be accessible. Automated captions on Zoom were needed for size, but not 100% accurate.
Conclusions: Despite the pilot nature of the study, completion of the 22 hours of planned training by three DHH trainees showed the feasibility of the CHW training in this population. Adaptations were needed to make the CHW training more accessible for trainees who communicate in ASL. Solely adding closed captioning would not meet the needs of people who primarily communicate using ASL. Diabetes CHW trainings should be delivered in ASL for more effective communication and additional time to ensure DHH culture-appropriate communication and learning experiences.

Disclosure
M.L. Litchman: Research Support; American Diabetes Association, Association of Diabetes Care & Education Specialists, Dexcom, Inc. Other Relationship; Association of Diabetes Care & Education Specialists. Research Support; National Institutes of Health. K.A. Mirus: None. S. Lee: Research Support; Olera, Clairvoyant Network, Inc. N.A. Allen: Research Support; Dexcom, Inc. Consultant; Diathrive Health.

Funding
American Diabetes Association (11-22-ICTSHD-06 )
598-P: Sex-Specific Differences of Human Skeletal Muscle—A Multiomics Exercise Study
Authors: DREHER SIMON I. , GOJ THOMAS , VON TOERNE CHRISTINE , HOENE MIRIAM , IRMLER MARTIN , OUNI MERIEM , JÄHNERT MARKUS , BECKERS JOHANNES , PETER ANDREAS , BIRKENFELD ANDREAS L. , SCHÜRMANN ANNETTE , HAUCK STEFANIE M. , WEIGERT CORA 
Published: June 2024

Exercise is a potent skeletal muscle stimulus and one of the most effective strategies to prevent muscle loss and type 2 diabetes. Biological sex-based differences are reported for aerobic capacity, muscle mass, and exercise performance. We aimed to provide a yet missing comprehensive picture of molecular differences between female and male skeletal muscle at baseline, after acute exercise and training. Further we investigated which differences were conserved in vitro. We characterized muscle biopsies from 25 (16f/9m) subjects in a multi-omics approach employing epigenomics, transcriptomics and proteomics at baseline, after acute exercise and 8 weeks of supervised endurance training. Donor matched myoblasts and myotubes were analyzed in vitro. We found differential CpG-site methylation in 16.012 genes, 1.366 differentially expressed genes and 120 proteins at baseline. Differential transcripts were associated with translational regulation, histone methylation, glucose homeostasis and insulin signaling. Type-2 fast-twitch fiber-type proteins were elevated in males, along with proteins regulating glycolysis. Y-linked transcript expression was conserved in vitro, but only a few differences in expression of autosomal genes, e.g. elevated LDHB in females. Acute exercise upregulated oxidative stress-responsive transcripts predominantly in males. After 8-week-training, both sexes had upregulated mitochondrial proteins involved in substrate oxidation and ATP production, while glycolytic fiber marker MYH1 and MYH3 were only reduced in males. Thus, sex specific differences exist in resting skeletal muscle and in exercise adaptation on epigenomic, transcriptomic and proteomic level. The few conserved differences in vitro hint towards hormonal or yet undefined mechanisms. Training might mitigate initially differential responses to exercise. The question remains whether there are sex specific differences within individual fiber-types or whether it is just a matter of composition.

Disclosure
S.I. Dreher: None. T. Goj: None. C. von Toerne: None. M. Hoene: None. M. Irmler: None. M. Ouni: None. M. Jähnert: None. J. Beckers: None. A. Peter: None. A.L. Birkenfeld: None. A. Schürmann: None. S.M. Hauck: None. C. Weigert: None.