bluuebunny/crossref_metadata_2025_split huggingface dataset:
536-P: Characteristics of People with Type 2 Diabetes Based on the Extended Parallel Processing Model (EPPM)
Authors: HU JIANLI , KIM SARAH , CHEN SOPHIA K. , ZISMAN-ILANI YAARA , SWAVELY DEBORAH A. , KELLY PATRICK J. , HOADLEY ARIEL , BASS SARAH B. , RUBIN DANIEL J. 
Published: June 2024

A better understanding of perceived T2D threat and self-efficacy may inform improvements in self-management education. The EPPM was used to categorize 168 adults with T2D from urban safety-net clinics and the local community by self-efficacy and perceived threat from T2D. EPPM categories were high threat (HT)/high efficacy (HE), low threat (LT)/low efficacy (LE), HT/LE and LT/HE. Characteristics of participants with T2D (PwD) were compared within and between clinic and community settings across EPPM categories.
Among clinic PwD, HT/LE PwD had the lowest medication adherence (MARS-5) (p&lt;0.001) vs other EPPM categories. Among community PwD, HT/LE PwD had the lowest T2D management scores (p&lt;0.001) while LT/LE PwD had the lowest BMI (p&lt;0.05). Demographics except age did not vary by EPPM category.
Compared to the community cohort, HT/LE PwD from clinics had higher health literacy (p&lt;0.05), lower weight (p&lt;0.05), lower BMI (p&lt;0.01), and were more likely to be male (p&lt;0.01) and use insulin (p&lt;0.01). HT/HE PwD from clinics had higher MARS-5 scores (p&lt;0.05), more microvascular complications (p&lt;0.01) and were more likely to use statins (p&lt;0.01).
The EPPM identified different subgroups within and between clinics and community settings. Differences in characteristics were mostly not attributable to demographics. The EPPM may be useful to tailor behavioral interventions to people with T2D in different settings.

Disclosure
J. Hu: None. S. Kim: None. S.K. Chen: None. Y. Zisman-Ilani: None. D.A. Swavely: None. P.J. Kelly: None. A. Hoadley: None. S.B. Bass: None. D.J. Rubin: None.

Funding
It was partially funded by the ADA Diabetes INSIDE program.
542-P: Does Intensive Type 2 Diabetes Care Management Improve Multiyear Mortality
Authors: MONTERO ALEX R. , NAM JOON , NASSAR CARINE M. , MAGEE MICHELLE F. 
Published: June 2024

Introduction & Objective: The UKPDS Study demonstrated mortality benefit of pharmacologic interventions lowering A1C (NEJM 2008). Diabetes care management (DCM) in type 2 diabetes (T2D) has been shown to lower A1C but not studied mortality. Our aim was to assess mortality in adults with T2D and A1C &gt;9% who had completed diabetes boot camp (DBC), an intensive 3-month DCM intervention (BMJ Open DRC 2019. doi: 10.1136/bmjdrc-2019-000731).
Methods: This retrospective cohort study compared mortality in DBC versus concurrent propensity matched controls. Kaplan Meier survival curves were constructed from time of DBC start. Follow up was ascertained via query of the data warehouse underlying our health system EMR. The most recent encounter date was assigned as censoring date when date of death was absent.
Results: All DBC participants (n=366) and controls (n=366) in the original cohort were included. Demographics, pre-post A1C and mortality outcomes are shown on table 1. At an average of 5.5 years of follow up, the overall mortality rate was 10% and not significantly different. In patients over 60 with A1C &gt;= 12.0, DBC participants experienced borderline improved survival (p = 0.06 by Log-Rank test).
Conclusion: Participation in DBC, a DCM intervention, was not associated with an overall mortality benefit but older patients with markedly elevated A1C may have experienced improved survival compared to matched controls.

Disclosure
A.R. Montero: None. J. Nam: None. C.M. Nassar: None. M.F. Magee: Research Support; Medtronic. Other Relationship; Lilly Diabetes.
546-P: Impact of Virtual Patient Simulation on Improving Obesity Management With and Without Type 2 Diabetes by Primary Care Providers
Authors: LARKIN AMY , LE ANNE 
Published: June 2024

Introduction: Impact of online, virtual patient simulation (VPS)-based continuing medical education (CME) on primary care physician (PCP) performance related to management of obesity in patients with and without T2D was assessed.
Methods: The VPS included two different patient scenarios. Tailored clinical guidance (CG) was shown after each clinical decision, followed by the opportunity to modify to their decisions. Data were collected post-CG and compared with each user’s baseline (pre-CG) using a McNemar’s test. Data collected March 2023 through June 2023.
Results: 624 PCPs were included. Case 1 (48 YO Obese Female with history of T2D, hypertension, and hyperlipidemia): Ordering tests: 13% absolute improvement (P&lt;.001; baseline 40%); Making diagnoses: 33% absolute improvement (P&lt;.001; baseline 0%); Ordering comprehensive treatment plans: 28% absolute improvement (P&lt;.001; baseline 19%). Rationales for not prescribing therapy included not sure who to treat or when to use pharmacotherapy (41%), concerns with past obesity drugs (37%), and poor safety profiles (21%). Case 2 (55 YO obese male following-up on recent labs): Ordering tests: 10% absolute improvement (P&lt;.001; baseline 42%); Making diagnoses: 38% absolute improvement (P&lt;.001; baseline 26%); Ordering comprehensive treatment plans: 23% absolute improvement (P&lt;.001; baseline 12%). Rationales for not prescribing therapy included not sure who to treat or when to use pharmacotherapy (39%), concerns with past obesity drugs (37%), and poor safety profiles (25%). Continued Gaps: Approximately half of PCPs have continued gaps in ordering tests to screen or monitor metabolic conditions, as well as making an obesity diagnosis. Over half of PCPs failed to comprehensively treat obesity.
Conclusion: VPS can improve evidence-based clinical decisions by PCPs related to comprehensive management of obesity in patients with and without T2D.

Disclosure
A. Larkin: None. A. Le: None.

Funding
Developed through an independent educational grant from Lilly.
555-P: Modalities for Diabetes Technology Education—Perspectives and Priorities from Caregivers, Youth, and Clinicians
Authors: MEIGHAN SEEMA , MILLER VICTORIA , BALMER DORENE , STREISAND RANDI , ALICEA-TRELLES NICOLE , MARKS BRYNN E. 
Published: June 2024

Introduction: The COVID-19 pandemic forced a rapid transition to telemedicine. The unique benefits and challenges of virtual diabetes technology education must be considered as we adapt educational methods to meet the individual needs and preferences of youth with type 1 diabetes (T1D) and their families.
Methods: Parent-youth dyads ages 8-12 and diabetes clinicians participated in ~45 minute semi-structured interviews about unmet diabetes technology educational needs. Interviews were recorded and transcribed. Modified inductive coding with two independent coders was used for thematic analysis. Twenty percent of interviews were double coded to ensure dependability of the data. Thematic saturation was achieved.
Results: Twenty parent-youth dyads (Mage child 10.7 yrs, 65% female youth, MT1D duration 3.9 yrs; Mage parent 40.6yrs, 85% mothers) and 8 clinicians (Mage 39.8 yrs, Mexperience 8.0 yrs) were interviewed. Three themes emerged: 1) Although virtual education minimized time away from work and school, families and clinicians overwhelmingly preferred in-person education because it allowed for better focus and hands-on troubleshooting as families programmed and placed devices. 2) Problematic internet connections, difficulties visualizing and hearing the education, and distractions in the home setting made telehealth visits less preferred. 3) Physical aspects of diabetes technology education are best suited for hands-on, in-person learning whereas intellectual concepts can be taught virtually.
Conclusions: T1D families without prior virtual education experience are unlikely to recognize that physical aspects of education are best suited to in-person training. Considering transportation, uncompensated time away from work, access to a reliable internet connection, a quiet space in the home, and an appropriately sized screen for telemedicine may help to guide families in choosing the best modality for diabetes technology education.

Disclosure
S. Meighan: Speaker's Bureau; Dexcom, Inc. V. Miller: None. D. Balmer: None. R. Streisand: None. N. Alicea-Trelles: None. B.E. Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic, Digostics. Advisory Panel; International Society for Pediatric and Adolescent Diabetes, American Diabetes Association, T1D Exchange. Board Member; Juvenile Diabetes Research Foundation (JDRF).

Funding
National Institutes of Health (K23DK129827)
572-P: Perspectives on the SDOH and CGM Uptake in Latino Adults with Type 1 Diabetes
Authors: NEWLIN LEW KELLEY , PEREZ-BRESCIA MARYANN , CHANNAMSETTY VEENA , ALLEN NANCY A. 
Published: June 2024

Introduction & Objective: Little is known about the social determinants of health (SDOH) and uptake of continuous glucose monitoring (CGM) in Latino adults with type 1 diabetes (T1D). This study explores SDOH as barriers to CGM uptake in Latino adults with T1D from the perspective of Latino health advocates (LHAs), diabetes health care providers (HCPs), and federally qualified health center (FQHC) HCPs.
Methods: In this qualitative study, convenience sampling was used to recruit: (1) LHAs (n=7); (2) diabetes HCPs (n=4); and (3) FQHC HCPs (n=5) to participate in focus groups, respectively. Participants were queried about SDOH as barriers to CGM uptake in Latino adults with T1D. Content analysis was used to analyze data.
Results: The LHA, diabetes HCP, and FQHC HCP groups all identified suboptimal health care quality as a potent barrier to CGM uptake, particularly in terms of poor translation (literal, abbreviated, and culturally insensitive translations) of key health concepts by certified Spanish/English medical interpreters. The LHA and diabetes HCP groups revealed that providers may limit health care access to CGM based on translation issues, insurance hassles, and unsuccessful CGM uptake experienced previously with Latinos. The FQHC HCP group identified unreliable transportation to clinic visits as an impediment to health care access for CGM while food and housing insecurity, due to a lack of economic stability, were barriers to CGM uptake. With respect to the social and community context, lack of family inclusion in clinic visits and negative family/neighborhood perceptions of CGM were viewed as salient barriers.
Conclusion: Findings indicate that interventions targeting CGM uptake in Latino adults with T1D address SDOH barriers.

Disclosure
K. Newlin Lew: None. M. Perez-Brescia: None. V. Channamsetty: None. N.A. Allen: Research Support; Dexcom, Inc. Consultant; Diathrive Health.

Funding
National Institutes of Health/ National Institute of Diabetes and Digestive and Kidney Diseases (R01DK135016)
579-P: ADA Diabetes Medical Management Plan Implementation—Barriers and Opportunities
Authors: MARCH CHRISTINE , MCMANEMIN JACQUELINE , PELLIZZARI MARGARET , RODRIGUEZ JANET , RODRIGUEZ HENRY , HARRIMAN KAREN , WOODWARD CRYSTAL 
Published: June 2024

Introduction & Objective: The ADA’s Diabetes Medical Management Plan (DMMP), revised in 2021, provides medical orders for diabetes care in schools. The objective was to assess multistakeholder experiences with the revised DMMP, barriers to uptake, and potential strategies to enhance usability.
Methods: We conducted a national survey of diabetes providers and school nurses with the ADA Safe at School Working Group, National Association of School Nurses, and other professional organizations. Questions addressed processes for DMMP integration, perceived barriers, and recommendations.
Results: We received responses from 507 school nurses and 79 providers representing all US regions. Of these, 57% of school nurses and 62% of the providers had used the DMMP. Views of the DMMP were generally favorable; 100% of providers and 92% of nurses agreed that the DMMP was comprehensive and &gt;60% felt it was the right length. The DMMP was usually completed on a computer by providers (82%), though only 31% could share the form electronically with schools. Common barriers reported by school nurses included delays in receiving the DMMP (57%) including updates (64%) and alternative forms from providers (41%); for providers, barriers included lack of health record integration (72%) and time required to complete the DMMP (50%). Both groups endorsed difficulty with parent engagement with DMMP completion (37% nurses, 44% providers). Over 750 comments suggested modifications to enhance usability; themes included fostering parent and provider input for all sections, streamlining references to accommodations, and providing more flexible formats to customize based on local practices.
Conclusion: Barriers at the health system level interfere with uptake of the DMMP. Multi-stakeholder input can co-create medical orders and school resources which can be customized to meet the needs of local centers. Electronic systems for bidirectional information transfer between schools and diabetes centers would facilitate adoption.

Disclosure
C. March: None. J. McManemin: None. M. Pellizzari: None. J. Rodriguez: None. H. Rodriguez: Consultant; Provention Bio, Inc. Speaker's Bureau; Sanofi. Other Relationship; Merck & Co., Inc., Sanofi. Research Support; Boehringer-Ingelheim, Dexcom, Inc., Eli Lilly and Company, MannKind Corporation, Medtronic, Novo Nordisk, Tandem, Teva. K. Harriman: None. C. Woodward: None.
616-P: Self-Reported Fasting Habits in Patients with Type 1 Diabetes Mellitus
Authors: WONG ALISON L. , OLDENBURG NIKI C. , CHOW LISA S. 
Published: June 2024

Introduction & Objective: Although intermittent fasting (IF) has increased in popularity for weight loss, it’s unknown whether patients with Type 1 diabetes (T1DM) engage in IF. Roughly 60% of patients with T1DM are overweight or obese, but are generally not encouraged to fast due to concerns about hypoglycemia or ketoacidosis. We inquired about self-reported IF among patients with T1DM.
Methods: This was a REDCAP survey administered through the EPIC-based Electronic Health Record (EHR) at the University of Minnesota/Fairview Health System from Sept-Oct 2023. This was an anonymous, voluntary survey, sent through the EHR myChart system, to patients with T1DM, ages 18-89 years old. The survey asked about IF habits and if affirmative, inquired further on their fasting habits and impact on T1DM management.
Results: Surveys went out to 1551 patients. Of the 105 respondents, 28 (26.7%) reported IF. These patients [17F and 11M: mean(SD): age 42.8 (10.9) years, BMI: 27.9 (5.6) kg/m2, duration of T1DM diagnosis 23.3 (15.0) years] engaged in IF for an average of 40 months (SD=33.3). Of these patients, 5 engaged in IF (eat less/fast a few days per week) and 24 engaged in time-restricted eating [daily eating window 8.56 hours (2.8) - patients choice could overlap]. Self-reported average weight loss was 5.7 kg (SD=7.1) and only 3 used GLP-1s agonists. Four (14.3%) reported hypoglycemia related to fasting of which insulin adjustment, primarily basal reduction, was needed in 10 patients (55%). All patients wore a continuous glucose monitor (CGM), and 21 patients (75%) used an insulin pump. Overall satisfaction with IF was high, with 18 (64%) recommending it to friends/family and 21 (75%) recommending it to other T1DM patients. There were no self-reported cases of DKA in this population.
Conclusion: IF remains rare among patients with T1DM, but among those who participate, satisfaction was high. IF could be considered within the context of CGM usage, with monitoring for hypoglycemia and insulin adjustment as needed, in patients with T1DM who are overweight.

Disclosure
A.L. Wong: None. N.C. Oldenburg: None. L.S. Chow: Research Support; Dexcom, Inc.
631-P: Effectiveness of Freedom from Diabetes Protocol in Managing Prediabetes in Indian Population—A Quasi-experimental Study
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , TIWARI DIPTIKA , VYAWAHARE ANAGHA R. , SHARMA BABY , KATHRIKOLLY THEJAS , GANLA MALHAR H. , HIREMATH MAMATA , SABOO BANSHI D. 
Published: June 2024

Introduction: Prediabetes, a crucial metabolic state, significantly increases the risk of type 2 diabetes (T2D). India's surging prediabetes cases outpace those of diabetes, highlighting an impending T2D crisis. Urgent attention and effective management strategies are crucial.
Aim: To assess the effectiveness of a one-year online lifestyle intervention program in prediabetes patients, while exploring gender-specific and BMI-based differences in outcomes.
Methods: This study analyzed data from 715 patients with prediabetes (HbA1c: 5.7%-6.4%; not on insulin or OHAs, aged &gt;18 years) attending a one-year online lifestyle intervention program at the Freedom from Diabetes Clinic, India. The intervention consisted of personalized plant-based diet, physical activity, stress management, and medical management. The baseline and end-line assessments included anthropometric and biochemical parameters.
Results: The study population, consisting of 60% females and a mean age of 50.6±10 years, exhibited a median HbA1c of 6.0% (5.8-6.2). Post-intervention, a substantial reduction in HbA1c (&lt;5.7%) and BMI (&lt;25 kg/m2) was observed in 56% and 16.1% of patients, respectively (p&lt;0.05). Women showed greater improvements in weight loss, BMI, fasting insulin, and HOMA-IR than men (p&lt;0.05). Patients with a BMI greater than 25 kg/m2 showed greater weight loss (kg) (-6.7 vs. -1.8) and improvements in total cholesterol, triglycerides, and non-HDL compared to those with a BMI less than 25 kg/m2 (p&lt;0.05). In both BMI categories, the improvement in HbA1c levels was comparable (p&gt;0.1) and weight loss was positively correlated with HbA1c drop (p&lt;0.01).
Conclusion: Women with prediabetes showed better outcomes in response to the lifestyle interventions than men. Weight loss relative to BMI improved the glycemic profile of both obese and non-obese patients. Comprehensive lifestyle interventions may serve as effective strategies for managing prediabetes.

Disclosure
P. Tripathi: None. N.S. Kadam: None. D. Tiwari: None. A.R. Vyawahare: None. B. Sharma: None. T. Kathrikolly: None. M.H. Ganla: None. M. Hiremath: None. B.D. Saboo: None.
649-P: Medical Students’ Recognition of Psychosocial Issues in a Behavioral Diabetes Case
Authors: WISNIEWSKI LUKE , BEVERLY ELIZABETH A. 
Published: June 2024

Introduction & Objective: Psychosocial care should be provided to all people with diabetes. Psychosocial problems can impair a person’s ability to carry out diabetes self-care. Thus, addressing these problems is critical to improve outcomes. To better understand medical students’ awareness of psychosocial problems, we created a mock behavioral diabetes case for evaluation.
Methods: We conducted a descriptive, cross-sectional study with medical students of all four years at a school in the Midwest. Students were asked to provide a written description of a case of a 67-year-old man with type 2 diabetes. All students were provided laboratory results (HbA1c=9.8%), family history, and comments from the man. The comments noted that he recently retired from his job and moved to a new city. He referred to his diabetes as very hard, and he felt there was nothing he could do to make it better. The case concluded with the man saying he felt he should no longer bother with his diabetes because it would only get worse. We analyzed all written case summaries using content analysis in NVivo software.
Results: A total of 248 medical students participated (mean age=25.0±2.4 years, 65.1% women, 69.8% White, 6.3% Black, 16.4% Asian, 28.2% third-year students). Of the 248 students, 144 (58.1%) noted in their description a potential behavioral health concern, such as depression, anxiety, distress, and/or burnout. Interestingly, only one participant wrote about diabetes distress, despite this topic being taught in the curriculum, and only three participants noted his recent move and retirement. Conversely, 112 participants focused their descriptions on HbA1c, of which 90 referred to it as poorly controlled or uncontrolled diabetes.
Conclusion: Findings showed half of participating medical students recognized a potential psychosocial problem in the case. However, a third of participants used stigmatizing language to describe glycemic targets. More research at other medical schools is needed to confirm these findings.

Disclosure
L. Wisniewski: None. E.A. Beverly: None.
664-P: Preliminary Results of a New Scalable Digital Treatment for Diabetes Distress (DD) in Families of School-Age Children with Type 1 Diabetes (T1D)
Authors: PATTON SUSANA R. , PIERCE JESSICA S. , KAHHAN NICOLE , BENSON MATTHEW R. , FOX LARRY A. , CLEMENTS MARK A. 
Published: June 2024

We present feasibility, acceptability, and efficacy of 3 delivery arms of a new scalable, digital treatment we designed to target DD in families of school-agers with T1D. We randomized 34 families (mean child age= 10&lt;u&gt;+&lt;/u&gt;1.4 years; 53% male, 85% White, mean HbA1c= 7.24&lt;u&gt;+&lt;/u&gt;0.71%) to 1 of 3 delivery arms differing only by number of telehealth visits: 0 visits= self-guided (SG), 3 visits= enhanced self-guided (ESG), or 8 visits= video visits (VV). All families had 24x7 access to digital treatment materials via their hospital’s patient portal app for 10 weeks. We recorded telehealth visit attendance (ESG & VV families) to examine feasibility. We compared parent and child treatment satisfaction by delivery arm to examine acceptability. We compared parent and child DD using the Problem Areas in Diabetes-Child (PPAIDC and PAIDC, respectively) by time and delivery arm to test efficacy. 81% of ESG families attended all 3 and 20% of VV families attended all 8 telehealth visits. Parents and children reported high satisfaction scores with no differences by delivery arm. There were significant pre-post reductions in PPAIDC (p=0.026) and PAIDC (p=0.026) scores but no differences by delivery arm. All 3 delivery arms appear acceptable and may reduce DD in families of school-agers with T1D. However, without the burden of telehealth visits, SG may be more feasible than the other delivery arms.

Disclosure
S.R. Patton: None. J.S. Pierce: None. N. Kahhan: None. M.R. Benson: Research Support; Novo Nordisk A/S. Other Relationship; American Diabetes Association. Research Support; Provention Bio, Inc., Sanofi-Aventis U.S., Beta Bionics. Stock/Shareholder; KiHealth Board Member. L.A. Fox: Advisory Panel; Ki Health. Research Support; Dexcom, Inc. M.A. Clements: Research Support; Abbott. Consultant; Glooko, Inc. Research Support; Dexcom, Inc.

Funding
National Institutes of Health (R01 DK127493)