bluuebunny/crossref_metadata_2025_split huggingface dataset:
669-P: How Do Emerging Adults (EAs) with Type 1 Diabetes (T1D) Seek Self-Care Information?
Authors: SHANK KAITLYN R. , VITALE REBECCA J. , ASHER NOA , KATYAL BIREN , GARVEY KATHARINE , LAFFEL LORI M. 
Published: June 2024

Aim: As EAs with T1D become independent in self-care, they often confront diabetes management challenges. We sought to assess ways in which EAs seek information when faced with uncertainty in their diabetes care.
Methods: EAs (ages 18-25) with T1D participated in a qualitative study regarding their experiences of transitioning to self-management. In semi-structured interviews, participants were asked, “Tell me more about how you look for answers when you’re not sure what to do [in your diabetes management].” De-identified interview transcripts were analyzed using directed qualitative content analysis.
Results: Interviews were conducted with 24 participants, mean age 21.5 ± 1.8 years; 46% were male, 42% female, 13% trans/non-binary; 75% identified as non-Hispanic white. Mean age at diagnosis was 10.0 ± 6.3 years; 71% reported A1c &lt;8%. Many used technology with 83% using pumps and 96% using CGM. Two main themes emerged regarding information sources, endorsed roughly equally by participants: (1) Seek out people with lived experience of T1D (either personal acquaintances or online) as the best knowledge source, (2) Identify people with formal education/training about diabetes management (e.g. clinical providers, device companies) for most reliable information. Two sub-themes emerged regarding verification of information from non-medical professionals: (1a) Look for agreement across multiple sources, and (1b) Differentiate between universal and individualized aspects of diabetes management.
Conclusion: While many EAs with T1D seek others with personal lived experience of T1D to problem-solve self-care challenges, others prefer to rely on people with formal education/training. Clinicians/educators should consider ways to offer virtual opportunities for EAs to seek support for their self-care between clinical encounters. Online forums may offer a way for EAs with T1D to connect. Providers can help EAs learn how to evaluate the reliability of their information sources.

Disclosure
K.R. Shank: None. R.J. Vitale: None. N. Asher: None. B. Katyal: None. K. Garvey: Advisory Panel; Sanofi. L.M. Laffel: Consultant; Dexcom, Inc. Advisory Panel; Medscape, Medtronic, Vertex Pharmaceuticals Incorporated. Consultant; Novo Nordisk. Advisory Panel; Lilly Diabetes, Provention Bio, Inc., Sanofi-Aventis U.S., Janssen Pharmaceuticals, Inc., MannKind Corporation.

Funding
Endocrine Fellows Foundation; NIH T32DK007529; NIH P30DK036836; Iacocca Foundation Senior Postdoctoral Fellowship
670-P: Self-Efficacy and Fatalism as a Pathway between Delay Discounting, Delay Aversion, and Glycemic Control
Authors: CAMPBELL JENNIFER A. , WALKER REBEKAH J. , EGEDE LEONARD E. 
Published: June 2024

Background: Delay discounting (DD) is the cognitive process of comparing values between immediate and delayed rewards. Delay aversion (DA) refers to the negative emotional response when faced with a delay. Pathways between DD/DA and glycemic control are poorly understood. Based on prior evidence, self-efficacy and fatalism were hypothesized as key mechanisms through which DD/DA influences glycemic control.
Methods: Baseline data on 200 African Americans with T2DM enrolled in a diabetes intervention trial was analyzed. DD and DA were measured with the validated quick delay questionnaire, self-efficacy was measured with the validated perceived diabetes self-management scale, fatalism was measured using the validated diabetes fatalism scale, and glycemic control was measured via HbA1c. Structural equation modeling (SEM) was used to investigate the direct and indirect relationships between DD/DA and HbA1c via self-efficacy, and fatalism respectively using Stata V17.
Results: Sample mean age was 56.4 years, 33% were women, 61% had income &lt;$25K, 31% were employed, and mean diabetes duration was 15 years. In the final SEM model for DD, self-efficacy was directly associated with HbA1c (r=-0.05; p&lt;0.05). Fatalism was marginally associated with HbA1c (r=0.12; p&lt;0.10). DD was significantly associated with self-efficacy (r=0.17; p&lt;0.05) and fatalism (r=0.19; p&lt;0.001). In the final SEM model for DA, self-efficacy was directly associated with HbA1c (r=-0.16; p&lt;0.05) while fatalism was marginally associated with HbA1c (r=0.14; p&lt;0.10). DA was significantly associated with self-efficacy (r=-0.27; p&lt;0.001) and fatalism (r=0.32; p&lt;0.001).
Conclusion: In African Americans with T2DM, delay discounting and delay aversion are associated with worse glycemic control indirectly via lower self-efficacy and marginally via higher diabetes fatalism. This study provides new evidence on potential mechanisms of action and potential pathways for interventions in this population.

Disclosure
J.A. Campbell: None. R.J. Walker: None. L.E. Egede: None.

Funding
National Institute of Diabetes and Digestive Kidney Disease (R01DK118038, R01DK120861, PI: Egede; K01DK131319, PI: Campbell); National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker; R01MD018012, R01MD017574, PI: Egede/Linde)
701-P: Exploring the Lived Experience of Self-Care in Young Adults with Type 2 Diabetes Mellitus
Authors: BERRY-PRICE HOLLY , HEMPHILL JEAN C. , HASELSCHWERDT MEGAN L. , WEIERBACH FLORENCE M. , TODT KENDREA L. 
Published: June 2024

Introduction: The prevalence of prediabetes in adults aged 18 or older was as high as 38% between 2017-2020. Youth-onset T2DM is a more aggressive phenotype than T2DM that occurs later in life. Young adults with T2DM have poorer health outcomes, lose an average of 15 years of life, all resulting in significant economic burden impacting the person. Current self-management interventions do not improve health outcomes in young adults with T2DM.
Objective: The purpose of this research was to explore the self-care experiences of young adults living with T2DM.
Methods: Existential hermeneutic phenomenology informed the research. Inclusion criteria as follows: adults aged 18 to 30 with a self-reported diagnosis of T2DM, physical presence in the United States, English proficiency. Purposive and snowball sampling were used. Nineteen participants were interviewed: 16 self-identified as Black, 2 as White, and 1 as Latino. Interviews were transcribed verbatim. Transcripts were analyzed using an iterative approach for meaning units and themes. Thematic meanings were identified from the data.
Results: Overarching theme “Then & Now,” and 4 additional themes: health anxiety/death anxiety, I’m very supported, my routine/my duties/my rules, juggling, and 3 subthemes. Several factors were unique to young adults' perception of self-care. Perceptions of time, support networks, novel coping strategies, and search for disease literacy impacted self-care perceptions and understanding. Results suggest the need for future person-centered, self-care intervention research with young adults that could result in improved health outcomes.

Disclosure
H. Berry-Price: None. J.C. Hemphill: None. M.L. Haselschwerdt: None. F.M. Weierbach: None. K.L. Todt: None.
714-P: Influence of Eating Behavior Patterns on Online Weight Loss Program Engagement and Weight Loss
Authors: CLYNES SASHA , CHURCH TIMOTHY S. , JONES DAVID , WOODCOCK BRIAN 
Published: June 2024

Objective: To determine if eating behavior phenotype affects engagement and weight loss in an online corporately sponsored weight loss program.
Methods: Participants (N=206,426, mean age=46.5, 74.5% women, 72.4% Non-Hispanic White; 62.7% with obesity; 29.3% with overweight; 8.5% with diabetes; 17.6% with pre-diabetes) were from employers and health plans. We adapted an Epstein questionnaire to categorize eating behavior patterns as social (eating in social situations in the absence of true hunger), emotional (eating when experiencing strong emotions like stress, sadness, anxiety, or anger), hunger (having persistent hunger throughout the day), rigid (having a set of strict rules for the diet; an all-or-nothing approach), or classic struggle (having none of the other eating behavior patterns).[i] Outcomes were number of attended classes (online educational videos) and maximum percent weight loss over time in program. Linear regression models were fit with age and gender as covariates. We also gathered qualitative feedback on the survey from a small sample of users (n= 127).
Results: 154,740 (75%) completed the survey. The social eating behavior was the most common phenotype (64% of participants), followed by emotional (49%), hunger (48%), rigid (24%), and classic struggle (12%). Mean participation was 11.3 online classes and mean weight loss was 3.2%. We did not find any clinically meaningful differences between the groups for in-class attendance or weight loss. Additionally, there were no meaningful differences in diabetic and pre-diabetic subgroups. The participants who provided qualitative feedback rated the eating behavior survey as valuable and believed their eating behavior patterns were accurate after viewing survey results.
Conclusion: A social eating pattern was the most prevalent phenotype in this sample. Participants with all eating behavior phenotypes engaged to a similar degree in online program classes and had similar amounts of weight loss.

Disclosure
S. Clynes: Consultant; Wondr Health. T.S. Church: None. D. Jones: Employee; Wondr Health. B. Woodcock: Employee; Wondr Health.
715-P: Multilevel Health Care System Factors Influencing Type 2 Diabetes Disparities in the United States—An Integrative Review
Authors: GODFREY TIMIAN , OWOLABI EYITAYO O. , SINGH MANTEJ , DIAZ MONICA , BRAXTON MORGAN , SHAIBI GABRIEL Q. 
Published: June 2024

Introduction: In the United States, minority populations are disproportionately impacted by and experience worsened outcomes from type 2 diabetes (T2D). The National Institute of Minority Health and Health Disparities (NIMHD) Research Framework guided this study to synthesize the scientific evidence identifying health care system factors influencing T2D health disparities among minority populations in the US.
Methods: A literature search was conducted on PubMed, CINAHL, PsycINFO, and Scopus for articles published between 2017 and 2023 with outcomes of glucose homeostasis and T2D disparities in minority populations (as defined by NIMHD). Two reviewers independently extracted data for descriptive and narrative analysis.
Results: Among the 108 included studies, 33 (30.5%) reported associations between measures of glucose homeostasis and multilevel factors in the health care system. Within this domain, most studies were conducted at the community (30.3%) and individual (21%) levels, with only 15% including multiple levels. The overarching factors influencing T2D disparities included: 1) Treatment preferences, 2) Multidisciplinary approaches, 3) Technology enhanced education and support, 4) Language translation services, 5) Integrated clinical and community care approaches, 6) Access to services in rural areas, 7) Insurance access/coverage/stability, and 8) Racism and discrimination.
Conclusions: Studies included in this review highlight the complex interplay between the levels of influence in the NIMHD framework, the health care system, and the subsequent outcome of T2D disparities. More studies are needed across multiple levels of influence in the health care system to better understand drivers of these inequities and inform T2D health disparities research and practice.

Disclosure
T. Godfrey: None. E.O. Owolabi: None. M. Singh: None. M. Diaz: None. M. Braxton: None. G.Q. Shaibi: None.
724-P: Implementing an Early Type 1 Diabetes Clinic and Immunotherapy Treatment Program for Patients with Stage 1 and Stage 2 Type 1 Diabetes
Authors: SIMMONS KIMBER M. , CHESSHIR LEXIE , O'DONNELL HOLLY K. , WALKER SONYA C. , MARTINEZ ANDRES D. , ALONSO GUY T. , TRIOLO TAYLOR M. , GOTTLIEB PETER , FROHNERT BRIGITTE I. , STECK ANDREA 
Published: June 2024

Introduction & Objective: In November 2022, teplizumab-mzwv was approved for delaying onset of stage 3 type 1 diabetes (T1D). We designed an early T1D clinic to identify individuals eligible for treatment and provide proper anticipatory guidance around treatment options.
Methods: In December 2022, we opened a weekly clinic staffed with a nurse, physician and psychologist. Individuals with islet autoimmunity and concern for dysglycemia are offered metabolic staging, which includes a fasting glucose level, HbA1C, 2-hour OGTT, and 10-day CGM wear. Patients are offered a health and behavior assessment with a psychologist to assess psychological factors affecting their medical condition (e.g., anxiety, coping). Metabolic staging results are obtained during clinic, and treatment options are discussed. If a patient desires teplizumab-mzwv therapy, we prescribe and initiate the prior authorization process.
Results: We have completed staging and education visits in 32 patients. Using ADA T1D staging criteria, 21/32 (66%) patients were stage 2, 9/32 (28%) stage 1, and two patients were diagnosed stage 3. Since April 2023, we have successfully infused a full 14-day course of teplizumab-mzwv in 10 patients with stage 2 T1D. Most patients treated were adolescents and young adults (age 10-32 years, median age 17.5±17.6 years), male (n=7/10) and non-Hispanic white (n=8/10). Approximately half of treated patients have a first degree relative with T1D (n=6/10). Five patients in stage 2 progressed to symptomatic T1D and were therefore no longer eligible for treatment. Four patients declined treatment, and two are under review for treatment by their insurance carriers at this time.
Conclusions: Individuals attending Early T1D clinic tolerated complete metabolic staging per ADA guidelines. Of those meeting criteria for teplizumab-mzwv treatment, most patients wanted to pursue therapy. We successfully treated approximately half of eligible patients to date.

Disclosure
K.M. Simmons: Advisory Panel; Provention Bio, Inc. Consultant; Provention Bio, Inc. Research Support; Provention Bio, Inc., Novartis AG. Consultant; Medtronic. L. Chesshir: None. H.K. O'Donnell: None. S.C. Walker: Other Relationship; Dexcom, Inc., Insulet Corporation. A.D. Martinez: None. G.T. Alonso: Advisory Panel; MannKind Corporation. T.M. Triolo: None. P. Gottlieb: Other Relationship; IM Therapeutics. Research Support; Imcyse. Advisory Panel; Imcyse. Consultant; Juvenile Diabetes Research Foundation (JDRF). Research Support; Hemsley Charitable Trust, Novartis AG, Provention Bio, Inc., Precigen, Inc. Advisory Panel; ViaCyte, Inc. Research Support; Nova Pharmaceuticals. B.I. Frohnert: None. A. Steck: None.
725-P: TOTUM-63 (T63), a Novel Plant-Based Polyphenol-Rich Substance, Improves Glucose Homeostasis and Modulates Gut Microbiota Diversity among Adults at Increased Cardiometabolic Risk
Authors: BOUCHARD-MERCIER ANNIE , OTERO YOLANDA F. , CHAVANELLE VIVIEN , MAROIS JULIE , PILON GENEVIÈVE , VARIN THIBAULT , MITCHELL PATRICIA L. , ERIK JOHANSEN ODD , BARGETTO MAXIME , SAPONE VERONIQUE , LE JOUBIOUX FLORIAN , CAZAUBIEL MURIELLE , BARD JEAN-MARIE , PELTIER SEBASTIEN , COUTURE PATRICK , VOHL MARIE-CLAUDE , SIRVENT PASCAL , MARETTE ANDRE 
Published: June 2024

Introduction: T63 has been shown to improve fasting blood glucose (FG) in individuals with prediabetes or early type 2 diabetes. However, the mechanisms underlying these effects are still unknown. We sought to assess the effects of T63 on fasting and postprandial (PP) metabolic parameters as well as on the gut microbiota.
Methods: In this 8-wk, single arm, open label, clinical trial (NCT05369585), a daily dose of 5g of T63 was given by capsules. Eligible participants had a BMI ≥27 and &lt;40kg/m2, and either triglycerides (TG) ≥1.35mmol/L, or FG ≥5.6 and ≤6.9mmol/L, or HbA1c ≥5.6 and ≤6.4%. Blood was sampled fasting and during a 6-hour test meal for analysis of glucose homeostasis, lipids, hs-CRP, fibrinogen and incretins. Assessments were made before and after an acute intake as well as after 8 wk of supplementation. The fecal microbiota was analysed by metagenomic sequencing and the Simpson’s reciprocal index used for determination of microbial diversity.
Results: A total of 19 participants were enrolled and supplemented, (mean±SD) age 55.4±11.3 yrs, BMI 31.3±4.1kg/m2, FG 5.5±0.4mmol/L, HbA1c 5.5±0.2%, TG 1.6±0.5mmol/L, hs-CRP 3.3±2.3mg/L. Following the first acute T63 intake, PP reductions in max glucose level (p=0.03), and GIP area under the curve (AUC, p=0.01) were observed. After 8 wk of T63, significant decreases in HbA1c (to 5.3±0.3%, p=0.005), hs-CRP (to 2.5±1.8mg/L, p=0.01), fibrinogen (p=0.04) and plasma lipids (TG, total-C, non-HDL-C, LDL-C and total-C/HDL-C ratio (p&lt;0.05 for all)) were observed, while PYY increased (p=0.02). The PP pattern at wk 8 was characterized by reductions in the AUC of both glucose (p=0.04) and insulin (p=0.009). Gut microbiota α-diversity was increased by T63 at wk 8 (p=0.003).
Conclusion: These results provide novel insights on the effects of T63 on fasting and PP glucose metabolism, inflammation and lipids, in conjunction with an increased gut microbiota diversity.

Disclosure
A. Bouchard-Mercier: Employee; Valbiotis. Y.F. Otero: Employee; Valbiotis. V. Chavanelle: Employee; Valbiotis. J. Marois: None. G. Pilon: None. T. Varin: None. P.L. Mitchell: None. O. Johansen: Employee; Nestlé Health Science. M. Bargetto: Employee; Valbiotis. V. Sapone: None. F. Le Joubioux: Employee; Valbiotis. M. Cazaubiel: Employee; Valbiotis. J. Bard: Consultant; Valbiotis. Stock/Shareholder; Valbiotis. S. Peltier: Stock/Shareholder; Valbiotis. Board Member; Valbiotis. P. Couture: None. M. Vohl: None. P. Sirvent: Board Member; Valbiotis. A. Marette: Advisory Panel; Valbiotis. Research Support; Acasti Pharma, Inc. Advisory Panel; Plexus, Amancia.
739-P: Efficacy and Safety of Tirzepatide in Overweight (OW) and Obese (OB) Patients with Type 1 Diabetes (T1D)
Authors: SNELL-BERGEON JANET K. , KAUR GURLEEN , BEATSON CHRISTIE , GARG SATISH K. 
Published: June 2024

Introduction & Objective: Today, most patients with T1D in the US are OW or OB, contributing to insulin resistance and suboptimal glucose control. The only FDA approved treatment for T1D, insulin, adversely affects weight. Tirzepatide is approved for managing T2D and causes weight loss. We assessed the use of tirzepatide in OW/OB subjects with T1D.
Methods: This was a retrospective single center real-world study in 62 adult OW/OB patients with T1D who were prescribed tirzepatide and followed for one year. The control group included 37 T1D patients (computer matched) with OW or OB who were not using any weight loss medications during the same period.
Results: The mean baseline age, duration of diabetes and HbA1c were similar in the 2 groups (Table 1a), while BMI and weight were higher in cases. There were significantly larger declines in BMI and weight in cases than controls across all time points (Table 1b). HbA1c decreased in cases as early as 3 months which was sustained throughout 1-year follow-up (Table 1 b). There was no reported increase in severe hypoglycemia or diabetic ketoacidosis throughout the study duration.
Conclusions: In this pilot off-label use study, we conclude that tirzepatide facilitated an average 18.5% weight loss and improved glucose control in OW/OB patients with T1D. We strongly recommend a large prospective randomized control trial in OW/OB patients with T1D.

Disclosure
J.K. Snell-Bergeon: None. G. Kaur: None. C. Beatson: None. S.K. Garg: Research Support; Eli Lilly and Company. Advisory Panel; Medtronic. Research Support; Medtronic. Advisory Panel; Novo Nordisk. Research Support; DarioHealth Corp., Dexcom, Inc., Diasome. Advisory Panel; Roche Diabetes Care.
748-P: Tirzepatide Adjunctive Therapy in Adults with Type 1 Diabetes Using Tandem Control-IQ
Authors: KARAKUS KAGAN E. , KLEIN MATTHEW P. , AKTURK HALIS K. , SHAH VIRAL N. 
Published: June 2024

Objective: Safety and efficacy of adjunct therapy with Tirzepatide, a dual agonist, in adults with type 1 diabetes (T1D) using Tandem Control-IQ automated insulin delivery system is unknown. This study investigates changes in insulin requirements and glycemic outcomes in adults with T1D over 8 months of Tirzepatide treatment.
Methods: In this single-center, observational study, we collected demographic, A1c, weight (from electronic medical records), sensor glucose and insulin dose (from t:connect) for adults with T1D who were using Tandem Control-IQ and initiated Tirzepatide adjunct therapy for clinical indications (n=11, median age 36.2, 64% female and mean BMI of 38.6 kg/m2). Data were compared from baseline and over 8 months.
Results: The insulin requirements (total, basal and bolus insulin per day) were reduced significantly within 2 months (p&lt;0.01 for all) of Tirzepatide therapy (2.5-5 mg/week), and thereafter, there was no clinically meaningful reduction in insulin dose (Figure 1-A). The frequency of user-initiated boluses did not differ throughout the study. Despite significant reduction in insulin dose, A1c (-0.46%), weight (mean weight reduction -10 kg) and significant improvement in time in range, there was no increase in time below 70 mg/dL (Figure 1-B).
Conclusion: Tirzepatide adjunct to Tandem Control-IQ improved glycemic and metabolic outcomes without increasing hypoglycemia.

Disclosure
K.E. Karakus: None. M.P. Klein: None. H.K. Akturk: Consultant; Medtronic. Research Support; Medtronic. Consultant; Dexcom, Inc. Research Support; MannKind Corporation, Tandem Diabetes Care, Inc. Consultant; Tandem Diabetes Care, Inc. V.N. Shah: Consultant; Dexcom, Inc., Insulet Corporation. Research Support; Insulet Corporation. Advisory Panel; Novo Nordisk. Research Support; Novo Nordisk. Advisory Panel; Sanofi, Medscape. Consultant; embecta, Tandem Diabetes Care, Inc.
758-P: PROs in Tirzepatide-Treated Adults with Type 2 Diabetes in SURPASS-1 to -6 by Age, Gender, BMI, and Weight Loss
Authors: BOYE KRISTINA , THIEU VIVIAN , DONG WENXIU , WILLIAMSON SUZANNE E. , SAPIN HELENE 
Published: June 2024

Tirzepatide treatment statistically and meaningfully reduced HbA1c, and substantially reduced weight, in adults with T2D in the Phase 3 SURPASS studies. PROs in adults treated with tirzepatide 5, 10, or 15 mg in SURPASS-1 to -6 were explored by age, gender, BMI, and weight loss.
Data from all SURPASS-1 to -6 tirzepatide-treated adults were pooled, regardless of dose. Weight-related and health status PRO measures at baseline and endpoint - Ability to Perform Physical Activities of Daily Living (APPADL), Impact of Weight on Self-Perceptions (IW-SP), EQ VAS - were analyzed in participants grouped by age and BMI category at baseline, gender, and weight loss category achieved at endpoint. Analyses used ANCOVA models adjusted for baseline clinical characteristics; ceiling effects were explored in subgroup analyses.
In main and subgroup analyses, lower vs. higher baseline age group was associated with larger improvements in APPADL and EQ VAS scores but smaller improvements in IW-SP score in tirzepatide-treated adults. Lower vs. higher baseline BMI group and greater vs. lesser weight loss group at endpoint were associated with larger improvements across all PRO measures. Improvement in IW-SP score was greater for males vs. females, with no significant difference for other PROs.
Age, BMI, weight loss, and, to a lesser extent, gender all impacted PROs in tirzepatide-treated adults with T2D in the Phase 3 SURPASS studies.

Disclosure
K. Boye: Employee; Eli Lilly and Company. V. Thieu: Employee; Eli Lilly and Company. W. Dong: None. S.E. Williamson: Consultant; Eli Lilly and Company, Takeda Pharmaceutical Company Limited, GlaxoSmithKline plc, Novo Nordisk, Lundbeck. H. Sapin: None.