bluuebunny/crossref_metadata_2025_split huggingface dataset:
599-P: Automated Insulin Delivery Systems and Physical Activity—Management and Outcomes
Authors: MOLVEAU JOSÉPHINE , RUSSON CATHERINE L. , BOUDREAU VALERIE , NGUYEN ELISABETH , HEYMAN ELSA , YARDLEY JANE E. , RABASA-LHORET RÉMI P.R. 
Published: June 2024

Introduction: Physical activity (PA), along with insulin adjustments and food intake for its purpose, can cause dysglycemia for people with type 1 diabetes (PWT1D), acting as a major barrier to activity. It is unclear if automated insulin delivery (AID) systems improve this situation.
Methods: Observational study in real-life conditions to assess time in, below or above range (TIR, TBR [&lt; 70mg/dl], TAR [&gt; 180 mg/dl]) and glucose variability (CV%) during PA, 1-h post-, 4-h post-PA compared to non-PA periods with continuous glucose monitors. Participants also completed a PA log for 6 weeks including PA type (continuous, intermittent or resistance) and duration. Data were analyzed using a mixed model with Bonferroni correction for post-hoc comparisons.
Results: We enrolled 22 PWT1D using AID (8 males, age: 48.7 ± 13.2 years, A1c: 6.7 ± 0.5%). Participants recorded a total of 339 PA sessions (mean 15 ± 13 [5 - 64]; 251 continuous, 59 intermittent, 29 resistance) lasting 60.9 ± 55.6 min (10 - 430 min). We found no significant effect of PA type on TIR, TBR, TAR or CV during, 1-h post or 4-h post PA. TBR as well as TAR during, 1-h and 4-h PA were comparable to non-PA periods. CV was higher in non-PA periods. All values for TBR, TAR and CV remained within optimal recommended ranges (Table).
Conclusion: PWT1D using AID successfully manage PA. Respective roles of AID algorithm and adaptive behaviors need to be investigated on a larger sample size.

Disclosure
J. Molveau: None. C.L. Russon: None. V. Boudreau: None. E. Nguyen: None. E. Heyman: None. J.E. Yardley: Speaker's Bureau; Dexcom, Inc. Research Support; LifeScan Diabetes Institute. R.P.R. Rabasa-Lhoret: Other Relationship; Abbott, AstraZeneca, Bayer Inc., Boehringer-Ingelheim, Dexcom, Inc. Research Support; Diabetes Canada. Other Relationship; Eli Lilly and Company. Research Support; Cystic Fibrosis Canada, Canadian Institutes of Health Research, FFRD - Fondation Francophone pour la Recherche du Diabète. Other Relationship; Janssen Pharmaceuticals, Inc. Research Support; Juvenile Diabetes Research Foundation (JDRF). Other Relationship; Novo Nordisk, GlaxoSmithKline plc. Consultant; HLS Therapeutics Inc., Insulet Corporation. Speaker's Bureau; CPD Networks. Other Relationship; Medtronic. Consultant; Pfizer Inc. Speaker's Bureau; Tandem Diabetes Care, Inc. Other Relationship; Sanofi. Speaker's Bureau; Vertex Pharmaceuticals Incorporated. Research Support; SFD - Société Francophone du Diabète.

Funding
Diabetes Canada (OG-3-21-5586-RR)
622-P: Carbohydrate Counting and Bolus Calculator Mobile-Based Application in Adults with Type 1 Diabetes Mellitus—A Randomised Controlled Study
Authors: ALBABTAIN SARA , ALAFIF NORA , ALMEHTHEL MOHAMMED , ALZAHRANI SAAD H. 
Published: June 2024

Introduction & Objective: Carbohydrates counting is crucial for proper glycaemic control of Type 1 diabetes mellitus (T1DM). We aimed to study the usefulness and safety of a mobile application (app) for Carbohydrates counting and bolus calculation (CHOC/BC) developed at King Fahad medical city, Riyadh.
Methods: The study included 127 subjects (63 controls) with T1DM using multiple daily insulin injections. Subjects were randomised to either use CHOC/BC app or continue using conventional nutritional management. Patients were taught about Carb counting and using the app in the first visit by a trained nutritionist and remotely followed every two weeks. Insulin sensitivity factor, Carbohydrates ratio and glucose target were calculated for each subject separately. Three months glucose data were recorded using Ambulatory glucose profile.
Results: The mean age of subjects was (mean±SD) 26.7±4.8 (39.1% males) and controls 26.6±6.5 years (54% males). Subjects on CHOC/BC app had better time in range compared to controls 51.2±11.6 vs 46.2±13.0% p=0.02 respectively, that is mainly driven by an improvement of Time above 250 mg/dl 17.3±11.6 vs 24.1±15.7% respectively p=0.002. Average glucose was better in app users 179.2±27.9 vs 191.7±35.8 mg/dl p=0.03. Glucose variability assessed by coefficient of variation was better in app users 39.8±5.5 vs 41.9±5.8 p=0.045. Time below range was not statistically different between the two groups 3.6±3.0 vs 3.8±2.4 % p=0.3. Furthermore, the CHOC/BC users didn’t gain significant weight compared to controls 67.3±15.1 vs 68.6±14.3 kg respectively p=0.6. HbA1c was not different between both groups 7.93±0.8 vs 8.15±1.0% respectively p=0.1.
Conclusions: CHOC/BC application was associated with better control of glucose and lower glucose variability without increased risk of hypoglycaemia or weight gain.

Disclosure
S. Albabtain: None. N. Alafif: None. M. Almehthel: None. S.H. Alzahrani: None.

Funding
King Fahad medical city, research centre
626-P: Insulin Dosing Strategies Surrounding Food Intake among Older Adults with Type 1 Diabetes (T1D)
Authors: KAHKOSKA ANNA , SPRINKLES JESSICA , GOPISETTY NIKHITA R. , ERCOLINO GABRIELLA , MUTHUKKUMAR RASHMI , QU XIAORUI , FRUIK ANGELA , MAYER-DAVIS ELIZABETH J. , CRISTELLO SARTEAU ANGELICA 
Published: June 2024

Introduction & Objective: T1D management evolves over the lifespan, as the risk for hypoglycemia increases. Data are limited to guide diabetes education and nutrition in older adults. Our objective was to assess strategies employed by older adults with T1D employ to accurately dose insulin surrounding food intake.
Methods: We administered a one-time electronic survey (Sept - Nov 2023) to capture dietary beliefs and practices among older adults (≥65 years) with T1D receiving care in a university-affiliated hospital system. We analyzed responses using descriptive statistics. We extracted clinical data from the EHR.
Results: Data from 77 older adults were analyzed [45.5% male, 93.5% non-Hispanic White; mean age 71.3±4.1 yrs; mean diabetes duration 33.5±18.1yrs; mean HbA1c 6.8±1.1; mean BMI 27.3±4.70]. Most older adults endorsed counting carbohydrates (CHO), checking glucose before eating, and eating in approximately the same way every day, while few endorsed using CHO exchanges, phone apps, or following a pre-specified meal plan. Education, sex, and age were associated with several strategies; mean HbA1c and BMI were significantly higher among those who did not count CHO (Figure).
Conclusion: Older adults with T1D utilize varying strategies to dose insulin. Understanding factors underlying preferences may enable better matching of adults with acceptable and effective methods for managing T1D and diet.

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

Funding
National Center for Advancing Translational Sciences, National Institutes of Health (K12TR004416)
628-P: Receipt and Perceived Importance of Nutrition Counseling among Older Adults with Type 1 Diabetes (T1D)
Authors: KAHKOSKA ANNA , SPRINKLES JESSICA , GOPISETTY NIKHITA R. , ERCOLINO GABRIELLA , MUTHUKKUMAR RASHMI , QU XIAORUI , YOUNG LAURA A. , MAYER-DAVIS ELIZABETH J. , FRUIK ANGELA , CRISTELLO SARTEAU ANGELICA 
Published: June 2024

Introduction & Objective: Dietetics guidelines recommend adults with T1D are referred to nutrition counseling for individualization of an eating plan. We characterized the extent to which older adults receive nutrition counseling and how important they perceive it to be.
Methods: Adults (≥65 yrs) with T1D receiving care in a university-affiliated hospital system completed a one-time electronic survey (Sept- Nov 2023). Respondents reported history of nutrition education/counseling and perceived importance on a scale of 1-10 (low -&gt; high) and provided suggestions to support nutrition among older adults with T1D.
Results: Data from 77 older adults were analyzed (45.5% male, 93.5% non-Hispanic White; mean age 71.3±4.1 yrs; diabetes duration 33.5 ± 18.1 yrs; HbA1c 6.8 ± 1.1%). The range of most recent nutrition counseling varied (Figure). The perceived importance was rated ≤5/10 by 67.9% of respondents and was highest among those with higher BMI and more disordered eating behaviors (DEPS-R score), with no differences by age, gender, disease duration, or HbA1c. Free responses underscored the need for easy and specific meal suggestions, to account for age-related difficulties, and increased peer support.
Conclusion: There are opportunities to increase awareness for and utilization of evidence-based nutrition counseling for older adults with T1D, incorporating age-relevant guidance and peer support.

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

Funding
National Institutes of Health (DK056350); National Center for Advancing Translational Sciences, National Institutes of Health (K12TR004416)
633-P: Insight to the Association between Serum Fibroblast Growth Factor 23 Levels and Presarcopenia in Nondiabetic Individuals—A Longitudinal Cohort Study
Authors: XU YITING , HU TINGTING , SHEN YUN , WANG YUFEI , MA XIAOJING , BAO YUQIAN 
Published: June 2024

Introduction & Objective: Pre-sarcopenia, characterized by early signs of muscle wasting and weakness, represents a critical stage for intervention and prevention strategies. While pre-sarcopenia is commonly observed in adults with diabetes, there is growing interests in understanding its occurrence in nondiabetic individuals. This study was aimed to identify a predictive biomarker of pre-sarcopenia in nondiabetic individuals.
Methods: This study included 1243 adults (Men 51.5%, median age: 58 [53-62] years) without baseline diabetes from 2013-2014. The follow-up assessment was conducted in 2015-2016. Participants underwent serum FGF23 measurement at baseline and follow-up visit. Serum FGF23 levels were determined using a sandwich enzyme-linked immunosorbent assay. Skeletal muscle mass was estimated by bioelectrical impedance analysis and converted to skeletal muscle index (SMI) adjusted for body weight. Pre-sarcopenia was defined as SMI less than 1 SD of the sex-specific mean for a young reference group. The glycemic status was defined according to the American Diabetes Association 2023 guideline.
Results: Serum FGF23 levels were significantly higher in participants with baseline pre-sarcopenia than those without (P = 0.001). During an average follow-up of 2.1 years, pre-sarcopenia occurred in 57 (5.3%) participants without baseline pre-sarcopenia. Multivariate Logistic regression model showed that, compared with lowest tertile of baseline FGF23, the highest tertile was associated with an elevated risk of incident pre-sarcopenia (HR 2.69, 95%CI 1.33-5.73). Further stratified by glycemic status, the predictive ability of serum FGF23 on pre-sarcopenia was more predominant in those with prediabetes.
Conclusion: Serum FGF23 levels may be a promising clinical marker for pre-sarcopenia in nondiabetic individuals, especially those with prediabetes.

Disclosure
Y. Xu: None. T. Hu: None. Y. Shen: None. Y. Wang: None. X. Ma: None. Y. Bao: None.
634-P: Effects of 72-Hour Induction Fast on Participants with Type 2 Diabetes Mellitus Participating in Early Time-Restricted Eating Plan
Authors: NIJJAR AVNEET , SHAIKH KANNAN , CALINAWAN TESS L. , MALDONADO ITZEL , MARIE JONES GRACE , SHUBROOK JAY H. 
Published: June 2024

There continues to be debate about optimal eating times and patterns for weight management and glycemic control in people with T2D. Intermittent fasting or early time-restricted eating (eTRE) has succeeded in clinical trials and gained popularity. The impact of a 72 - hour induction fast is a novel approach to amplify the benefits of eTRE in type 2 diabetes.The aim of this study is to determine the effects of 72 - hour induction fast on T2D patients undergoing 3 months of eTRE.In this single cohort experimental study, participants were randomized into either an initial 72 - hour induction fast group or a non-induction fast group. Both groups underwent an 8 - hour feeding window (8 AM to 4 PM) and a 16 - hour fasting window daily for 3 months.Participants were recruited from a network of healthcare centers of FQHC and were required to have a T2D diagnosis and diabetes medication therapy. A total of 17 participants enrolled with 11 completing the study. Key exclusion criteria included recent AKI or DKA. At baseline and 12 - weeks blood draws were performed to analyze glycemic and lipid profiles, and anthropometrics, number of medications, and blood pressure were measured.Paired t-tests showed there were no significant differences in results between the two groups. Induction Fast + eTRE group (n = 4), the pre - and post - data mean, respectively were A1c (7.9% vs 7.7%, p = 0.7), weight (265 vs 259 lbs., p = 0.09), BMI (37.8 vs 37.1, p = 0.12), & systolic bp (123 vs 112 mmHg, p = 0.05). For the non-Induction Fast + eTRE group (n = 7), the pre- and post-data mean, respectively were A1c (7.6% vs 7.7%, p = 0.69), weight (231 vs 227 lbs., p = 0.01), BMI (36 vs 33, p = 0.03), & systolic bp (122 vs 118, p = 0.46).This pilot study demonstrates that a 72 - hour Induction Fast resulted in a significant reduction in blood pressure whereas eTRE alone showed significant reductions in weight and BMI. Further planned analysis of blood chemistries may illustrate the additional benefits of a 72 - hour Induction Fast on eTRE.

Disclosure
A. Nijjar: None. K. Shaikh: None. T.L. Calinawan: None. I. Maldonado: None. G. Jones: None. J.H. Shubrook: Consultant; Abbott Diagnostics. Advisory Panel; Bayer Inc., Eli Lilly and Company, Madrigal Pharmaceuticals, Inc., Nevro Corp. Consultant; Novo Nordisk, Sanofi.
638-P: Feasibility of Using eButton for Dietary Management in Chinese Americans with Type 2 Diabetes
Authors: GREENLEE MICHAELA D. , WYLIE-ROSETT JUDITH , CHEN KEER , SUN MINGUI , WU BEI , ZWEIG SUSAN , JIA WENYAN , MELKUS GAIL D. , PAREKH NIYATI , ZHENG YAGUANG 
Published: June 2024

Background & Objective: Chinese Americans are at a higher risk for type 2 diabetes (T2D) than other racial/ethnic groups despite having a lower body mass index. This population has challenges in dietary management that is key for glycemic control. Leveraging wearable sensors (e.g., eButton) is promising to overcome such challenges. We aimed to assess the feasibility of the eButton for dietary management among Chinese Americans, as its effectiveness in this group remains unknown.
Methods: Chinese Americans with T2D (N=11) participated in a one-group prospective study. They wore an eButton on their chest to record their 10-day meals over two weeks. This wearable device contains a digital camera that collects dietary intake data by automatically taking pictures every three seconds. The eButton pictures were used to determine food names, volumes, and nutrient value. Individual interviews were conducted after 2 weeks to discuss their experience. We used ATLAS.ti software to thematically analyze the interviews.
Results: Facilitators included the device’s ease of use, ability to make participants more mindful, and influence on increased sense of control. Being more conscious of food intake enabled participants to eat smaller portions. Barriers include subjects’ privacy concerns, having difficulty staging the camera for pictures, and needing a record of pictures to understand the trends in glucose spikes. Suggestions for future eButton designs were adding language translations, sending reminders to turn the camera off, and automatically detecting and saving pictures of meals.
Conclusions: Our findings suggest that it is feasible for Chinese Americans with T2D to use the eButton for dietary management. The practice of taking meal pictures improved their awareness of food portion sizes. Future studies are needed with adding certain features (e.g., saving pictures), larger sample sizes, and a longer duration of wearing to inform effective dietary management for Chinese Americans with T2D.

Disclosure
M.D. Greenlee: None. J. Wylie-Rosett: None. K. Chen: None. M. Sun: None. B. Wu: None. S. Zweig: None. W. Jia: None. G.D. Melkus: None. N. Parekh: None. Y. Zheng: None.

Funding
National Institutes of Health (Grant No: R56 DK113819 and R01 DK127310); NIH/NCATS (UL1TR001445); CTSI Collaborative Translational Pilot Project Award
650-P: Attitudes and Barriers to Implantable AID Solutions—Development of a New Assessment Tool
Authors: HERMANNS NORBERT , FINKE-GROENE KATHARINA , KULZER BERNHARD , EHRMANN DOMINIC 
Published: June 2024

Major limitations of current automated insulin delivery (AID) systems are the subcutaneous insulin route and the need to wear devices on the body. The EU project “FORGETDIABETES” (supported by H2020-FETPROACT, n.951933) will develop a fully implantable AID systems to overcome these barriers. To assess attitudes and barriers to such an implantable solution, a new assessment tool was developed. A list of 19 items assessing different aspects of an implantable AID system were developed. In an online survey, 366 people with type 1 diabetes (27.0% insulin pen, 45.9% insulin pump, 27.0% AID) completed the item pool and answered questions about the expected reductions in diabetes distress and improvement in quality of life from such an implantable AID system. Factor analysis revealed 4 factors explaining 63.7% of the variance. Overall reliability was very high with Cronbach’s alpha (CR-a)=0.88. The factors were named “glycemic benefits” (e.g. protection from complications; 6 items, CR-a =0.85), “mental benefits” (e.g. less thinking about diabetes; 3 items, CR-a =0.81), “technical barriers” (e.g. complications during implantation; 3 items, CR-a =0.80), and “emotional barriers” (e.g. loss of control; 7 items, CR-a =0.86). Higher glycemic benefits and higher mental benefits were associated with higher expected reductions in diabetes distress (r=0.47, r=0.42) and quality of life (r=0.42, r=0.38) (all p&lt;.01). Higher technical and emotional barriers were associated with lower expected reductions in diabetes distress (r=-0.35, r=-0.41) and quality of life (r=-0.34, r=-0.42) (all p&lt;.01). There were no differences between therapy regimens, except for lower emotional barriers in AID users (p&lt;.001). The new questionnaire is a reliable and valid tool to assess attitudes and barriers to implantable AID systems. It can be used to assess and consequently address human factors associated with use of implantable AID solutions.

Disclosure
N. Hermanns: Speaker's Bureau; Berlin-Chemie AG, Sanofi-Aventis Deutschland GmbH. Research Support; Sanofi-Aventis Deutschland GmbH. Speaker's Bureau; Roche Diabetes Care. Research Support; Roche Diabetes Care. Speaker's Bureau; Dexcom, Inc. Advisory Panel; Abbott Diagnostics, Ypsomed AG. K. Finke-Groene: None. B. Kulzer: Advisory Panel; Abbott Diagnostics, Berlin-Chemie AG, Dexcom, Inc., Sanofi, embecta, Novo Nordisk, Roche Diabetes Care. Speaker's Bureau; Bayer Inc., Insulet Corporation, Lilly Diabetes. D. Ehrmann: Advisory Panel; Dexcom, Inc. Speaker's Bureau; Dexcom, Inc., Sanofi-Aventis Deutschland GmbH. Advisory Panel; Roche Diabetes Care. Speaker's Bureau; Roche Diabetes Care, Berlin-Chemie AG.

Funding
This project has received funding from the European Union's Horizon 2020 research and innovation programme (No 951933)
661-P: Exploring the Real-World Impact of Late-Day Glucose Spikes on Weight Loss in People without Diabetes
Authors: DIXON WILLIAM , LEVONIAN DMITRI , KIM STEPHANIE , FOULADGAR-MERCER SHARAM , TANCER BILL , GUSZ DAN 
Published: June 2024

Background and Aims: Population-level distribution of various glucose spikes throughout the day for people without diabetes is a relatively under-researched domain. Enhanced insights at population-level as well as individual patterns in the timing of glucose spikes and their correlation with weight loss may shed light on behavior modifications that individuals may adopt to stimulate weight loss or pause / reverse weight gain.
Methods: As part of a larger study (in partnership with Dexcom), we analyzed the correlation patterns between participants' weight trajectories and the timing of their glucose spikes using data from more than 19,000 participants (median age: 46, 66% women, 76% overweight or obese) wearing a Dexcom G6 or G7 real-time CGM. Participants were also utilizing the Signos personalized program for weight management. We identify glucose spikes based on individual variability in CGM signals for each participant and will further review glucose spike definitions.
Results: Overall, the earlier the glucose spikes occurred during the day, the more weight loss that individual experienced. The pattern is observed at both population level and demographic cohort level, e.g. for gender, age, BMI cohorts. The earliest-spiking cohort (~20% of participants) started their latest glucose excursion before 4 pm, whereas the latest-spiking cohort (~20% of participants) started their spikes after 6:15 pm. The observed 180-day Total Body Weight Loss for the earliest-spiking cohort was twice more compared to the latest-spiking cohort (p-value &lt; 0.01).
Conclusions: The observed data suggests that having glucose spikes earlier in the day (e.g. shifting heavier carb intake earlier in the day) is a positive behavior modification for weight management. Further research into time-based postprandial glucose excursion monitoring and the associated behavior modifications is needed.

Disclosure
W. Dixon: Employee; Signos. D. Levonian: Employee; Signos. S. Kim: None. S. Fouladgar-Mercer: Employee; Signos. B. Tancer: Employee; Signos. D. Gusz: Employee; Signos.
667-P: Disordered Eating Attitudes and Behaviors among Older Adults with Type 1 Diabetes (T1D)—An Exploratory Study
Authors: KAHKOSKA ANNA , ERCOLINO GABRIELLA , SPRINKLES JESSICA , GOPISETTY NIKHITA R. , FRUIK ANGELA , MUTHUKKUMAR RASHMI , QU XIAORUI , YOUNG LAURA A. , MAYER-DAVIS ELIZABETH J. , CRISTELLO SARTEAU ANGELICA 
Published: June 2024

Introduction & Objective: Despite evidence associating T1D in young people with disordered eating attitudes and behaviors (DEBS), there is scarce evidence in the growing number of older adults with T1D. We explored the association of DEBS with demographic and clinical outcomes among older adults with T1D.
Methods: Adults 65+ years with T1D from a university-affiliated hospital system were recruited via clinical messaging, e-mail, and in-person to complete a one-time electronic survey (Sept-Nov 2023) that included the Diabetes Eating Problem Survey-Revised (DEPS-R)). Clinical data were collected from the EHR. Total DEPS-R scores were plotted against HbA1c and BMI.
Results: The DEPS-R was completed by 77 older adults (age 71.3 ± 4.1, 93.5% non-Hispanic White) with T1D (duration 33.5 ± 18.1). Mean (sd) HbA1c was 6.83 (1.12) and mean (sd) BMI was 27.3 (4.70). Mean DEPS-R Score was 11.5 (6.05), with 5.2% (n=4) classified as having clinically significant DEBs (DEPS-R score &gt;20). We found a non-linear association between the DEPS-R score and BMI and HbA1c, with increasing DEPS-R score correlating with increasing HbA1c and BMI until DEPS-R score of 20 (Figure).
Conclusion: To our knowledge, this is the first study to explore DEBS in older adults with T1D using the DEPS-R. The relationships between scores and clinical outcomes suggest the instrument may confer construct validity in this age group.

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

Funding
National Center for Advancing Translational Sciences, National Institutes of Health (K12TR004416)