bluuebunny/crossref_metadata_2025_split huggingface dataset:
534-P: Structured CGM Education Delivered via Mobile Phone Is Associated with Increased Time in Range—Proof-of-Concept Study Results
Authors: HOLLOWAY MELISSA P. , GRACE THOMAS , PARKIN CHRISTOPHER 
Published: June 2024

Introduction & Objective: SmartStart CGM is a structured educational program for current users of continuous glucose monitoring (CGM) designed for use on a mobile phone. It presents basic and advanced information about using CGM and interpreting CGM data. We assessed the effects of SmartStart CGM on CGM knowledge level and time in range vs. baseline.
Methods: This proof of concept study enrolled 20 adults with type 1 diabetes on intensive insulin therapy (n=15 on hybrid closed-loop insulin pump therapy, n=5 on multiple daily injections). After enrollment, participants answered 20 "welcome check" questions to assess baseline knowledge. Upon completion of 7 interactive content modules, they answered the same 20 questions as a “final check.” Participants’ time in range 70-180 mg/dL (%TIR) and time below range &lt;70 mg/dL (%TBR) were obtained at baseline and 6 weeks post-completion. Changes from baseline in CGM knowledge and time in range were measured.
Results: Average duration of CGM use prior to enrollment was 31.5+/-19.3 months. The mean CGM knowledge score rose from 38% to 88%. At 6 weeks post-completion, 72.7% of participants with %TIR of &lt;70% at baseline (n=11) showed a clinically meaningful increase of at least 5%. Among participants with baseline %TIR of at least 70% (n=9), 77.8% maintained/increased %TIR up to 4%; 22.2% showed an increase of at least 5%. The proportion of participants reaching %TBR of &lt;4% rose from 70% to 100%. The percentage of participants reaching both %TIR of at least 70% and %TBR of &lt;4% increased from 25% to 65%.
Conclusion: The results of this proof of concept study strongly suggest that completion of SmartStart CGM was associated with increased CGM knowledge, increased %TIR and reduced %TBR.

Disclosure
M.P. Holloway: Other Relationship; Dexcom, Inc. Consultant; Insulet Corporation. T. Grace: Speaker's Bureau; Sanofi, Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. Employee; Dexcom, Inc. C. Parkin: Consultant; Abbott, embecta, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., Roche Diabetes Care, PharmaSens, MannKind Corporation, Provention Bio, Inc.

Funding
Diabetes Center Berne; Dexcom Inc (MED00032)
535-P: Success of Interactive, Online, Case-Based Education Related to Use of CGM for Type 2 Diabetes
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE 
Published: June 2024

Objective: We sought to determine if interactive, case-based, online continuing medical education (CME) could improve the competence and confidence of primary care physicians (PCPs) and diabetologists/endocrinologists (D/Es).
Methods: Educational design included a “test, then teach” approach to elicit cognitive dissonance, with evidence-based feedback provided following each learner response. A repeated pairs pre-/post-assessment study design and a McNemar’s test (P &lt;.05 is considered significant) assessed educational effect, with Cohen’s d assessing impact (&lt;0.2 modest effect, 0.2-0.49 small effect, 0.5-0.79 moderate effect and &gt;0.8 extensive effect). The activity launched September 28, 2023, data were collected through November 7, 2023.
Results: In total, 300 PCPs and 51 D/Es were included in the analysis. Matched learner data indicate that overall, 77% of PCPs and 82% of D/Es improved their competence from pre-to-post (both P&lt;.001 with extensive overall impacts in both groups 1.32-1.67). On a question-level: 20% of PCPs (P&lt;.01) improved at recognizing effective strategies for patient education related to T2D technology, and 65% of PCPs (P&lt;.01) and 82% of D/Es (P&lt;.01) improved at identifying TIR goals for a given patient with T2D. Overall, 46% of PCPs and 35% of D/Es reported increased confidence in initiating CGM devices in patients with T2D.
Conclusion: This study demonstrates the success of interactive, case-based, online CME on improving competence and confidence of PCPs and D/Es related to using CGM to manage T2D. Additionally, baseline competence levels were higher among D/Es related to identification patients for whom to recommend CGM (baseline gap 29% for PCPs and 6% for D/Es), and recognizing effective patient education strategies when initiating CGM (baseline gap 36% for PCPs and 16% for D/Es), resulting in larger improvements among PCPs. Baseline gaps were similar among both groups related to TIR goals, resulting in larger improvement and clinical understanding in D/Es.

Disclosure
A. Larkin: None. J. Schrand: None. A. Le: None.

Funding
Developed through an independent educational grant from Dexcom.
54-OR: Feasibility of a Multidisciplinary Pilot Intervention for Parent/Caregiver Diabetes Distress
Authors: ALKHATIB EINAS , SEGAWA MAI , DANNER ALYSSA , KASPER HANNAH , FRYMARK EMILY , ROBERTS SARAH , CLARY LAUREN , STREISAND RANDI , MAJIDI SHIDEH 
Published: June 2024

Introduction: Caregiver diabetes distress (DD) consists of negative emotions about a child’s T1D diagnosis, associated with increased A1c and family conflict. We aimed to identify the feasibility of a multidisciplinary pilot intervention for caregiver DD in a diverse academic pediatric diabetes center.
Methods: We held 3 monthly, 1 hour educational/support group virtual sessions per cohort (6-8 caregivers) on Nutrition, Fear of Hypoglycemia, and Parent/Child Collaboration. Sessions were led by an endocrinologist and social work, dietician, and/or diabetes educator. Target enrollment was 30 caregivers with DD (PAID-PR/Problem Areas in Diabetes - Parent Revised score &gt;56/100) of youth 5-17yo with T1D for &gt; 6mo. Data include demographics, pre-/post- PAID-PR scores, and session satisfaction.
Results: Caregiver participants (table 1) were 85% female, ages 42.5 + 11.3y; child characteristics: 38% female, ages 10.9 + 2.1y, 47.6% Black, 33.3% Caucasian, 9.5% Hispanic, 9.6% other, 43% public insurance, Mdiabetes duration 4.3 + 0.18y, and MA1c 8.5 + 0.7 %. PAID-PR scores (Table 1) improved from 68 to 51 (p&lt;.05). Satisfaction feedback included “No one has ever offered support like this in the 10 years since my son was diagnosed.”
Discussion: The pilot intervention was feasible, with 2/3 attending &lt;u&gt;&gt;&lt;/u&gt;2 sessions. PAID-PR scores improved. Limitations are a small sample; future goals are incorporating into the clinical setting.

Disclosure
E. Alkhatib: None. M. Segawa: None. A. Danner: None. H. Kasper: None. E. Frymark: None. S. Roberts: None. L. Clary: None. R. Streisand: None. S. Majidi: Other Relationship; Sanofi.

Funding
(10300-30200-37600-30007021-2) Dauber-GenMed AWD2735
54-PUB: Exploring Categories of Controlled Cardiovascular Risk Factors in the Elderly—Insights from the Costa Rican Longevity and Healthy Aging Study
Authors: CALVO MARIN JAVIER , TORREALBA-ACOSTA GABRIEL , ERNEST-SUAREZ KENNETH 
Published: June 2024

Introduction: The prospective cohort Costa Rican Longevity and Healthy Aging Study (CRELES) offers comprehensive data on the lifestyle of elderly Costa Ricans enrolled in 2005, with survival status up to 2019. We aimed to describe the characteristics of the participants based on the number of controlled cardiovascular risk factors (CVRFs).
Methodology: We recruited 1943 participants and categorized the number of CVRFs meeting targets from 0 to 5 (A1c, blood pressure, exercise, BMI, and smoking). Descriptively, we report proportions and means with SD for each variable categorized according to the number of controlled CVRFs. We used ANOVA for continuous and chi-square tests for categorical variables to establish differences between groups.
Results: The distribution of CVRFs varied among participants, with 35.8% successfully managing three CVRFs. Notably, only 3.0% of participants attained control over all five CVRFs. The global prevalence of diabetes was 20.3%, exhibiting variations between groups. The mortality rate for all participants was 51.1% (see Table 1).
Conclusions: The categorization of participants based on the number of CVRFs highlights variations in sociodemographic and clinical parameters across different subgroups. This stratification allows a better understanding of the cohort’s distribution of risk factors in the elderly.

Disclosure
J. Calvo Marin: Speaker's Bureau; Novo Nordisk, AstraZeneca. G. Torrealba-Acosta: None. K. Ernest-Suarez: Advisory Panel; Janssen Pharmaceuticals, Inc. Consultant; Janssen Pharmaceuticals, Inc. Speaker's Bureau; Janssen Pharmaceuticals, Inc. Advisory Panel; Pfizer Inc. Speaker's Bureau; Pfizer Inc. Advisory Panel; AstraZeneca. Consultant; AstraZeneca. Speaker's Bureau; AstraZeneca. Advisory Panel; Takeda Canada. Speaker's Bureau; Sandoz.
544-P: Early Evidence from a Pragmatic Trial to Increase Uptake of Diabetes Self-Management Education and Support Services in Rural Health Care Systems in Kentucky
Authors: LACY MARY E. , KECK JAMES , ELLIOTT JESSICA , WRIGHT LAURA , DRAKEFORD VANCE H. , MCKUNE BRENT , KRUSE-DIEHR AARON J. , DOUTHITT KEY 
Published: June 2024

Introduction & Objective: Diabetes self-management education and support (DSMES) is recommended for persons with diabetes (PWD) and is associated with a range of improved outcomes, but it is underutilized (&lt;10% of patients complete). In this study we present interim findings from a pragmatic trial that integrates health information technology and a quality improvement learning collaborative framework based on the Institute for Healthcare Improvement model to increase DSMES referrals among PWD.
Methods: Two healthcare systems from rural Kentucky participated in the study; within each system, two clinics were assigned to be intervention clinics and one clinic served as the control clinic. At the midpoint of the intervention (4.5 of 9 total months), we assessed preliminary effectiveness of the intervention on the primary outcome - percent change in DSMES referrals from baseline.
Results: Across the two healthcare systems, a total of 956 PWD were served by intervention clinics and 489 by control clinics. At the intervention midpoint, all intervention clinics had participated in ~16 hours of education plus monthly coaching calls with a quality improvement advisor and had completed four Plan-Do-Study-Act cycles to optimize their DSMES referral process. At baseline, 0% of PWD at both intervention and control clinics had been referred to DSMES in the prior 12 months. At study midpoint, 0% of PWD from control (0/489) and 19.4% (185/956) of PWD from intervention clinics were referred to DSMES.
Conclusion: Preliminary evidence suggests the effectiveness of our multipronged intervention to increase DSMES referrals among clinics in rural Kentucky. Rates of DSMES attendance among PWD that were referred and implementation outcomes, including feasibility, acceptability, scalability and sustainability, will be assessed.

Disclosure
M.E. Lacy: None. J. Keck: None. J. Elliott: None. L. Wright: None. V.H. Drakeford: None. B. Mckune: None. A.J. Kruse-Diehr: None. K. Douthitt: None.

Funding
This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (R34DK132548)
551-P: A Tailored Approach to Increase Engagement in Lifestyle-Change Programs in Women with Previous Gestational Diabetes
Authors: PIKE JULIE M. , HABERLIN-PITTZ KATHRYN , MACHUCA LUZ A. , MCKINNEY BRETT M. , YAZEL LISA , KOTARSKI ARIC , HANNON TAMARA S. 
Published: June 2024

Women with pGDM are at high risk for T2D. Yet, engagement of this population in lifestyle change programs (LCPs) is low. We evaluated the effect of a tailored diabetes prevention approach on engagement and health outcomes.
This unrandomized cohort study engaged women with pGDM in an informed decision-making process to discuss T2D risk, explore preferences for a LCP, and select a LCP aligned with priorities. Seven evidence-based LCPs with a variety of delivery modes, duration, time of day, and childcare availability were offered free of charge. The primary outcome was LCP engagement. Secondary outcomes were psychosocial questionnaires and clinical measures at baseline, 6 months, and 12 months. Paired t-tests compared changes over time.
We consented 116 women (34.9 ± 5.7 y). Ninety-six participants were included in data analysis after exclusions due to pregnancy (n=9) and BMI &lt;25 (n=11). Engagement was 78 percent at 6 months and 71 percent at 12 months. Psychosocial and clinical measures were stable at all time points.
A tailored diabetes prevention strategy is feasible and acceptable in women with pGDM, even during the COVID-19 pandemic and shutdown, which impacted the outcomes. LCPs that meet the unique priorities of women with pGDM are needed to optimize engagement and outcomes.

Disclosure
J.M. Pike: None. K. Haberlin-Pittz: None. L.A. Machuca: None. B.M. McKinney: None. L. Yazel: None. A. Kotarski: None. T.S. Hannon: Advisory Panel; Eli Lilly and Company.

Funding
Funding was provided by the Indiana University Grand Challenge Precision Health Initiative grant
56-PUB: Understanding the Patient Experience of Heart Failure with Preserved Ejection Fraction (HFpEF) and Obesity—Qualitative Insights from Patients and Clinicians
Authors: KANU CHISOM , AL-ZUBEIDI TAMARA , SHINDE SHRADDHA , AL-JASSAR GEMMA , LING POON JIAT , MILLER JORDAN , MARSHALL CHRIS , CARMICHAEL CHLOE 
Published: June 2024

Introduction & Objective: Heart failure with preserved ejection fraction (HFpEF) is a heterogenous clinical syndrome. Individuals living with HFpEF and obesity display a distinct phenotype that places considerable burden on their health-related quality of life. This study explored signs, symptoms, and impacts most relevant to individuals living with HFpEF and obesity. Clinician interviews provided a clinical perspective on the patient experience.
Methods: Qualitative interviews were conducted virtually with adults in the US diagnosed with HFpEF and obesity (body mass index ≥30.0 kg/m2). Clinicians in the US, China, and Germany with ≥3 years of experience treating HFpEF were also interviewed. Patient interviews were conducted until conceptual saturation was achieved. Content analysis was conducted using ATLAS.ti v9.0 software. A conceptual model (CM) of the lived experience of HFpEF and obesity based on patient and clinician feedback was developed.
Results: Twenty-two patients and 6 clinicians participated in the interviews. The CM demonstrated that living with HFpEF impacts many facets of life, with participants and clinicians reporting impacts on their (or their patients’) physical functioning (e.g., walking), activities of daily living (e.g., household chores) and work. Participants also reported impacts on their emotional well-being (e.g., feeling anxious or worried), social lives, relationships, and sleep. Shortness of breath and fatigue were spontaneously noted as salient and bothersome symptoms by most participants with edema noted by most on probing; this was further corroborated by clinicians who also considered these symptoms as the most bothersome symptoms of HFpEF.
Conclusion: This study highlighted the substantial burden of living with HFpEF and obesity. The resultant conceptual model highlights the key concepts that should be considered in patient-focused drug development.

Disclosure
C. Kanu: None. T. Al-Zubeidi: Consultant; Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi, Edgewise Therapeutics, Alimentiv. Employee; Clarivate Analytics. Consultant; Pfizer Inc. S. Shinde: None. G. Al-Jassar: None. J. Poon: Employee; Eli Lilly and Company. Stock/Shareholder; Eli Lilly and Company. J. Miller: Employee; Clarivate. Other Relationship; Clarivate. C. Marshall: None. C. Carmichael: Employee; Clarivate. Stock/Shareholder; Clarivate. Other Relationship; Clarivate.
565-P: Baseline Findings from the Dulce Digital 2.0 Trial—Innovative Diabetes Self-Management in the Digital Age
Authors: SAN DIEGO EMILY ROSE N. , RUIZ MONICA , ORENDAIN NATALIA , MILLAR KRISTA L.C. , SAENZ SHIRLEY M. , DE JESUS-GONZALEZ JOSELYN , SHAIKH HANI A. , PHILIS-TSIMIKAS ATHENA 
Published: June 2024

Introduction: Telehealth delivery of diabetes self-management education and support (DSMES) has been widely adopted, yet lower participation is occurring in Hispanics who are disproportionately impacted by type 2 diabetes (T2D). Objective: Describe baseline and recruitment characteristics in an in-progress 3-way RCT that will compare the effectiveness of the Dulce Digital text messaging program and live in-person and virtual delivery (video telehealth classes) of Project Dulce DSMES in improving glycemic management of 150 Hispanic adults with T2D and A1C of ≥ 8%.
Methods: Descriptives statistics.
Results: There were 612 patients approached after EHR review. After recruitment screening, 69% did not meet the eligibility criteria, 8% were eligible and interested, and 24% were eligible but not interested. Reasons for disinterest were inconvenient class times (48%), concerns about study demands (e.g., length of study; 23%), distrust in research or health professionals (20%), lack of access to study location (6%), and limited access/knowledge of technology (2%). Enrolled participants (n=46) were on average 55 ± 11.3 years old, and 50% were female, 44% were born in the US, 70% had English as the preferred language, 54% were employed full-time, 49% had ≤ high school education, and 38% had an annual household income of ≥ $55K. Mean baseline A1C was 9.5% ± 1.5. Mean scores for Summary of Diabetes Self-Care Activities subscales were diet = 3.8 ± 1.9, exercise = 3.2 ± 2.4, glucose management = 3.8±2.6, and foot care = 3.5 ± 2.5 (range = 0-7); and Brief Measure of Healthy Literacy scale was 2.4 ± 1.5 (range = 0-10).
Conclusion: The average baseline A1C was high while mean scores for self-care behaviors were low-to-moderate and low for health literacy. Healthcare systems should consider addressing multilevel barriers to in-person and telehealth DSMES delivery to enhance engagement and improve diabetes outcomes, especially in high-risk Hispanic adults with limited health literacy.

Disclosure
E.N. San Diego: None. M. Ruiz: None. N. Orendain: None. K.L.C. Millar: None. S.M. Saenz: None. J. De Jesus-Gonzalez: None. H.A. Shaikh: None. A. Philis-Tsimikas: Advisory Panel; Dexcom, Inc., Lilly Diabetes, Novo Nordisk, Sanofi, Medtronic, Bayer Inc.

Funding
Merck (IIS#60691); National Institutes of Health (K12 TR004410); National Institutes of Health (KL2 TR001112); National Institutes of Health (P50MD017344)
568-P: Living With Diabetes—A Hands-on Workshop
Authors: JENKINS ALEX , TODD JENNIFER N. 
Published: June 2024

Background: Diabetes affects 37.3 million people, with a total estimated cost of $327 billion. Studies have shown significant knowledge gaps in resident education regarding diabetes management, resulting in medical errors and inappropriate care. Although studies show that hands-on diabetes education is beneficial, most curricula are delivered as online, self-paced, or case-based learning, without insight into the day-to-day management of diabetes.
Description: Using personal experience of living with diabetes as a unique educational tool, we created an education session to share the patient experience of daily diabetes tasks, teach diabetes management skills, and foster peer teaching. The hour-long interactive session included an introduction about the presenter’s experience with diabetes and three 15-minute hands-on sessions, where participants counted their own carbohydrates for a meal, tested their blood sugar and/or tried on a Dexcom G7 sensor, and put on an insulin pump site.
Methods: We presented the session to pediatric residents and clerkship students, and surveyed participants on their understanding of diabetes care before and after the session and their overall rating of the session.
Results: A total of 17 participants answered the pre-session survey and 7 answered the post-session survey. Prior to the session, the proportion of participants indicating they somewhat or strongly agreed they knew what it felt like to check a blood glucose, give an insulin injection or pump insertion, or to perform the work of carbohydrate counting was 53%, 18%, and 29%; post-session these proportions increased to 100%, 100%, and 86% respectively. All the post-session respondents somewhat or strongly agreed they found the session valuable and would recommend to other residents.
Discussion: The session increased participants’ understanding of daily tasks of diabetes management and was perceived as a valuable part of residency education. Future directions include expanding to internal medicine and family practice residents.

Disclosure
A. Jenkins: None. J.N. Todd: None.
576-P: Adherence to Recommended Dietary Self-Care Behaviors and Its Related Factors for Patients with Type 2 Diabetes
Authors: OUYANG CHUNG-MEI 
Published: June 2024

Diabetes mellitus is a leading cause of disability and a major contributor to healthcare costs in most countries. Patient education to facilitate diabetes self-care is a cornerstone of the quality of diabetes care. Adherence to diabetes dietary self-care helps achieve a sense of general well-being and minimize diabetes complications. Patients with type 2 diabetes were surveyed to evaluate demographic, psychological, and environmental factors affecting perceived six dietary self-care behaviors to their prescribed regimens. A cross-sectional evaluation was performed in adult outpatients aged 40 years and older with type 2 diabetes who had received at least one individualized dietitian-led nutrition session. Adherence to six dietary self-care behaviors was assessed by using the Diabetes Self-Care Behavior (DSCB) questionnaire and the influencing factors of each behavior were investigated by using the Factors Affecting Diabetes Self-Care (FADSC) questionnaire. Odd ratios derived from logistic regression analysis were used to identify predictive factors resulting in adherence to dietary self-care behaviors and related factors. A total of 200 patients were completed in this study and the average age was 60.2±12.1 years old. We found that women were more likely to follow reducing fat intake (237 %) and eating more fiber foods (192 %). Patients who received more than 4 nutrition education sessions had better adherence to four different dietary self-care behaviors. Patients with more family support were more likely to have lower fat and more fiber foods. Patients with more self-efficacy showed following meal plans better. Patients’ adherence to six dietary self-care behaviors prescribed for diabetes varied. Many factors are important for supporting adherence to dietary self-care behaviors. The need for individualization of patient characteristics in diabetes nutrition education is the key point to adherence to recommended dietary self-care behaviors.

Disclosure
C. Ouyang: None.