bluuebunny/crossref_metadata_2025_split huggingface dataset:
558-P: Virtual Reality to Educate Health Professional Students about the Complexity of Care in Older Adults with Type 2 Diabetes
Authors: BEVERLY ELIZABETH A. , LOVE CARRIE , LOVE MATTHEW 
Published: June 2024

Introduction & Objective: Diabetes care for older adults is complex. Older adults are at increased risk for geriatric syndromes, including cognitive impairment, hearing loss, visual impairment, depression, polypharmacy, incontinence, disability, and injurious falls. To address this complexity, we created a virtual reality (VR) training for health professional students. The purpose of this single arm, pre-post-test study was to assess students’ changes in empathy, attitudes toward disability, and self-efficacy in identifying and managing elder abuse and neglect before and after participating in the VR training.
Methods: Health professional students at a large university in the Midwest were invited to participate in the VR training centered on an 80-year-old man, with a history of type 2 diabetes, a mobility disability, hearing loss, urinary incontinence, and potential dementia. Participants completed pre-post questionnaires via Qualtrics.
Results: A total of 67 health professional students participated (mean age=22.7±3.9 years, 80.6% women, 67.2% White, 20.9% Black, 9.0% Asian, 29.9% pre-medical). Surprisingly, we observed a decrease in empathy post-VR training (t=3.204, p=.002). This may reflect a potential empathy bias, such that the participants overestimated their empathy prior to the VR training but became more aware of their lack of experience in understanding different perspectives and emotions of adults with complex health issues. Next, we observed an improvement in participants’ attitudes toward disability (t= -2.799, p=.007) and an improvement in their self-efficacy to identify and manage elder abuse and neglect (t= -2.209, p=.032).
Conclusion: Findings suggest that this VR training may improve health professional students’ attitudes toward disability and self-efficacy towards identifying and managing elder abuse and neglect; more research is needed to determine its impact on empathy.

Disclosure
E.A. Beverly: None. C. Love: None. M. Love: None.

Funding
Ohio Department of Medicaid (ODM202238)
571-P: Life-Stage Specific Education for Young Adults with Diabetes—Integrating Theory into Practical Tools
Authors: JANE ROCHE MARY , SAMAI KRYSTLE , KIM STEPHANIE 
Published: June 2024

Introduction: There is a lack of targeted resources to promote self-management behaviors in young adults (ages 18-30) with diabetes. Online information-seeking commonly occurs among this group for chronic disease management and support. To fill this unmet need, The Diabetes Link created an e-learning framework (“The Framework”) and utilized it to develop life-stage specific, online educational resources that result in high engagement.
Methods: The Framework incorporated Adult Learning Theory and Bloom’s Taxonomy, a model used to classify levels of educational learning outcomes, along with inputs relevant for this demographic such as resource format, length, and media type. A clinical advisory panel provided feedback to ensure materials were clinically sound and achieved learning outcomes. The Diabetes Link created four topic modules using this framework. Engagement analytics include quantitative measures of online usage.
Results: The Framework was used to develop and release materials focusing on 4 topic modules over 9 months on an online platform: Mental Health & Wellbeing, Sex & Diabetes, Relationships, and Management 101: Technology. Each topic module contains 11-20 assets, defined as videos, infographics, and peer perspectives. Each asset highlights independence, lived experiences, and practical skills. Each topic module focuses on 6-8 specific learning outcomes based on the 6 different levels of hierarchical learning, ranging from building knowledge to evaluation. From 5/11/23-12/31/23, these topic modules have reached 2228 individuals and 228 hours spent engaging with the educational resources.
Conclusion: The Diabetes Link has developed an e-learning framework that enables age appropriate online content development. Adoption of The Framework has resulted in high engagement above industry standards. The four topic modules will be tested in a pilot study to measure the relevance and impact of materials on young adults with diabetes.

Disclosure
M. Roche: None. K. Samai: None. S. Kim: Consultant; Signos, Inc.

Funding
Novo Nordisk
584-P: A Case Study Approach to Explore Barriers Associated with Uncontrolled Diabetes among Patients Receiving Care at Health Centers in the U.S. Virgin Islands
Authors: SHEEN JULIA 
Published: June 2024

Introduction & Objective: The prevention and control of diabetes is a significant public health issue in the U.S. Virgin Islands (VI). This study explored the barriers associated with uncontrolled diabetes among Federally Qualified Health center patients in the VI.
Methods: This study followed a case study method of qualitative inquiry. The novelty of this study lies in its exploration of a critical public health concern within a specific and often neglected subset of the U.S. healthcare system, the VI. Existing literature focusing on diabetes prevention and control in the VI is both infrequent and sparse. Subsequently, this study addressed a major gap in the literature, about the barriers associated with uncontrolled diabetes in the VI and particularly among health center patients.
Results: It found that the overarching barriers associated with uncontrolled diabetes among patients receiving care at health centers in the VI, from the patient, provider and executive director’s perspectives included the following: (1) the social determinants of health; (2) lack of family support; (3) lack of medication adherence; (4) culture; (5) lack of access to care; (6) mental and social issues; (7) lack of patient knowledge about diabetes, and (8) lack of exercise and inability to maintain a healthy diet.
Conclusion: This study had several implications for future research, for example it presented an opportunity to explore cultural factors and patient adherence to lifestyle measures; the use of naturopathic remedies in the treatment of diabetes and emergency preparedness related to hurricanes and its impact on patients with type 2 diabetes. There were also policy implications related to healthcare provider shortages, the use of community health workers in the support of patients with type 2 diabetes and the need for the establishment of standards of care for the treatment of patients with diabetes across the lifespan.

Disclosure
J. Sheen: None.
586-P: Enhancing Diabetes Prevention through Lifestyle Modifications in Idaho
Authors: RANI RAVEEN 
Published: June 2024

Introduction & Objective: In response to the escalating diabetes epidemic, the U.S. National Diabetes Prevention Program encourages lifestyle modifications among individuals at high risk of diabetes. Nationally, these interventions, aimed at causing a modest 5-7% body weight reduction, led to a remarkable 58%decline in type 2 diabetes risk among participants. This study objective was to evaluate the impact of lifestyle changes on obesity and diabetes incidence among high-risk individuals in Idaho.
Methods: This study analyzed data collected from University of Idaho Extension DPRP-enrolled participants. We enrolled 226 participants at high risk of diabetes in a year-long program focused on promoting lifestyle modifications. Inclusion criteria encompassed individuals aged 18 or older with a Body Mass Index (BMI) of ≥24 kg/m² (≥22 kg/m² for Asian individuals) and a recent blood test indicating prediabetes or a history of gestational diabetes mellitus (GDM). Using paired t-tests, we analyzed the changes in final BMI (31.4851 kg/m²) compared to initial BMI(32.5775 kg/m²) and physical activity changes among participants.
Results: The analysis revealed a statistically significant decrease in final BMI by an average of 1 kg/m²among participants. Furthermore, a notable increase in physical activity levels was observed among those that completed the year-long program, characterized by an average increase of 98minutes per week.
Conclusion: The study showcased a significant decrease in BMI, affirming the effectiveness of DPRP lifestyle intervention program.

Disclosure
R. Rani: None.
592-P: The Association of the Timing and Magnitude of Peak Physical Activity with Cardiometabolic Health Outcomes in People with Diabetes
Authors: ALOZAIRI EBAA S. , ALKANDARI JUMANA , ALSAEED DALAL , IRSHAD MOHAMMAD , ALESMAEEL BATOOL C. , ABDALLA MOHAMED , ABDULLAH MARIAM A. , GRAY STUART R. 
Published: June 2024

Introduction & Objective: To investigate the association of the timing and magnitude of peak physical activity with cardiometabolic outcomes, such as glycated haemaglobin (HbA1c) and body mass index (BMI), in people with type 1 and type 2 diabetes.
Methods: We recruited 810 people with type 1 diabetes and 1381 people with type 2 diabetes to the study. Participants wore a wrist-worn accelerometer for a 7 day and the start time of the most active 5 hours (M5time) and the acceleration (physical activity) performed in this 5 hour period (M5value) quantified. Outcome variables recorded were HbA1c, total cholesterol, HDL cholesterol, LDL cholesterol, waist circumference and BMI. Associations were assessed by linear regression after adjustment for sex, age and total (24 hour) physical activity levels.
Results: In people with type 1 diabetes the M5 time was no associated with any of the outcome variables, but the M5value was associated with HbA1c (β-coefficient [95%CI], -0.19[-0.05,-0.32], p-value 0.005), HDL cholesterol (0.004,[0.001,0.007], p-value 0.016) and LDL cholesterol (-0.008[-0.001,-0.016], p-value 0.034). In people with type 2 diabetes both the M5time 0.45[0.05,0.85], p-value 0.028) and M5value (-0.23[-0.03,-0.43], p-value 0.032) were associated with HbA1c. No other associations were observed.
Conclusions: A greater amount of physical activity during the peak activity time was associated with better glycaemic control in people with type 1 and 2 diabetes, even after adjusting for total physical activity levels. Performing peak physical activity levels earlier in the day was also associated with better glycaemic control, only in people with type 2 diabetes.

Disclosure
E.S. Alozairi: None. J. AlKandari: None. D. Alsaeed: None. M. Irshad: None. B.C. Alesmaeel: None. M. Abdalla: None. M.A. Abdullah: None. S.R. Gray: None.

Funding
Kuwait Foundation for the Advancement of Sciences (KFAS), Kuwait
607-P: Associations of Gut Microbiome with Glycemic Control in a Carbohydrate-Restricted, High-Protein Diet for Type 2 Diabetes Mellitus
Authors: HOOPS SUSAN L. , KNIGHTS DAN , BANTLE ANNE 
Published: June 2024

Objective: The Low Biologically Available Glucose (LoBAG) diet was designed to improve glycemic control of type 2 diabetes mellitus (T2D). We evaluate changes in the gut microbiome when participants with T2D are given the LoBAG diet.
Methods: Thirty-six participants with T2D taking metformin or no glucose-lowering medication were enrolled in a 12-week randomized controlled trial. Participants were randomly assigned to the LoBAG diet (30% low-starch carbohydrate, 30% protein, 40% fat) or a control diet (50% carbohydrate, 15% protein, 35% fat). Fecal samples were collected at weeks 0, 6, and 12 along with the primary outcome, hemoglobin A1c (HbA1c).
Results: Diet groups were significantly distinct in terms of Bray-Curtis dissimilarity in weeks 6 and 12 following the dietary intervention (p&lt;0.001, PERMANOVA), indicating shifts in the microbiome profile following the diet intervention. In particular, abundance of Firmicutes was lower in the LoBAG diet group (Mann-Whitney U test, p &lt; 0.001). The primary outcome, HbA1c, was significantly more reduced in the LoBAG diet group (t-test, p=0.04, week 12 - baseline) following dietary intervention.
Conclusions: Participants with T2D consuming the LoBAG diet had greater reduction in HbA1c over 12 weeks than those consuming a control diet. This difference was also associated with shifts in the gut microbiome, but further studies are needed to explore a relationship between HbA1c and the gut microbiome.

Disclosure
S.L. Hoops: None. D. Knights: None. A. Bantle: None.

Funding
University of Minnesota Department of Medicine (Faculty Research Award); National Center for Advancing Translational Sciences (UL1TR002494 and KL2TR002492); National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115906)
610-P: Effect of Butyrate on GI signs, SIBO, and Diabetes Control—Randomized, Placebo-Controlled Study in Patients with Type 2 Diabetes
Authors: PANUFNIK PAULINA , WIECEK MARTYNA , SZWARC PAULINA , KANIEWSKA MAGDALENA , LEWANDOWSKI KONRAD , FRANEK EDWARD , RYDZEWSKA GRAZYNA 
Published: June 2024

Introduction & Objective: Patients with type 2 DM have frequently GI signs/symptoms and small intestinal bacterial overgrowth (SIBO), which may impair beta cell function and diabetes control. The study aimed to evaluate the influence of microencapsulated oral sodium butyrate on GI signs, SIBO incidence, and diabetes control.
Methods: In a prospective, randomized, placebo-controlled double-blind study, 52 patients with type 2 DM treated with diet or oral antidibetics (2 pts. on insulin) and abdominal pain were randomly assigned to butyrate 1.5 g/day (n=29) or placebo (n=23) for 12 weeks. Before and after the intervention the presence of abdominal pain, diarrhoea, constipation and flatulence was assessed, laboratory tests and hydrogen breath tests were performed, HbA1c was assessed.
Results: After the intervention in the butyrate group there was significantly more patients relieved from GI signs and symptoms as in the placebo group (Table 1). Additionally, there was a significant decrease of SIBO prevalence in the butyrate group as compared with placebo group. In the patients treated with butyrate a slight but significant improvement of BMI and HbA1C level was also observed (Table 1).
Conclusion: Oral microencapsulated sodium butyrate supplementation is effective in relieving abdominal signs, treating SIBO, improving body mass and metabolic control in patients with type 2 DM.

Disclosure
P. Panufnik: None. M. Wiecek: None. P. Szwarc: None. M. Kaniewska: None. K. Lewandowski: None. E. Franek: Speaker's Bureau; AstraZeneca. Research Support; BIOTON. Speaker's Bureau; BIOTON, Boehringer-Ingelheim, Berlin-Chemie AG, Merck & Co., Inc., Eli Lilly and Company, Novo Nordisk, Sanofi. G. Rydzewska: Speaker's Bureau; AlfaSigma. Consultant; AbbVie Inc. Speaker's Bureau; Bayer Inc., Pfizer Inc. Consultant; Takeda Pharmaceutical Company Limited. Speaker's Bureau; Janssen Pharmaceuticals, Inc.

Funding
The sodium butyrate preparation and placebo was provided by the Bioton company.
632-P: Beta-Cell Function Is a Stronger Predictor Than Insulin Resistance for Development of Type 2 Diabetes in Obese Indian Population—A Matched-Pair Cohort Analysis
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , VYAWAHARE ANAGHA R. , KATHRIKOLLY THEJAS , TIWARI DIPTIKA , SHARMA BABY , GANLA MALHAR H. , HIREMATH MAMATA , SABOO BANSHI D. 
Published: June 2024

Background: Insulin resistance is often thought to be the primary factor in the development of type 2 diabetes, especially in obese individuals.
Aim: To determine the relationship between the homeostatic assessment model and diabetes, as well as the associated comorbidities, using matched-pair analysis in an obese Indian population.
Methods: The present study retrospectively analyzed data from 451 gender-age-BMI matched pairs (with and without diabetes) of obese patients (BMI &gt; 25 kg/m², aged 40-60 years) enrolled in a one-year online lifestyle intervention program at the Freedom from Diabetes Clinic, India. Baseline anthropometric data, biochemical parameters, and medical history were used for the analysis. The homeostatic assessment model was used to calculate HOMA-IR and HOMA2-B. Insulin resistance was defined as HOMA-IR&gt;2.5, while good beta cell function was defined as HOMA2-B &gt;50.
Results: The mean age and BMI of the patients was 47.7±5.7 years and 31±4.5 kg/m², respectively; patients with diabetes had a mean disease duration of 7.9 years. Patients with diabetes had a significantly higher prevalence of insulin resistance (72.5%), inflammation (hs-CRP &gt;3) (62%), hypertension (36%), and dyslipidemia (43%) than those without diabetes (37.5%, 47%, 27%, and 22%, respectively) (p&lt;0.05). In contrast, good beta-cell function was observed in those without diabetes (96%) than those with diabetes (55.4%; 81% of them were on OHA) (p&lt;0.05).
Conclusion: The majority of matched patients without diabetes exhibited good beta cell function. These findings emphasize that beta-cell function rather than insulin resistance may be the primary deficit leading to the development of diabetes in obese individuals.

Disclosure
P. Tripathi: None. N.S. Kadam: None. A.R. Vyawahare: None. T. Kathrikolly: None. D. Tiwari: None. B. Sharma: None. M.H. Ganla: None. M. Hiremath: None. B.D. Saboo: None.
640-P: Disordered Eating Screening within a Pediatric Diabetes Clinic
Authors: ANDORKO NICOLE , PANTESCO ELIZABETH J. , WILLI STEVEN M. , GENUARIO KIMBERLY , JENSSEN BRIAN , POWELL MAURA A. , DIFIORE GABRIELLE , GETTINGS JULIE M. 
Published: June 2024

Adolescents with type 1 (T1D) and type 2 diabetes (T2D) are at elevated risk for mood and eating disorders, which are associated with numerous negative outcomes. Depression screening is now standard within pediatric diabetes clinics, yet formal screening for disordered eating is rare. Due to the comorbidity between these presentations, depression screening may effectively identify youth with disordered eating concerns. Goals were to describe the frequency of depressive and disordered eating symptoms for adolescents with T1D and T2D and examine associations between these symptoms. In a retrospective analysis of clinical data from outpatient medical visits in patients with T1D and T2D aged 13.0 to 18.9 years, body image and extreme weight control behaviors were assessed from a self-reported adolescent health questionnaire (AHQ; DiFiore et al., 2023) and depressive symptoms via the Patient Health Questionnaire-9 Adolescent Version (PHQ-9; Johnson et al., 2002). On average, patients with T1D (n = 216) were 15.9[1.25] years old, had diabetes for 7.7 [4.08] years, and an average BMI%ile of 75.95 [22.03]; while those with T2D (n = 85) were 16.1 [1.16] years old with diabetes for 2.7 [1.29] years, and an average BMI%ile of 98.05 [3.26]. Regarding depressive symptoms, 6.0% (T1D) and 11.8% (T2D) scored at or above threshold (≥ 11) on the PHQ-9. Concerns of body image were reported in 13.0% (T1D) and 42.4% (T2D) and of extreme weight control behaviors in 6.0% (T1D) and 27.1% (T2D). Linear regressions adjusted for relevant background variables including BMI indicated higher PHQ-9 scores were associated with both increased body image concerns (T1D: B = 4.14, p &lt; .001; T2D: B = 3.41, p = .004) and extreme weight control behaviors (T1D: B = 3.49, p = .002; T2D: B = 4.30, p &lt; .001). These findings highlight concern for disordered eating, especially within T2D, and routine screening is indicated. If clinic constraints limit multiple screenings, follow up disordered eating screening for those with concerning depressive symptoms may be appropriate.

Disclosure
N. Andorko: None. E.J. Pantesco: None. S.M. Willi: Advisory Panel; MannKind Corporation. Other Relationship; Medtronic. Advisory Panel; Boehringer-Ingelheim. Other Relationship; National Institute of Diabetes and Digestive and Kidney Diseases. K. Genuario: None. B. Jenssen: None. M.A. Powell: None. G. DiFiore: None. J.M. Gettings: None.
665-P: Inequities in Access to CGMs, Pump, and Insulin Pens among Type 1 Diabetes Adult Population at a Southeastern Academic Medical Center
Authors: HALL MEGAN , RODRIGUEZ CARLA , GONDER-FREDERICK LINDA 
Published: June 2024

Introduction & Objective: Academic medical centers have identified disparities in access to diabetes technology. This analysis performed a self-assessment of potential inequities in access to diabetes technology at this medical center, including CGMs, insulin pumps, and insulin pens, to guide our community outreach efforts.
Methods: This study analyzed deidentified EMR data using multivariable logistic regressions to determine the association of social determinants (age, sex, race-ethnicity, insurance, and neighborhood socioeconomic disadvantage) with technology use among adults (ages≥18) with T1D.
Results: Of 1,480 patients with T1D seen at UVA Health in 2022, 479 accessed CGMs, 370 used pumps, and 133 used insulin pens. For CGMs, older age (80+ years), Non-Hispanic Black (NHB) race-ethnicity, public insurance and uninsured status related to lesser use/access. For pumps, female gender related to higher usage while NHB race-ethnicity and public insurance and uninsured status were associated with less use. Hispanic ethnicity was associated with higher pen use while Medicare/uninsured status related to with less use. (Fig 1.)
Conclusion: The majority of center patients do not use advanced technology for diabetes management, indicating that outreach efforts should target all racial-ethnic/SES groups with extra effort focusing on NHB groups and those with public/no insurance.

Disclosure
M. Hall: None. C. Rodriguez: None. L. Gonder-Frederick: None.

Funding
Lomar Foundation
678-P: Feasibility of Integrating Social Needs Interventions in Community-Based Diabetes Programs
Authors: VERDECIAS NIKO 
Published: June 2024

Addressing diabetes disparities requires a holistic approach that recognizes the challenges faced by marginalized populations in integrating diabetes self-management education (DSME) into their daily lives. Unmet social needs such as food insecurity, unstable housing, and utility instability impact diabetes self-management behaviors and health outcomes. The purpose of this study is to understand the perspectives of community-based organizations (CBOs) that provide DSME to marginalized populations to identify social needs of their patients and approaches taken to address social needs. Semi-structured 1-on-1 interviews were conducted with (n=15) DSME facilitators and leadership from urban and rural CBOs. Using a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework, thematic analysis was performed to explore the feasibility of implementing a social needs intervention alongside DSME. Participants acknowledged the impact of social needs on their clients' self-management behaviors and highlighted the urgent need for intervention. Results revealed that the existing organizational structure and DSME programs provide flexibility for implementing a social needs intervention, but the CBOs expressed uncertainty about where to begin. Opportunities that could transform weaknesses into strengths included leveraging existing partnerships and establishing new ones to foster a greater sense of community within the CBOs to benefit their clients. Also, partnering with an expert to develop a concise standardized process and to train staff to screen and address social needs to strengthen CBO's rapport with their clients for personalized goal-setting. Needed is a focus on evaluating the effectiveness of integrating a social needs intervention into CBO services to improve DSM. This research aims to enhance the support provided to marginalized populations and address the multifaceted challenges they face in managing their diabetes.

Disclosure
N. Verdecias: None.