bluuebunny/crossref_metadata_2025_split huggingface dataset:
496-P: Early-Onset Diabetes Increase the Risk of Referable and Sight-Threatening Diabetic Retinopathy
Authors: MENG CHUCHEN , MA YUHANG , WANG YUFAN 
Published: June 2024

Objective: This study aimed to investigate the influence of early-onset type 2 diabetes on the risk of developing diabetic retinopathy (DR), referable diabetic retinopathy (referable DR), and sight-threatening diabetic retinopathy (STDR).
Method: A total of 6847 individuals with type 2 diabetes were included. Individuals diagnosed with type 2 diabetes at or before the age of 40 are defined as having early-onset T2DM. Logistic regression and interaction analysis were used to assess the risk of DR, referable DR, and STDR in early versus late-onset diabetes. Kaplan-Meier analysis and cox regression analysis were employed to measure the relationship between incidences of retinopathy and early-onset diabetes in 1507 patients without DR at baseline.
Results: The early-onset group exhibited a higher prevalence of any DR, referable DR, and STDR with a diabetic duration exceeding 5 years (all P&lt;0.05).After adjusting for confounding factors, early-onset diabetes showed a significant association with an increased risk of referable DR and STDR (P=0.02 and P=0.03, respectively), with an interaction based on diabetes duration (P for interaction = 0.01 and P for interaction = 0.02 respectively).In follow-up analysis, the early-onset group had a significantly higher cumulative incidence of referable DR in terms of diabetes duration compared to the late-onset group (12.21% vs 9.8%, P=0.03).The multivariable-adjusted hazard ratios for referable DR in early-onset diabetes were 3.25 (95% CI 1.11-9.47) relative to the late-onset group, only in patients with a duration over 10 years.
Conclusions: Early-onset diabetes increased the risk of referable and sight-threatening DR, especially in those with diabetes duration over 10 years. Enhanced retinal screening and comprehensive diabetes manangement are vital for individuals with early-onset diabetes.

Disclosure
C. Meng: None. Y. Ma: None. Y. Wang: None.

Funding
National Key Research and Development Program of China (2021YFC2501600, 2021YFC2501601)
538-P: Multilevel Behavioral Drivers of Type 2 Diabetes Disparities in the United States—An Integrative Review
Authors: OWOLABI EYITAYO O. , DIAZ MONICA , BRAXTON MORGAN , GODFREY TIMIAN , SINGH MANTEJ , RASCON ALIRIA M. , SHAIBI GABRIEL Q. 
Published: June 2024

Introduction: Type 2 diabetes (T2D) disproportionately impacts minority populations. The National Institute of Minority Health and Health Disparities (NIMHD) Research Framework identifies drivers of health disparities across multiple levels and domains. This study synthesized evidence on the behavioral drivers of T2D disparities among minority populations in the US and categorized them across individual, interpersonal, community, and societal levels.
Methods: Relevant articles were retrieved from PubMed, CINAHL, PsycINFO, and Scopus. Eligible studies, defined as studies published between 2017 and 2023 that report glycemic measures or differences in T2D prevalence or related outcomes for US minority populations were abstracted and summarized descriptively.
Results: Of the 108 included studies, 28 (26%) addressed behavioral drivers or strategies for addressing T2D disparities, the majority of which were at the individual level 20 (71%), 7(25%) at the community level, and 1(4%) at the interpersonal level. Individual-level drivers included physical activity, dietary practices, dysfunctional eating, sleep quality and duration, health-seeking behavior, and coping strategies such as anxiety, stress, depression, or distress. The interpersonal-level factors were emotional and maternal abuse. The identified community-level interventions to improve T2D outcomes included lifestyle interventions, self-management education, and interventions aimed at improving resilience. No identified behavioral factors at the societal level.
Conclusions: This review identified a persistent focus on individual-level behavioral drivers of T2D disparities. Given the clear evidence that disparities in T2D are the result of upstream factors, more studies are needed at the interpersonal, community, and societal levels to inform comprehensive interventions and policies aimed at reducing T2D disparities.

Disclosure
E.O. Owolabi: None. M. Diaz: None. M. Braxton: None. T. Godfrey: None. M. Singh: None. A.M. Rascon: None. G.Q. Shaibi: None.
541-P: Medicare’s Initial or Annual Wellness Visits and Participation of Diabetes Self-Management Education and Support among Medicare Beneficiaries with Type 2 Diabetes
Authors: PENG NG BOON , LAMANNA JACQUELINE B. , HAWKINS GEORGIANNE T. , TOWNE SAMUEL D. , PARK CHANHYUN 
Published: June 2024

Welcome to Medicare and Annual Wellness Visits (AWV) provide opportunities for providers to engage beneficiaries in health promotion-related discussions. Diabetes self-management education and support (DSMES) facilitates beneficiary competence in complex technical skills, critical decision-making, and coping behaviors required to achieve individualized blood glucose goals. Although covered by Medicare, DSMES utilization is low. Increasing AWVs may help improve DSMES participation by older adults. Using the 2020 national sample of the Medicare Current Beneficiary Survey Public Use File, a survey-weighted multivariable logit model, adjusting for socio-demographics and comorbidities, was performed to estimate predictive margins for comparing the prevalence of participating in DSMES among beneficiaries aged ≥65 years with type 2 diabetes (n=1,837). Of beneficiaries, 50.9% self-reported participation in DSMES. Beneficiaries with AWV were 7.2% [95%CI=1.2%, 13.1%] more likely to participate in DSMES. Beneficiaries with lower educational attainment (less than high school, -18.9% [-26.4, -11.4] and high school, -10.0% [-15.8, -4.4]) were less likely to participate in DSMES than those with a college education. Beneficiaries with lower incomes (less than $25,000, -14.4% [-21.5, -7.4]) were also less likely to participate in DSMES. Beneficiaries of Other race (-15.1% [-22.9, -7.4]) were less likely to participate in DSMES than non-Hispanic White beneficiaries. About half of study beneficiaries with type 2 diabetes, representing almost 4 million older adults, did not access DSMES services. AWV was significantly associated with DSMES participation. Disparities in DSMES participation were observed by race, income, and education. Implementation efforts from both provider and beneficiary perspectives to improve the use of AWV and DSMES among at-risk beneficiaries should be considered.

Disclosure
B. Ng: None. J.B. LaManna: None. G.T. Hawkins: None. S.D. Towne: None. C. Park: None.
543-P: Characterizing Predictors of Receipt of Diabetes Self-Managment Education in the United States
Authors: MONTERO ALEX R. , NAM JOON 
Published: June 2024

Introduction& Objective: ADA recommends DSMES in general and at critical time points, such as hospital admission - a care transition. The National Health and Nutrition Examination Survey (NHANES) has asked about receipt of care from providers of DSME (nurse educators / dieticians) since 2005. Our aim was to characterize predictors of receipt of DSMES services with a focus on health system factors in NHANES, a nationally representative sample of the U.S. population.
Methods: This cross sectional study utilized NHANES 2005-2018 limited to those self-reporting diabetes and age ≥ 30. Our primary outcome was ever receipt of DSMES. Predictors of interest were insurance, current PCP, and recent hospital admit. Analyses used Student T-test, Chi square, and logistic regression as appropriate. All analyses were done in SAS and used weighting/sampling to account for the complex survey design of NHANES.
Results:4612 met eligibility. Those with A1C ≥ 9.0 were more likely to be younger; male of non-Hispanic black race/ethnicity (NHB); and on insulin. In multivariable analyses high A1C, NHB race/ethnicity, age ≤ 65, presence of PCP, and hospital admit were positively associated with DSME. Receipt of DSME has been decreasing over time.
Conclusion: Health system factors such as presence of PCP and recent hospital admit were positively associated with receipt of DSMES but insurance status was not associated with DSMES.

Disclosure
A.R. Montero: None. J. Nam: None.
550-P: Utilization of an Electronic Clinical Decision Support Tool by Health Care Providers for Hospital Glycemic Management in a Large Academic Center
Authors: MILLER THEODORE J. , MAREBOINA MANVITA , GONG JASON , KEARCHER KALEN , ORR MELISSA , PICHARDO-LOWDEN ARIANA 
Published: June 2024

Introduction: Sequelae of dysglycemia include infections and non-infectious complications, longer hospitalizations, and added hospital expenditure. Clinical Decision Support (CDS) is linked to optimization of glycemic control and shorter hospital stay. However, knowledge about clinicians’ responsiveness to CDS for diabetes care is limited.
Objective: This study aims to evaluate response to an inpatient electronic health record (EHR) CDS tool that detects gaps in glycemic care in real-time, and offers notifications containing evidence-based management recommendations.
Methods: We conducted abstractions of 65 patients’ charts with notifications delivered to providers related to persistent hyperglycemia, hypoglycemia or near hypoglycemia, or insulin sliding scale monotherapy. We calculated the proportion of response to CDS recommendations.
Results: Insulin reduction after alerts for or near hypoglycemia (≤80 mg/dL) or hypoglycemia risk (81-100 mg/dL) was 0% and 16.7% respectively. Insulin was initiated (50%) or increased (33%) after notifications for hyperglycemia (180 mg/dl x 2) in patients with diabetes, and initiated (60%) for stress hyperglycemia. After alerts for sliding scale monotherapy, insulin was initiated (53%) or stayed the same (55%).
Conclusions: There were variable reactions to CDS prompts. Even though our program is characterized by a standardized process that presents evidence-based real-time recommendations in the context of practice, uses a knowledge-promoting approach, and delivers automated prompts in the EHR, the overall response was noted to be limited. This phenomenon is likely multifactorial and requires closer investigation. CDS programs can benefit from careful assessment of users’ engagement, notification burden, and implementation strategies. Further, assessment of programs’ design to foster adoption of guidelines and evidence-based recommendations is warranted.

Disclosure
T.J. Miller: None. M. Mareboina: None. J. Gong: None. K. Kearcher: None. M. Orr: None. A. Pichardo-Lowden: None.

Funding
National Institute Of Diabetes And Digestive And Kidney Diseases of the National Institutes of Health Award Number: R01DK130992
590-P: Nutrition Able—A Lecture-Based Intervention to Increase Childhood Health Literacy of Nutrition Labels in Bexar County
Authors: BOLTE JEFFERY 
Published: June 2024

Intro: Nutrition Able aims to teach food scarce Bexar County middle/high school students how to read a nutrition label via lectures at Southside and Southwest ISD. Notably, Southside ISD is a food desert.
Methods: Our team gave lectures and administered a pre-survey. Following the pre-survey, a lecture was given. Afterwards, an identical post-survey was administered. The anonymous survey consisted of 7 multiple-choice questions about calories, macronutrients, calories/serving, macronutrient content, fiber, protein, and diabetes/obesity prevention. We collected demographics at the students’ discretion- height, weight, sex, grade, age, and family history of obesity/diabetes (FH).
Results: To date, we have reached 432 students from 6th-12th grade. There were improvements in pre-/post-survey scores (2.47 vs. 3.31, P&lt;&lt;&lt;.05), median (2 vs. 3), and mode (2 vs. 4). Positive FH predicted higher BMI (23.6 vs. 21.8, P=.003). Those with a positive FH reported their BMI more frequently (OR 1.63, CI 1.0-2.6).Predictors of better pre-survey scores include negative FH (2.65 vs. 2.42, P=.066), male sex (2.62 vs. 2.30, P=.01), and overweight or greater BMI (2.72 vs. 2.33, P=.01). Predictors of larger improvements in pre/post surveys include reporting BMI (0.93 vs. 0.60, P=.058), positive FH (.92 vs. .73, P=.16), and female sex (0.96 vs. 0.71, P=.092) - with large improvements in overweight girls(+1.4), healthy weight girls(+1.2), obese girls(+1.08) and obese boys(+1.0). The only predictor of higher post-survey scores was overweight girls scored better than overweight boys (4.03 vs. 3.1, P=.03).
Conclusion: Nutrition Able improves health literacy. Negative FH, male sex, and overweight/obese BMI are predictors of higher pre-survey scores. Overweight/obese BMI, positive FH and female sex are predictors of higher pre-/post-survey improvement. There were no material predictors of post-survey score. Nutrition Able effectively reaches those in need.

Disclosure
J. Bolte: None.

Funding
University of Texas Health Science Center Community Service Learning Grant
602-P: Relationships between Diagnosis Duration, Motor Proficiency, and Physical Fitness in Youth with Type 1 Diabetes
Authors: THRASHER BRAD J. , WINTERGERST KUPPER A. , SKETCH AMY E. , FRYE CAROLINE , OLAJUYIGBE TOLUWANIMI G. 
Published: June 2024

Introduction & Objective: Individuals with T1D encounter unique challenges regarding physical activity, glucose control, and chronic health conditions. Understanding the connection between diagnosis duration, motor proficiency (MP), physical fitness, and glycemic control is crucial for optimizing health and quality of life. The purpose of this study was to examine the relationships between diagnosis duration, MP, and physical fitness in pediatrics and young adults with T1D enrolled in a clinical sports & activity program (CSAP).
Methods: Data were collected from individuals with T1D enrolled in a CSAP, aged 6-21, receiving care at the Wendy Novak Diabetes Institute. Participants underwent assessments for MP, grip strength (GS), sit and reach (SR), body composition, resting metabolic rate (RMR), and cardiorespiratory fitness (VO2max). Data were analyzed using Spearman’s correlation test.
Results: Data were analyzed for 37 participants (14.1± 3.5 years; male, n=22, 59.5%&lt;u&gt;,&lt;/u&gt; white, n=34, 91.9%). Positive correlations were seen between percent body fat (BF) and GS (rs = -0.382, p &lt;0.05), BF and VO2max (rs =-0.507, p &lt;0.05), BF and vertical jump (VJ; rs =-0.608, p&lt;0.05), RMR and GS (rs =0.791 p&lt;0.05), RMR and VJ (rs =0.615, p&lt;0.05), VJ and MP composite (rs =0.495, p&lt;0.05), GS and VJ (rs =0.619, p&lt;0.05), and MP composite and diagnosis duration (rs = 0.393, p&lt;0.05).
Conclusion: MP composite scores were found to still be high in individuals with T1D even years after diagnosis. Improved physical fitness shows improved markers in cardiorespiratory fitness. Future research should continue to assess motor proficiency and physical fitness as duration of diagnosis increases.

Disclosure
B.J. Thrasher: None. K.A. Wintergerst: None. A.E. Sketch: None. C. Frye: None. T.G. Olajuyigbe: None.
62-PUB: Diabetes Control and Complications in Men vs. Women in India—Three-Year Results of LANDMARC Trial
Authors: DAS ASHOK K. , THACKER HEMANT , CHAWLA MANOJ S. , GOPALAKRISHNAN UNNIKRISHNAN AMBIKA , KUMAR WANGNOO SUBHASH , MENON SHALINI K. , GADEKAR ARVIND , CHODANKAR DEEPA 
Published: June 2024

Glycemic control, therapy trends, and diabetes complications were evaluated in LANDMARC, a prospective observational 3-year study (CTRI/2017/05/008452), of participants with T2D on ≥2 antihyperglycemic medications. This subgroup analysis included 6222 participants, comprising 3517 men and 2705 women. The mean (SD) duration of T2D was 8.72 (5.8) years in men and 8.42 (5.4) years in women. At baseline, 1935 (75.4%) men and 1412 (74.4%) women had HbA1c ≥ 7%, which dropped to 1298 (63.0%) men and 1046 (63.8%) women at 3-year. The mean HbA1c, FPG, and PPG improved from baseline to 3-year in both genders (Table). The mean (SD) basal insulin dose reduced from 24.1 (19.1) U at baseline to 23.3 (16.3) U at 3-year in men and from 24.4 (18.7) U at baseline to 23.8 (16.2) U at 3-year in women. At 3-year, the most common macrovascular complication was myocardial infarction in men and peripheral vascular disease in women. Neuropathy was the most common microvascular complication in both genders at 3-year (Table). Hypertension and dyslipidemia were the most common CV risk factors reported at 3-year in both genders. This pivotal understanding of anthropometry, glycemic parameters, complications, and CV risk factors among genders may help strategize future diabetes management practices in India.

Disclosure
A.K. Das: Other Relationship; Sanofi. H. Thacker: Other Relationship; Merck Sharp & Dohme Corp., Novartis India, Sanofi. M.S. Chawla: Advisory Panel; Novo Nordisk. Speaker's Bureau; Novo Nordisk. Advisory Panel; Biocon. Speaker's Bureau; Biocon. Advisory Panel; Eris Lifesciences Ltd. Speaker's Bureau; Eris Lifesciences Ltd. Advisory Panel; Torrent Pharmaceuticals Ltd. Speaker's Bureau; Torrent Pharmaceuticals Ltd. Advisory Panel; USV Private Limited, Lupin Pharmaceuticals, Inc. A. Unnikrishnan: Speaker's Bureau; Sanofi. Other Relationship; Novo Nordisk. Speaker's Bureau; AstraZeneca, Boehringer-Ingelheim, Abbott, Intas Pharmaceuticals Ltd. Research Support; Torrent Pharmaceuticals Ltd. S. Wangnoo: None. S.K. Menon: Employee; Sanofi. A. Gadekar: None. D. Chodankar: Employee; Sanofi.

Funding
Sanofi
637-P: Longitudinal Metabolic and Microbial Responses to Habitual Dietary Changes in Individuals at Risk for Type 2 Diabetes
Authors: PARK HEYJUN , SHEN XIAOTAO , PERELMAN DALIA , BERRY PRANAV , BATTERSBY RACHEL , CELLI ALESSANDRA , BEJIKIAN CAROLINE , SNYDER MICHAEL 
Published: June 2024

Introduction & Objective: Despite normal glucose levels, individuals with insulin resistance (IR) are more likely to develop Type 2 diabetes as compared to those with insulin sensitivity (IS). Moreover, the gut microbiome changes in response to diet and is associated with glucose regulation. Nonetheless, it is unclear whether and how metabolic and microbial responses to longitudinal changes in habitual diet would differ by one’s insulin resistance status.
Methods: We utilized biological samples obtained from a cohort study where 71 healthy adults (mean 53.4y) were longitudinally followed every quarter for one year. At each visit, participants completed dietary assessments using food records. They also provided blood and stool samples for plasma metabolomics and gut microbiome analyses using untargeted liquid chromatography-mass spectrometry and 16S rRNA sequencing, respectively. Furthermore, the insulin suppression test determined the insulin resistance status of the participants.
Results: We found that 22 nutrients, including total fiber and soluble fiber, significantly changed over the study period and/or differed between IS and IR individuals (p&lt;0.05). Notably, our correlation analysis showed fewer and weaker associations between longitudinal changes in nutrients and metabolites in participants with IR than those with IS (q&lt;0.05). The pathway enrichment analysis further confirmed that dietary change-related metabolites were associated with several metabolic pathways in IS participants, which were not as observed in those with IR. The pathways include steroid hormone biosynthesis, sphingolipid metabolism, and pyrimidine metabolism. Similarly, the numbers and degree of correlations between changes in nutrients and gut microbiome were reduced in IR compared to IS.
Conclusion: People with insulin resistance might need careful dietary interventions likely due to compromised nutrient signaling related to microbial and metabolic processes.

Disclosure
H. Park: None. X. Shen: None. D. Perelman: None. P. Berry: None. R. Battersby: None. A. Celli: None. C. Bejikian: None. M. Snyder: Stock/Shareholder; January, Inc., Personalis, Inc, Iollo, Qbio, RTHM, Enovone, Marble Therpeutics, Fodsel, Mirvie. Advisory Panel; Applied Cognition.

Funding
National Institutes of Health (NIH 5R01AT01023204, 5RM1HG00773509, U54DK102556, R01DK110186-03, R01HG008164, S10OD020141, UL1 TR001085, P30DK116074)
66-PUB: Remission Patterns and Associated Factors for Hypertension (HT) and Dyslipidemia (DL) Accompanied by Remission of Type 2 Diabetes Mellitus (DM)—Comprehensive Analysis
Authors: MON KHIN LAY , FUJIHARA KAZUYA , FERREIRA EFREM D. , GOTO WAKANA , YAMASHITA YUKO , KODAMA SATORU , SONE HIROHITO , STUDY GROUP JDDM 
Published: June 2024

That DM coexists with HT and/or DL is well known. To clarify this association, using a specialist clinic database from 1989 to 2022, we analyzed data on 2,630 Japanese with DM at baseline aged ≥18 years and HbA1c ≥6.5% and/or glucose-lowering drug prescription. Factors related to remissions of HT and DL in DM patients also in remission during follow-up were studied. DM remission was defined as HbA1c &lt;6.5% for 3 months after cessation of a glucose-lowering drug. Remission of HT was defined as SBP &lt;130 mmHg and that of DL as HDLC and non-HDLC of ≥40 mg/dL and &lt;150 mg/dL, respectively without any drug. In addition to DM remission, 495 (26%), 419 (26%), and 96 (8%) achieved remissions of HT, DL and both HT and DL, respectively (Fig). Baseline HbA1c was positively associated with HT or DL remission (p for trends= 0.02, &lt;0.01) along with DM remission. Baseline body mass (BMI) index was inversely associated with all (HT, DL and DM) remissions (p for trends ≤0.01). Compared with BMI changes from -2.9 to 2.9%, BMI reductions were significantly associated with all remissions (p for trend ≤0.01). About 25% of participants achieved either HT or DL remission while only 8% achieved remission of both. Although BMI change was a common factor in all remissions, remission of HT in people with DM requires physiological approaches differing from weight loss.

Disclosure
L. Khin: None. K. Fujihara: None. E.D. Ferreira: None. W. Goto: None. Y. Yamashita: None. S. Kodama: None. H. Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Eisai Inc., Sumitomo Dainippon Pharma Co., Ltd.
672-P: Feasibility of Caregiver Diabetes Distress Screening in Routine Clinical Care of Youth with Type 1 Diabetes
Authors: ALKHATIB EINAS , CLARY LAUREN , EDDINGTON ANGELICA , STREISAND RANDI , MAJIDI SHIDEH 
Published: June 2024

Introduction: Caregiver diabetes distress (DD) consists of sadness or burn out; 1/3 of parents report severe distress up to 1-4y after youth T1D diagnoses. PAID-PR (Problem Areas in Diabetes Survey - Parent Revised) assesses DD in research; however, less is known about its clinical utility. We aimed to identify the feasibility of implementing PAID-PR screening at a diverse academic pediatric diabetes center during routine clinic visits.
Methods: The PAID-PR was offered in English to caregivers of all T1D patients, by the front desk at appt. check-in, or via RedCap before telehealth visits or at local sites. Adult psychosocial resources were provided to all, regardless of score. Forms were scored after visits; scores &gt;80 were referred to Diabetes Psychologists.
Results: A total of 391 caregivers completed the PAID-PR; response rates were highest in person (&gt;90%), vs. RedCap (25%). In total, 27% (n=107) scored &gt;56 (DD). Of those with DD, 21% (n=23) scored &gt;80 and were referred to psychology. Demographics are in Table 1. PAID-PR correlated to A1c (p=0.038) and inversely to child age (p=0.014). Of those with severe distress, 30% are Hispanic/Latino.
Discussion: Clinic caregiver DD screening was feasible; however, limitations were scoring/administration time constraints; we plan to screen annually. Since the PAID-PR was in English, some caregivers with DD were missed. Future directions are screening in more languages.

Disclosure
E. Alkhatib: None. L. Clary: None. A. Eddington: None. R. Streisand: None. S. Majidi: Other Relationship; Sanofi.