bluuebunny/crossref_metadata_2025_split huggingface dataset:
662-P: Diabetes Self-Management in Breast Cancer Survivors—Racial and Ethnic Disparities
Authors: LEITER AMANDA , DORON EILAM , GOEL MITA S. , LIN JENNY J. 
Published: June 2023

Type 2 diabetes (T2DM) is associated with 40% increased breast cancer (BC) mortality. Black and Latina BC survivors have worse BC mortality outcomes and are more likely to have T2DM. We aimed to assess the association of race/ethnicity with adherence to T2DM self-management behaviors (SMBs), medication beliefs, and control in BC survivors. We recruited Stage 0-III BC survivors ≥ 55 years who had preexisting T2DM taking ≥ 1 oral DM medications. Adherence to T2DM SMBs and medication beliefs were assessed with validated questionnaires. Hemoglobin A1c (A1c) was measured at recruitment to assess T2DM control. We compared variables by race/ethnicity using the Fisher's exact (categorical) and Kruskal Wallis (continuous) tests. Multivariable linear regression evaluated the relationship between race/ethnicity and T2DM variables and adjusted for age, education and BC stage. Of 194 participants, median age was 67 years (interquartile range [IQR] 60-72), A1c was 7.4% (IQR 6.4-7.9); 27% self-identified as Black, 41% as non-Hispanic white (NHW), 18% as Latina, and 14% as other/unknown race. NHWs (70 years, IQR 56-83) were older than Black (63 years, IQR 55-87), Latina (64 years, IQR 56-83), and other/unknown race (64 years, IQR 55-77) participants (p=0.01). Black (76%), Latina (49%), and other/unknown race (83%) participants were less likely to have some college education than NHWs (88%, p&lt;0.01). BC stage did not significantly differ by race/ethnicity. In multivariate analyses, Latina participants were more likely to believe T2DM medications disrupted their lives and were not important for their health. However, race/ethnicity was not associated with adherence to T2DM SMBs nor A1c in multivariate analyses.
In summary, race/ethnicity was not correlated with T2DM SMBs or control in BC survivors, but Latinas differed regarding some medication beliefs. Future studies should explore other T2DM-related factors, potentially related to medication beliefs, to improve outcomes for Black and Latina BC survivors.

Disclosure
A. Leiter: None. E. Doron: Other Relationship; Teva Pharmaceutical Industries Ltd. M.S. Goel: None. J.J. Lin: None.
665-P: Longitudinal Impact of Daily Experienced Diabetes Distress and Affective Symptoms on the Incidence and Remission of Depressive Symptoms—Results of the DIA-LINK 1 and 2 Studies
Authors: EHRMANN DOMINIC , SCHMITT ANDREAS J. , OLESEN BIRGIT , KULZER BERNHARD , HERMANNS NORBERT 
Published: June 2023

We analyzed whether daily experience of diabetes distress and affective symptoms, assessed with ecological momentary assessment (EMA) can predict incidence or remission of elevated depressive symptoms in people with type 1 and type 2 diabetes. In the DIA-LINK studies, 203 people with type 1 and 193 people with type 2 diabetes participated. In the 17-day EMA phase, participants completed daily prompts assessing different affective symptoms and diabetes distress. 358 participants completed the CES-Depression questionnaire at baseline and 3 months later. Incidence and remission of elevated depressive symptoms were defined by a cut-off score of 22. Area under receiver operating characteristics curves were used to analyse the predictive performance of EMA variables on incidence and remission of depressive symptoms. Incidence of elevated depressive symptoms was 18.3% while 32.3% showed a remission. Predictive performances of 15 different EMA variables are shown in Table 1. Daily experience of diabetes distress and affective symptoms can predict incidence and remission of elevated depressive symptoms. These variables could be used for designing just-in-time adaptive interventions for preventing elevated depressive symptoms in people with diabetes experiencing daily emotional burden of living with diabetes.

Disclosure
D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. A.J.Schmitt: None. B.Olesen: Advisory Panel; AstraZeneca, Evivamed, Berlin-Chemie AG, Speaker's Bureau; Medtronic, Medtrixx. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG.

Funding
German Center for Diabetes Research (FKZ82DZD1102A)
666-P: How Satisfied Are People with Type 2 Diabetes with a Basal Insulin Titration App? Findings from the Intervention Group of a Randomized Controlled Trial
Authors: EHRMANN DOMINIC , HERMANNS NORBERT , ROOS TIMM , FINKE-GROENE KATHARINA , KULZER BERNHARD 
Published: June 2023

A randomized controlled trial (RCT) was conducted to evaluate the efficacy of the myDoseCoach app, an insulin titration app for basal insulin for people with type 2 diabetes. We asked app users in this study to evaluate the quality of the app via a modified version of the Mobile App Rating Scale (MARS). A total of 120 participants (median age: 60.0 yrs; A1C 8.1%; BMI 31.8 kg/m², diabetes duration 10.0 yrs., 39.0% female) of the intervention arm completed the MARS. Reliability of the 11 item version was high with Cronbach’s α = 0.915. Mean MARS rating was 4.4 (range 1-5), indicating a rather high quality rating. Less than 10% indicated a low quality of the app (rating &lt;3); 10% were indifferent and more that 70% rated the quality of the app as “4” or higher. Figure 1 shows the ratings of the 11 single items. Bivariate correlations showed that neither older age (r=-0.064; p=0.322) nor gender (r=0.102; p=0.180) were significantly associated with the quality rating. The results indicate that the vast majority of the app users evaluated the quality of the App positively with regard to its engagement, functionality, aesthetics, and information quality.

Disclosure
D.Ehrmann: Advisory Panel; Roche Diabetes Care, mySugr, Dexcom, Inc., Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. N.Hermanns: Advisory Panel; Insulet Corporation, Research Support; Sanofi-Aventis Deutschland GmbH, Roche Diagnostics, Becton, Dickinson and Company, Speaker's Bureau; Dexcom, Inc., Berlin-Chemie AG. T.Roos: None. K.Finke-groene: None. B.Kulzer: Advisory Panel; Berlin-Chemie AG, Abbott Diabetes, Bayer Inc., Dexcom, Inc., Novo Nordisk, Insulet Corporation, embecta, Research Support; Sanofi, Roche Diabetes Care.

Funding
Sanofi
67-OR: Examining the Association between Health Care Utilization and Race/Ethnicity in U.S. Adults with Diabetic Kidney Disease—2000–2020
Authors: OZIEH MUKOSO N. , DAWSON APRILL Z. , WILLIAMS JONI S. , EGEDE LEONARD E. 
Published: June 2023

Background: No recent national estimates have examined overall trends in health care utilization in adults with diabetic kidney disease (DKD) or the association between DKD health care utilization and race/ethnicity. This study sought to fill this current gap in knowledge.
Methods: Medical Expenditure Panel Survey data (2000-2020) for adults with DKD was used for this analysis. The dependent variable was total health care utilization for the calendar year for each individual including office-based medical provider, hospital outpatient, emergency room, inpatient hospital, pharmacy, dental, and home health care visits. The primary independent variable was race/ethnicity. Mean health care utilization by DKD status was estimated and negative binominal regression was used to estimate Incident Rate Ratios (IRR) for health care utilization while adjusting for demographics, comorbidities, and time. Stata version 17 was used with a significant p-value set at &lt;0.05.
Results: After full adjustments, African American (IRR 1.20 95% CI 1.09 - 1.31) and Hispanic (IRR 1.15 95% CI 1.04 - 1.28) adults with DKD had significantly higher rates of total health care utilization compared with Whites. In addition, African American adults with DKD had significantly higher rates of office visits (IRR 1.10 95% CI 1.01 - 1.20) and outpatient visits (IRR 1.41 95% CI 1.14 - 1.75) compared with Whites and lower rates of dental care visits (IRR 0.74 95% CI 0.61 - 0.89) and prescription utilization (IRR 0.83 95% CI 0.78 - 0.88) compared with Whites with DKD. Further, over time adults with DKD had higher mean total health care visits (17.0 - 23.6) compared with 8.8-10.4 visits in adults without DKD.
Conclusions: Our findings show that compared with individuals without DKD, individuals with DKD had significantly higher health care utilization from 2000 to 2020 and racial differences in health care utilization exists and persists over this period.

Disclosure
M.N.Ozieh: None. A.Z.Dawson: None. J.S.Williams: None. L.E.Egede: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R21DK131356 to M.N.O.), (R01DK118038, R01DK120861 to L.E.E.); National Institute on Minority Health and Health Disparities (K23MD016448 to M.N.O), (R01MD013826 to L.E.E.)
671-P: Obesity in African Immigrants Is Associated with Body Size Dissatisfaction and Poor Cardiometabolic Health
Authors: HURSTON JAMAIICA , SHOUP ELYSSA , DE DIEU GATETE JEAN , SCHENK BLAYNE R. , MABUNDO LILIAN , DUBOSE CHRISTOPHER , JAGANNATHAN RAM , HORLYCK-ROMANOVSKY MARGRETHE F. , SUMNER ANNE E. , WORTHY CHARLITA C. 
Published: June 2023

In African immigrants, the relationship between obesity and body size dissatisfaction and cardiometabolic health is unknown. Hence, we assessed body size dissatisfaction and cardiometabolic health in 352 African-born Blacks living in the Washington DC area (female: 39% (137/352) age 40±11y (mean±SD)). Using the Stunkard Figure Rating Scale, participants ranked their perceived body size and wish body size. Body size dissatisfaction was defined as the difference between perceived and wish body size. Adverse cardiometabolic health was determined by the presence of type 2 diabetes (T2D) or elevated BP (BP≥120/80) or elevated non-HDL cholesterol levels. Obesity prevalence was 27% (94/352) and higher in women than men (38% (52/137) vs 20% (42/215) P&lt;0.01). Body size dissatisfaction was also higher in women than men (83% vs 69% P&lt;0.01). However, among participants with obesity there was no sex difference in body size dissatisfaction (94% vs 91% P=0.49). Persons with obesity judged themselves to be: Too Large (92%) Just Right (7%) or Too Small (1%) (Figure). Obesity was associated with a higher prevalence of T2D (14% vs 5% P&lt;0.01) elevated BP (51% vs 41% P=0.02) and higher non-HDL cholesterol (121±34 vs 113±33 mg/dL P=0.06). Obesity is viewed negatively by African immigrants and is associated with poor cardiometabolic health.

Disclosure
J.Hurston: None. C.C.Worthy: None. E.Shoup: None. J.Gatete: None. B.R.Schenk: None. L.Mabundo: None. C.Dubose: None. R.Jagannathan: None. M.F.Horlyck-romanovsky: None. A.E.Sumner: None.
674-P: Barriers to Healthy Lifestyle Behaviors among Adolescents with Comorbid Type 1 Diabetes and Overweight/Obesity
Authors: WARNICK JENNIFER , DARLING KATHERINE , SWARTZ TOPOR LISA , JELALIAN ELISSA 
Published: June 2023

Introduction: Comorbid obesity and type 1 diabetes (T1D) were previously rare, but the prevalence of overweight/obesity among youth with T1D now exceeds that of youth in the general population, significantly increasing cardiovascular risk. While the ADA recommends lifestyle modifications for youth with T1D and elevated cardiovascular risk, uptake is limited. The study purpose was to identify barriers to healthy lifestyle behavior engagement and T1D management concurrently.
Methods: Adolescents with comorbid T1D and BMI≥85th percentile (n=12; M(SD) age=15(1.2) years, 58% female) and their caregivers (n=12; 67% female) participated in individual interviews concerning adolescents’ engagement in healthy lifestyle behaviors and T1D management. Caregivers completed a demographics questionnaire, and adolescents completed the Barriers to Diabetes Adherence (BDA) measure. Interviews were transcribed verbatim, and two coders independently analyzed the data using thematic analysis. Coders came to 100% agreement on all codes.
Results: During interviews, 83% of adolescents reported wanting to change their weight/body shape. Three themes emerged from the interviews: (1) Discomfort with aspects of T1D management that draw attention to themselves and their illness; (2) Barriers to setting up environments that encourage healthy behaviors; and (3) Physiological dysregulation (i.e., aspects of T1D management that disrupt internal signals like hunger and sleep). Adolescents rated time (25%) and social support (16.7%) as the primary barriers to T1D adherence on the BDA.
Conclusions: Adolescents with T1D and overweight/obesity experience common barriers to healthy living that are exacerbated by environmental challenges and T1D management requirements. Specific recommendations on how to manage healthy living, weight/shape, and T1D concurrently are needed. Results will inform the design of a healthy lifestyles program specific to adolescents with T1D.

Disclosure
J.Warnick: None. K.Darling: None. L.Swartz topor: None. E.Jelalian: None.

Funding
National Institutes of Health (T32HL076134)
68-OR: Digital Divide and Medicare Diabetes Prevention Program of Beneficiaries with Elevated BMI
Authors: PENG NG BOON , LAMANNA JACQUELINE B. , MASSEY MCKAYLA , HAWKINS GEORGIANNE T. , PARK CHANHYUN 
Published: June 2023

The Medicare Diabetes Prevention Program (MDPP) encourages beneficiaries with prediabetes to build healthy lifestyle behaviors that reduce the risk of diabetes. Limited supply of in-person MDPP and telehealth growth, support virtual delivery of MDPP. Success of virtual MDPP is impacted by access to digital devices and the Internet. A survey-weighted multinomial logit model was performed to examine associations between socio-demographics, comorbidities, and computer access and internet usage among beneficiaries. Using the 2020 nationally representative Medicare Current Beneficiary Survey PUF, a three-level categorical dependent variable was created: (1) has a computer AND uses internet, (2) has a computer OR uses internet, and (3) has no access to either (reference group). Of beneficiaries reporting BMI ≥ 25 kg/m2 and no diabetes history (n=3,912), 70.6% had a computer AND used internet; 14.2% had a computer OR used internet; and 15.2% lacked a computer and did not use internet. Hispanics, Non-Hispanic Blacks (NHB), and Others were less likely to have a computer AND use internet than non-Hispanic Whites (NHB, OR=0.27; p&lt;0.001). Beneficiaries with lower educational attainment (&lt;high school (HS) and HS) were less likely to have a computer AND use internet (&lt;HS, OR=0.04; p&lt;0.001) or have a computer OR use internet (&lt;HS, OR=0.21; p&lt;0.001) than those with college education. Beneficiaries with lower incomes (&lt;$25,000) were less likely to have a computer AND use internet (OR=0.24; p&lt;0.001) or have a computer OR use internet (OR=0.58; p&lt;0.001) than those with higher incomes. This study found that ~30% of beneficiaries likely eligible for MDPP (potentially representing 6 million beneficiaries) lack digital tools for virtual MDPP. Digital divides by race/ethnicity, income, and education were observed. Efforts to improve access and enrollment in MDPP using virtual delivery must consider digital access to avoid technological disparities among populations with heightened type 2 diabetes risk.

Disclosure
B.Ng: None. J.B.Lamanna: None. M.Massey: None. G.T.Hawkins: None. C.Park: None.
683-P: Lived Experiences of Using Omnipod DASH System among Australians with Type 1 Diabetes—A Qualitative Study
Authors: STOCCO AMBER P. , TRAWLEY STEVEN , KONG YEE W. , YI YUAN CHENG , KIBURG KATERINA V. , BROWN KATRIN , PARTOVI ANDISHEH , ROEM KERRYN L. , HARRISON NATALIE , FOURLANOS SPIROS , EKINCI ELIF I. , O'NEAL DAVID N. 
Published: June 2023

Background: Tubeless insulin pump therapy (IPT) offers an alternative to tubed insulin pumps and multi-dose injections (MDI) for people with type 1 diabetes (T1D). No formal interview studies have explored individual's lived experiences of using tubeless IPT.
Aim: To gain insight into the lived experience of using a tubeless IPT system compared to usual tubed IPT or MDI care.
Methods: Interviews were conducted 12-weeks after using an Omnipod DASH® Insulin Management System (Insulet, Acton MA) in a randomised controlled trial. The interview transcripts were subject to a thematic analysis, a method for identifying patterned meaning across datasets.
Results: Thirty-six adults (24 female; age 43±14 years; 21 previous MDI) were interviewed. Overall experiences of the Omnipod DASH were encompassed by 3 major themes: 1. Taking back control of my diabetes: many previous MDI users perceived improvement in glycaemic control, explained by more accurate insulin dosing, with some reporting positive effects during exercise and sleep. 2. Taking back control of the narrative: many previous MDI and IPT users endorsed positive experiences in relation to concealing or disclosing their diabetes to others (“you can hide it if you want to, you can let it be seen if you want to”). However, some previous MDI users reported negative psychosocial experiences due to the visibility of their diabetes and continuous device attachment (“…it's always there, whereas with the needles, you just set and forget”). 3. Barriers affecting long-term use: many participants reported wearability issues, alarm issues and the financial burden of the device. However, the majority indicated they would use and recommend tubeless IPT to others with T1D.
Conclusion: Perceptions regarding tubeless IPT were related to individual needs and lifestyle, with previous treatment experience playing an important role. This work highlights the importance of understanding lived experience for future device development.

Disclosure
A.P.Stocco: None. S.Fourlanos: Advisory Panel; Viatris Inc., Pfizer Inc., Speaker's Bureau; Novo Nordisk, AstraZeneca, Boehringer Ingelheim and Eli Lilly Alliance. E.I.Ekinci: Advisory Panel; Eli Lilly Australia Pty Limited, Research Support; Eli Lilly Australia Pty Limited, Novo Nordisk, Boehringer Ingelheim and Eli Lilly Alliance, Insulet Corporation, Medtronic. D.N.O'neal: None. S.Trawley: Research Support; Insulet Corporation, Juvenile Diabetes Research Foundation (JDRF). Y.W.Kong: None. C.Yuan: None. K.V.Kiburg: None. K.Brown: None. A.Partovi: None. K.L.Roem: None. N.Harrison: None.
685-P: Possibility of Oral Glucose Tolerance Test Clearance in Patients with Type 2 Diabetes Who Underwent Complete Diabetes Remission
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , VYAWAHARE ANAGHA R. , SHARMA BABY , GANLA MALHAR H. , DAS BISWAS MAYURIKA , SABOO BANSHI D. 
Published: June 2023

Background and Aim­: Type 2 diabetes (T2D) remission through calorie and carbohydrate restriction has been reported. We conducted a pilot trial to observe whether oral Glucose tolerance test (OGTT) clearance is possible in T2D patients who underwent remission through a lifestyle modification program.
Methods: A total of 3689 patients who had previously undergone remission through our lifestyle modification program at Freedom from Diabetes Clinic, India, were asked to enroll for the OGTT; 1121 accepted the invitation and enrolled (June 2022). Remission was defined as HbA1c&lt;48mmol/mol for a minimum of three months without glucose-lowering medication. Of 1121, 400 participants completed a 3-month training (where foods with increasing glycemic load were introduced every week while monitoring the blood sugar levels (BSL)). Subsequently, they appeared for OGTT (75g) from October-November 2022.
Results: Of the 400 participants, 207 (51.7%) cleared OGTT [Fasting BSL(FBSL)≤100, 2-hrs postprandial (PP2) &lt;140], 175 (43.7%) cleared IGT-Impaired Glucose Tolerance (FBSL&lt;126, PP2&lt;200), while 18 (4.5%) did not clear. The median BMI at the time of appearing for OGTT was 22.8 kg/m2. Those clearing OGTT had significantly higher weight loss during the program than those clearing IGT (10 kg vs 6.4 kg) and had a shorter duration of diabetes (5 years vs 6.9 years) (p&lt;0.05). Medication status at the start of the intervention (OHA, Insulin, both, and no medication) did not affect the possibility of clearing OGTT (p&gt;0.1).
Conclusion: Complete remission of type 2 diabetes to the point of achieving a nondiabetes glycemic profile irrespective of initial medication status is possible through lifestyle intervention if weight loss is achieved and maintained. The long-term sustainability of lifestyle interventions in achieving remission needs to be explored through a larger cohort study with a control group.

Disclosure
P. Tripathi: Board Member; Freedom from Diabetes Clinic. N.S. Kadam: Research Support; Freedom from Diabetes Clinic. A.R. Vyawahare: Research Support; Freedom From Diabetes. B. Sharma: Research Support; Freedom From Diabetes clinic. M.H. Ganla: Employee; Freedom from Diabetes Clinic. M. Das Biswas: Employee; Freedom from Diabetes Clinic. B.D. Saboo: None.
688-P: Severity of Type 2 Diabetes and the Risk of Depression—A Nationwide Population-Based Study
Authors: CHO YUNJUNG , HAN KYUNGDO , JO KWANHOON , MOON SUNGDAE , HAN JEHO , SOOK KIM EUN 
Published: June 2023

Background: Because of a bidirectional relationship between type 2 diabetes mellitus (T2DM) and depression, we aimed to investigate the association of the severity of diabetes with the risk of depression.
Methods: Total 2,067,017 adults who diagnosis with T2DM excluding those diagnosed with depression before were identified from a nationwide population-based cohort in Korea. Diabetes mellitus (DM) severity scores consisted of insulin user, DM duration more than 5 years, using 3 or more oral hypoglycemic agents, and diagnosed with DM complications including chronic kidney disease, myocardial infarction, stroke, and diabetes retinopathy. DM severity scores were calculated as 0 to 6.
Results: As the DM severity score was increased, the frequency of depression was significantly increased, and the follow up period until the diagnosed with depression was significantly decreased. This tendency of increasing depression incidence was also significant in each components constituting the DM severity score.
Conclusion: An increase in the severity of diabetes, represented by duration of diabetes, insulin or multi-drug use, and presence of major complications of diabetes, was associated with higher risk of depression. Physicians should carefully monitor whether depression develops in patients with uncontrolled diabetes in order to improve quality of life and achieve glycemic control goals.

Disclosure
Y.Cho: None. K.Han: None. K.Jo: None. S.Moon: None. J.Han: None. E.Kim: None.