bluuebunny/crossref_metadata_2025_split huggingface dataset:
1130-P: Language and Ethnicity in the Experience of Social Determinants of Health in Pediatric Type 1 Diabetes
Authors: ADDALA ANANTA , MEDINA PENARANDA RICARDO , HANES SARAH , SHAW GARY M. , CHAMBERLAIN LISA , NARANJO DIANA , RAYMOND JENNIFER , MAAHS DAVID M. , HOOD KOREY K. 
Published: June 2023

Social determinants of health (SDOH) are recognized as drivers of health outcomes. In this pilot study, we explored SDOH in parents/guardians (PG) of youth with type 1 diabetes (T1D) and public insurance for differences across preferred language and ethnicity.
PG of youth &lt;12 years with T1D and public insurance were recruited to complete nine validated surveys in English or Spanish measuring perceived discrimination, childhood trauma, technology acceptance, and mental health. PG and child characteristics were gathered via self-report. Descriptive differences in survey responses were evaluated by three language and ethnicity groups: non-Hispanic English preferred (NHE), Hispanic English preferred (HE), and Hispanic Spanish preferred (HS).
We recruited 28 PG (37±7 yrs, youth 8±2 yrs, 68% Hispanic, 54% Spanish preferred, 71% with income &lt;$50K). Most children use sensors (93%) and, less frequently, pumps (54%). Compared to NHE and HS, HE PG score higher on discrimination scales, had lower technology acceptance, and poorer mental health (Table). Interestingly adverse childhood experiences were highest in the NHE group.
Language may play a role in the experience of discrimination, technology acceptance, and mental health for Hispanic PG. Although only two surveys were statistically significant, mean survey differences between the groups are clinically meaningful and warrant further investigation.

Disclosure
A.Addala: None. R.Medina penaranda: None. S.Hanes: None. G.M.Shaw: None. L.Chamberlain: None. D.Naranjo: None. J.Raymond: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. K.K.Hood: Consultant; Cecelia Health.

Funding
Maternal & Child Health Research Institute; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK13134201)
1133-P: Body Mass Index Trajectories in Youth with Type 1 Diabetes
Authors: GANTA AVANI , HAS PHINNARA , WARNICK JENNIFER , SWARTZ TOPOR LISA 
Published: June 2023

Background: About 35% of youth in Rhode Island (RI) meet criteria for overweight/obesity (OW/OB). Though previously rare, rates of OW/OB in youth with T1D are reportedly increasing.
Objective: To examine BMI trajectories of youth with T1D in RI from initial diagnosis over 5 years. We hypothesized that BMI would increase after diagnosis, continue to rise over time, and be similar to the general population.
Methods: A retrospective chart review was conducted. Youth ≥5 years old with new onset T1D diagnosed in 2015-2016, followed at least annually for 5 years were included. Linear growth curve models specifying visit date as a random effect were used to assess BMI percentiles and z-scores across time. P&lt;0.05 were considered significant.
Results: Subjects (n=76) were 57.9% male; mean (SD) age at T1D diagnosis=11 (2.9) years. At initial outpatient visit 35.5% had OW/OB, with M:F ratio of 1.4:1. By 2021, 53% had OW/OB, with equal M:F distribution. More males were observed to have obesity in 2021. Mean BMI percentile and z-score per subject per year increased gradually over time (p &lt;0.001).
Conclusion: Youth with T1D in RI experienced a steady increase in BMI over time and within 5 years of T1D diagnosis. Males were more likely to have obesity 5 years after diagnosis. The combination of T1D with OW/OB compounds the risks for metabolic syndrome. Targeted interventions to address OW/OB in these youths are needed, as are further studies of glycemic trajectory and clinical course.

Disclosure
A.Ganta: None. P.Has: None. J.Warnick: None. L.Swartz topor: None.
1134-P: Determination of Glucose-Independent Racial Disparity in HbA1c in Youth with Type 1 Diabetes in the Era of Continuous Glucose Monitoring
Authors: CHRISTAKIS NICHOLAS J. , FELIPE DANIA , GOMEZ RICARDO , CHALEW STUART 
Published: June 2023

Introduction: The extent and importance of higher HbA1c levels not due to mean blood glucose (MBG) in non-Hispanic Black (B) versus non-Hispanic White (W) individuals is controversial. We sought to clarify the relationship of HbA1c with metrics of glycemia derived from continuous glucose monitoring (CGM) in a young biracial population.
Methods: Glycemic data of 33 B and 85 W, otherwise healthy youth with type 1 diabetes (age 14.7±4.8 years, M/F=51/67, duration of diabetes 5.4±4.7 years) was derived from a factory calibrated CGM and compared with assayed HbA1c. Hemoglobin glycation index (HGI) a metric of MBG difference in HbA1c not due to MBG =assayed HbA1c - Glucose Management Index (GMI).
Results: B patients had higher unadjusted levels of HbA1c, MBG, MBGSD, GMI and HGI than W patients. Percent glucose time in range (TIR) and percent sensor use (PSU) were lower for B patients. HbA1c remained higher in B patients (8.6%) versus (7.7%) for W (p&lt;0.0001) after statistical adjustment for MBG, MBGSD, age, gender, insulin delivery method and PSU. MBG and race accounted for 80% of the variation in HbA1c in the model. Results were similar when TIR was substituted for MBG (R2=0.64, p&lt;0.0001). The 95% for HGI=0.47% in W patients, 52% of B patients had HGI ≥0.5%. Percent time below range was similar for both groups.
Conclusions: Young B patients have clinically relevant higher HbA1c (~0.9%) at any given level of MBG or TIR than W patients, which may pose an additional risk for diabetes complications. HGI ≥0.5% may be an easy way to identify high risk patients.

Disclosure
N.J.Christakis: None. D.Felipe: None. R.Gomez: None. S.Chalew: Advisory Panel; Medtronic.

Funding
National Institutes of Health (1R21DK118643-01A1, U54GM104940)
114-OR: Genetic Variants in GIPR and Effects of Dietary Carbohydrate Quantity and Quality on Glycemic Responses to an Oral Glucose Load—The OmniCarb Trial
Authors: HEIANZA YORIKO , WANG XUAN , XUE QIAOCHU , APPEL LAWRENCE J. , SACKS FRANK , QI LU 
Published: June 2023

The gut incretin hormone, glucose-dependent insulinotropic polypeptide (GIP), may play a pivotal role in mediating adverse effects of high glycemic index (GI) foods on metabolic diseases. GIP exerts its effects by binding to a receptor, GIPR; genome-wide association studies have identified variants in the GIPR region related to type 2 diabetes (T2D) and glycemic/GIP responses to glucose tolerance tests. We examined whether GIPR variants were related to impaired glycemic responses during oral glucose tolerance tests (OGTTs) after consuming 4 diets (each for 5 weeks) with different carbohydrate (Carb) content and GI levels in the OmniCarb randomized crossover feeding trial. A genetic risk score (GRS) was calculated by counting T2D-risk alleles of SNPs rs1800437, rs11671664, and rs2238689 at GIPR (n=146). We found that GRS was related to greater glycemic responses after consuming a high GI/high Carb diet, regardless of baseline glycemic status (Fig). When testing diet replacement effects, combined effects of high GI and high Carb (vs. low GI/low Carb) on glycemic responses were significantly modified by GRS (Pinteraction&lt;0.05). In conclusion, T2D-risk-related GIPR variants modified the effects of dietary carbohydrates on glucose tolerance. GIPR variants may be related to deteriorating glucose tolerance after eating a high GI, high Carb diet.

Disclosure
Y.Heianza: None. X.Wang: None. Q.Xue: None. L.J.Appel: None. F.Sacks: None. L.Qi: None.

Funding
National Institutes of Health (2P20GM109036-06A1-7233, DK091718, DK100383, DK115679)
1141-P: Characterizing Clinical Characteristics of 6q24-Related Transient Neonatal Diabetes
Authors: MCCULLOUGH MICHAEL , LETOURNEAU-FREIBERG LISA R. , BOWDEN TIANA L. , KANDASAMY BALAMURUGAN , DEL GAUDIO DANIELA , PHILIPSON LOUIS H. , GREELEY SIRI ATMA W. 
Published: June 2023

Introduction: Transient neonatal diabetes mellitus (TNDM) is a heterogeneous subtype of neonatal diabetes that usually presents within the first days or weeks of life, spontaneously remits in infancy, but can recur in childhood or adolescence as a permanent form of diabetes. Approximately 70% of TNDM cases are due to overexpression of genes at chromosome 6q24 caused by one of three potential mechanisms: uniparental disomy (UPD6), paternal duplication, or hypomethylation of the maternal allele. Our aim was to further elucidate clinical characteristics of a relatively large group of individuals with this rare condition.
Methods: Participants with a confirmed or suspected diagnosis of 6q24 TNDM were identified through the University of Chicago Monogenic Diabetes Registry. Research based genetic testing was provided. Clinical information was extracted from survey responses and medical records.
Results: There were thirty-three participants with 6q24-TNDM (58% male). Eight (24%) had hypomethylation of the maternal allele, seven (21%) had paternal duplication, seventeen (52%) had UPD6, and one had UPD6 vs. hypomethylation of the maternal allele. The mean age of initial diabetes presentation was 4.6 days (n=33). Remission occurred at a mean age of 4.5 months (n=28). Nine participants reported having relapse of diabetes, with a mean age of relapse of 17.4 years (range 12 - 31 years). There were six participants who reported umbilical hernia (22%, n=27), fifteen participants reported macroglossia (54%, n=27), and ten (36%, n=28) indicated speech therapy was required. No significant differences in clinical characteristics were identified across the three mechanisms (UPD6, paternal duplication, hypomethylation).
Conclusions: Clinical characteristics were not different across mechanism groups, suggesting that genetic testing is required to definitively determine a mechanism and diagnosis of 6q24 TNDM. Early assessment for speech therapy should be considered for this patient population.

Disclosure
M.Mccullough: None. L.R.Letourneau-freiberg: None. T.L.Bowden: Stock/Shareholder; Procter & Gamble, OPKO Biologics, Ltd. B.Kandasamy: None. D.Del gaudio: None. L.H.Philipson: Advisory Panel; Nevro Corp., Research Support; Novo Nordisk, Dompé, Provention Bio, Inc., Imcyse, Novo Nordisk Foundation. S.W.Greeley: None.

Funding
National Institutes of Health (R01DK104942, P30DK020595)
1146-P: Changes in Parent/Guardian and Youth Patient Reported Outcomes (PROs) after T1D Diagnosis for Families in the 4T Study 1
Authors: ALAMARIE SELMA A. , PANG ERICA , CORTES-NAVARRO ANA L. , ARRIZON-RUIZ NORA , BALISTRERI ILENIA , LOYOLA ALONDRA , SCHNEIDER-UTAKA AIKA , RITTER VICTOR , SHAW BLAKE , BISHOP FRANZISKA K. , ZAHARIEVA DESSI P. , PRAHALAD PRIYA , DESAI MANISHA , MAAHS DAVID M. , HOOD KOREY K. , ADDALA ANANTA 
Published: June 2023

The 4T Study 1 is a clinical pragmatic research trial that starts continuous glucose monitoring (CGM) within 30 days of T1D diagnosis and monitors PROs. We report the longitudinal relationship of PROs between newly diagnosed youth and parents/guardians (PG). PROs surveys were administered to youth and PG at baseline, 3, and 6 months. PG PROs included the 20-item parent Diabetes Distress Scale (DDS-P) and youth PROs were the 2-item Diabetes Distress Scale (DDS-2) and the 7-item PROMIS Pediatric Global Health Scale (PGH-7). Pearson correlations evaluated the relationship between scores on the PG and youth PROs. Youth (n=60 who were aged ≥11 years) with new onset T1D and their PG (n=125) were eligible to complete PROs, yet response rates varied (at baseline, 3-, 6-months: Youth 59%, 53%, and 50% vs PG 74%, 70%, and 66%). Correlations showed that PG diabetes distress was positively correlated with child diabetes distress at baseline (r=0.48, p=0.003) and at 3 months (r= 0.35, p=0.058). However, by 6 months, this association decreased in strength and significance (r=0.16, p=0.42). Youth global health was inversely correlated with PG diabetes distress at baseline (r=-0.36, p=0.029) and 3 months (r=-0.53, p=0.002) and this correlation was not significant at 6 months (r =-0.049, p=0.81). These data suggest that the relationship between PG diabetes distress and youth psychosocial states are dynamic. PG and youth psychosocial states are strongly associated after diagnosis and decrease over time. Utilization of CGM, age, T1D duration, response rate, and changes in the PG-youth relationship (such as decreased adult involvement or increased independence of youth) may contribute to our findings. Further investigation of longitudinal relationships between PG and youth PROs may provide additional insight into PG and youth psychosocial states and diabetes outcomes and indicate optimal timing for assessment and treatment referral.

Disclosure
S.A.Alamarie: None. F.K.Bishop: None. D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. P.Prahalad: None. M.Desai: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. K.K.Hood: Consultant; Cecelia Health. A.Addala: None. E.Pang: None. A.L.Cortes-navarro: None. N.Arrizon-ruiz: None. I.Balistreri: None. A.Loyola: None. A.Schneider-utaka: None. V.Ritter: None. B.Shaw: None.

Funding
National Institutes of Health (R18DK122422)
1149-P: Health Literacy and Numeracy Based on The Newest Vital Sign Is Not Associated with Hemoglobin A1c in Caretakers or Youth with Type 1 Diabetes
Authors: SANCRAINTE LEANNE , SHAH AMY S. , BOWERS KATHERINE A. , LEYENDECKER ANASTASIA C. , YAYAH JONES NANA-HAWA 
Published: June 2023

Management of type 1 diabetes (T1D) requires the ability to perform, process, and understand the clinical importance of mathematical calculations to correctly dose insulin. This degree of comprehension is the backbone of health literacy and numeracy (HLN). The Newest Vital Sign (NVS) is a valid and reliable tool to assess HLN in a clinic setting. Few studies have evaluated the NVS in youth living with T1D and its relationship to glycemic control. We hypothesized lower HLN in caretakers and patients would be associated with higher HbA1c among youth with T1D.
A cross sectional study was conducted to assess the degree of HLN in caretakers (for patient ages 6-18 years) and adolescent patients (ages 13-18 years) living with T1D. The NVS consists of 6 questions based on a fictitious nutrition label from an ice cream container. Total scores reflect probable level of HLN (0-1 likely limited; 2-3 possibly limited; 4-6 adequate literacy).
Data from 44 adult caretakers and 23 patients living with T1D was collected. Mean±SD HbA1c for youth was 8.0±1.8% (range 5.4-12.8%). Of the 44 caretakers, 42 (95.5%) scored 4-6, indicating adequate HLN, and 0 caretakers scored 0-1 points. Of 23 adolescent patients with T1D, 16 (69.5%) had adequate HLN, with 5 (21.7%) scoring 2-3, and 1 (4.3%) scoring only 1 point: high likelihood of low HLN. Youths’ HLN scores increased with age with the lowest HLN score of 1 in a patient that was 13.08 years. Mean age of those scoring 2-3 was 15.3 years and those scoring &gt;4 was 16.5 years. HbA1c levels did not correlate with HLN scores in either caretakers or patients.
In caretakers of youth living with T1D, the NVS was unable to capture variations in HLN, possibly because this tool is based on a nutrition label which underlies all diabetes education. Given the importance of HLN in diabetes care, future work is needed to identify the best tool to assess HLN in those providing and receiving care for T1D.

Disclosure
L.Sancrainte: None. A.S.Shah: None. K.A.Bowers: None. A.C.Leyendecker: None. N.Yayah jones: Consultant; Medtronic.
115-OR: Improving Glycemic Outcomes through Virtual Diabetes Self-Management Education Pathway
Authors: SOLIMAN ELIGIO DAVID P. 
Published: June 2023

The purpose of this quality improvement project was to implement and evaluate if a virtual diabetes self-management education (DSME) pathway is a cost-effective intervention in improving glycemic control for adult patients with type 2 diabetes (T2D). A one group pre and post-test design was utilized. Total of 41 participants completed the 4-week diabetes self-management pathway. The virtual curriculum integrated spaced education through a mobile health app called Calcium©. Primary outcome measure was change in HbA1c levels three months after intervention. Wilcoxon signed-rank test was used to analyze the difference before and after the DSME intervention. There was a 1.6% mean reduction of HbA1c levels (P=&lt;0.001). There was also statistically significant improvement of other metabolic markers including blood sugar averages, body weight, BMI and systolic blood pressure (P=&lt;0.005). Mean comparison of HbA1c shows that those who significantly utilized the virtual pathway were found to have greater improvement in glycemic control (-2.55% vs -0.43%). This quality improvement project implemented evidence-based interventions to improve patient outcomes, lower healthcare cost and hopefully influence health care policy. Moving this body of knowledge forward with attention to developing and implementing DSME initiatives and exploring novel practice models open doors for building this body of evidence further.

Disclosure
E.P.Soliman: None.
1152-P: COVID-19 Vaccination Status and Attitudes of Adolescents with T1D and Their Caregivers
Authors: OKONKWO NKEMJIKA , JASER SARAH S. 
Published: June 2023

People with type 1 diabetes (T1D) have an increased risk for adverse COVID-19 outcomes, but few studies have explored the current rates of vaccination in families of youth with T1D. We examined the vaccination status and attitudes toward the vaccine in this high-risk population. We conducted semi-structured interviews with adolescents with T1D (n=12; mean age =14.2 ± 5.9 years; 25% female; 75% non-Hispanic White; mean HbA1c =9.2± 1.9%) and maternal caregivers (n=19; mean age =42.9 ± 5.9 years) participating in an ongoing clinical trial in the Southeastern United States. Interviews were conducted from May-November 2022, after vaccine approval for children ≥5 years. Participants were asked how COVID-19 affected diabetes management, including an optional question about their household's vaccination status. Interviews were transcribed and coded, establishing inter-reliability (κ=.78). The vaccination question was answered by 71% of adolescents and 95% of caregivers. More than half of adolescents (58%) reported being unvaccinated, with many not viewing the vaccine as an immediate necessity. Most inoculated teens (60%) reported getting vaccinated because of parental influence. Among caregivers, 32% reported being unvaccinated. They cited the vaccine's novelty and limited data on long-term side effects, particularly for those with T1D, as reasons for their hesitancy. Many also doubted their child's risk for adverse outcomes, so they did not see the vaccine as crucial. Most immunized caregivers (62%) recalled receiving the vaccine within a few months after its approval. They reported having faith in the vaccine's effectiveness, especially when encouraged by medical professionals, as motivation for getting vaccinated. Our findings highlight the persistently low vaccination rates among youth with T1D and the importance of caregivers’ trust and buy-in. These results indicate the need for focused education and public health messaging to promote vaccination in families of children with T1D.

Disclosure
N.Okonkwo: None. S.S.Jaser: None.

Funding
National Institutes of Health (1R01DK115545-S1)
1155-P: Seasonal Impact on Sleep and Glycemia in Adolescents with Type 1 Diabetes
Authors: FIVEKILLER EMILY , SAKAMOTO CASEY , KARAMI ANGELA J. , MELTZER LISA J. , PYLE LAURA , COBRY ERIN C. 
Published: June 2023

Sleep is a key component in health maintenance. Adolescents often struggle to obtain sufficient sleep, and those with T1D are at increased risk for diabetes-related sleep disruptions and shorter sleep duration. We sought to examine sleep quality and glycemic outcomes between youth aged 11-17 with T1D, comparing summer (free schedule) and fall (school schedule). Twenty youth (mean 13.8 yrs, 65% female, 90% Non-Hispanic White), ten each during summer and fall, participated in an observational study. Participants were age matched due to sleep recommendation variations. Actigraphy data (sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset) and glycemic data from CGM (TIR, time hyperglycemic (&gt;180mg/dL), time hypoglycemic (&lt;70mg/dL)) were collected simultaneously for one week. No significant differences were found between summer and fall participants for demographics or sleep outcomes. Statistically significant differences were found for time hypoglycemic (p=0.034) and mean sensor glucose (p=0.021) and clinically notable differences were seen with higher TIR and lower hyperglycemia during summer. This study highlights that insufficient sleep is obtained in adolescents with T1D, regardless of season, and seasonal differences appear to exist in glycemic measures. Further research is needed to elucidate the extent of these differences and methods to improve both sleep and glycemia throughout the year.

Disclosure
E.Fivekiller: None. C.Sakamoto: None. A.J.Karami: None. L.J.Meltzer: Consultant; Egetis Therapeutics, Harmony Biosciences. L.Pyle: None. E.C.Cobry: None.

Funding
JDRF (5-ECR-2022-1179-A-N to E.C.C.)
1156-P: Diabetes Technology in the Pediatric Inpatient Setting
Authors: RAJAGOPAL NITYA , BAILEY ABBY , NGO CHLOE , HENDRIX-DICKEN AMY D. , MERCER SHELLY , CONDREN MICHELLE 
Published: June 2023

Introduction: Continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGMs) improve glycemic control and quality of life for children with diabetes. This study assessed the existence and content of pediatric inpatient diabetes technology policies in U.S. hospitals.
Methods: A cross-sectional survey was distributed to the Pediatric Pharmacy Association listserv. The survey had multiple-choice and open-ended items related to hospital practices on insulin pump and CGM use in the pediatric inpatient setting.
Results: Only 17 of the 31 responding hospitals (54.8%) allowed CGM use in the pediatric inpatient setting with 13 (76.5%) of those having written CGM policies. Primary barriers to allowing CGM use were lack of policy (n=11, 78.6%), limited policy knowledge (n=9, 64.3%), and lack of EMR integration (n=6, 42.9%). Most hospitals reported not utilizing CGM high and low blood sugar alarms (n=10, 58.8%). Hospitals typically used finger stick blood glucose testing while patients used a CGM (n=13, 76.5%).
More hospitals (n=29, 93.5%) reported an option for insulin pump use in the pediatric inpatient setting with 96.6% (n=28) having a written policy. Overall, hospitals’ reported policies did not differ for pump use in children admitted for diabetes complications versus nondiabetes diagnoses (n=24, 85.7%). Less than half had specific policies for suspected pump site failure (n=13, 46.4%). Verification of pump doses varied greatly with hospitals reporting nursing verification (n=17, 58.6%), patient report (n=10, 34.5%) and no verification policy (n=2, 6.9%).
Conclusion: Most hospital respondents had policies for inpatient insulin pump use while fewer had policies allowing CGM use. Best practice standards support having written guidelines to ensure patient safety and to guide the pediatric care team. Policy repositories may be a helpful resource for hospitals that lack written guidelines.

Disclosure
N. Rajagopal: None. A. Bailey: None. C. Ngo: None. A.D. Hendrix-Dicken: Stock/Shareholder; Catalyst Pharmaceuticals, Johnson & Johnson, AstraZeneca. S. Mercer: None. M. Condren: Consultant; Wolters Kluwer Health.