bluuebunny/crossref_metadata_2025_split huggingface dataset:
492-P: Utility of Measures of Nerve Fiber Function and Structure for the Diagnosis of Diabetic Peripheral Neuropathy
Authors: CASELLINI CAROLINA M. , PARSON HENRI , CUSHMAN COURTNY , INGRAM AMBER M. , PETTAWAY JORDAN L. , SEARS TANEISHA , SIRAJ ELIAS S. 
Published: June 2023

Introduction: Identifying diabetic neuropathy (DPN) in the clinic is challenging. The purpose of this study is to investigate the utility of various diagnostic tools for the detection of DPN
Methods: The following measures were assessed in controls and patients with type 2 diabetes with and without DPN: clinical neuropathy scores, quantitative sensory testing, corneal confocal microscopy, and sudomotor function. Receiver operating characteristics and areas under the curve with sensitivity and specificity were calculated
Results: See Table and Figure
Conclusions: Functional measures were more sensitive but less specific than structural ones. Similar to other studies, our study shows that no individual test is reliable per-se. Future studies are needed to investigate the best combination of tests for assessing DPN.

Disclosure
C.M.Casellini: None. H.Parson: None. C.Cushman: None. A.M.Ingram: None. J.L.Pettaway: None. T.Sears: None. E.S.Siraj: Research Support; Novo Nordisk, Speaker's Bureau; Novo Nordisk, Boehringer Ingelheim and Eli Lilly Alliance.
495-P: Comparing Detection of Diabetic Retinopathy by Three Artificial Intelligence Platforms in Subjects Not Known to Have Diabetes
Authors: BUTLER ALEXANDRA E. , KILPATRICK ERIC S. , HUNT STEVEN C. , ATKIN STEPHEN 
Published: June 2023

Background: The glycemic threshold for the diagnosis of type 2 diabetes (T2D) was determined based upon the prevalence of moderate retinopathy; however, diabetes related complications may occur below that threshold. This study utilized three companies to analyse retinal images using their commercial software and returned data on absence or presence of features of any diabetic retinopathy (DR) on a per-eye basis.
Methods: Ophthalmic retinal images from 11,449 subjects (right and left eyes for each, totalling 22,898 images) not known to have diabetes from the Qatar Biobank were subjected to assessment for detection of features of DR using three Conformitè Europëenne (CE)-marked independent commercial Artificial Intelligence (AI) software systems.
Results: From 11,449 patients: •DR was recorded as absent in both eyes in 7,094 (62.0%) patients by all 3 methods (Test Negative at patient level).•DR was detected by 2 or 3 of the AI systems in at least one eye in a total of 2,408 (21.0%) patients (Test Positive at patient level). Of these, in 1,532 (13.4%) cases DR was detected in just one eye of any given patient and in 876 (7.6%) cases DR was detected in both eyes of a patient. •Overall, 1,947 (17.0%) patients had at least one eye reported as unassessable by 2 or 3 of the AI systems; hence, No Overall Result for DR features could be obtained for these patients. Results from the three AI companies differed markedly: 17.7%, 32.9% and 46.6% ranked Test-Positive results at patient level. Only 304 right eyes and 280 left eyes were positive for all 3 companies.
Conclusion: This is the first direct comparison of three independent AI companies when simultaneously assessing retinal images from more than 10,000 individuals. It showed markedly differing prevalences of diabetic retinopathy between existing AI systems, indicating inconsistencies if wishing to apply these tools to detect retinopathy in subjects not already known to have diabetes, and may differ in patients with known diabetes.

Disclosure
A.E.Butler: None. E.S.Kilpatrick: None. S.C.Hunt: None. S.Atkin: None.
497-P: Hypertension Aggravated the Risk of Diabetic Retinopathy over 10 Years
Authors: NAM NGUYEN NHAT , THY KHUE NGUYEN 
Published: June 2023

Background: Diabetic retinopathy (DR) is a sight-threatening complication of diabetes. Hypertension may worsen DR risk due to additional vascular damage. We aimed to investigate whether hypertension could increase the 10-year incidence of DR in type 2 diabetes (T2DM) patients.
Method: We included T2DM individuals who were free of DR at baseline, completed at least one further clinic visit from 1997 to 2008, and followed up for ten years. Patients were categorized into normotension or hypertension based on the clinician’s diagnosis. The retinal photograph was taken annually. The Kaplan-Meier curve was used to estimate the cumulative incidence of DR, stratified by normotensive/hypertensive status. Log-rank test was used to compare the distribution of time until the occurrence of DR in two groups. A p-value &lt;0.05 was considered statistically significant.
Results: After a median follow-up duration of 61 months, cumulative incidences of DR among normotensive and hypertensive participants were 49% (95% CI 36%-60%) and 73% (95% CI 67%-78%), respectively. There was a significant difference in the risk of new-onset DR among groups (p &lt;0.001). The gap between the two Kaplan-Meier curves occurred early in the first year after recruiting (Figure).
Conclusion: Hypertension could further increase the risk of DR among type 2 diabetes patients. An effective strategy of DR screening is recommended for patients coexisting with hypertension.

Disclosure
N.Nguyen: None. N.Khue: None.
504-P: Association between Handgrip Strength and Triglyceride-Glucose Index Based on the Korean National Health and Nutrition Examination Survey
Authors: BAE LEE SANG , MI CHOI YUN , KYUNG KIM MIN 
Published: June 2023

Handgrip strength (HGS) is a simple, reliable method to measure muscle strength and assessing sarcopenia. Insulin resistance (IR) is important contributing factor to cardiovascular disease and also related with sarcopenia. In this study, we investigated the association between IR and muscle strength via the Triglyceride glucose index (TyG) index and HGS. We used data from the sixth Korean National Health and Nutrition Examination Survey to evaluate a total of 10048 subjects aged over 40. The TyG index was calculated as ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2] to represent IR. We defined absolute HGS as sum of the maximum values of the right and left sides of each of the three measurements. The relative HGS was calculated by dividing the absolute HGS by body mass index. The subjects were stratified into quartiles according to the TyG index. Relative HGS was decreased as the TyG index increased in total subjects. In linear regression analysis, relative HGS showed negative correlation with metabolic parameter and the TyG index in all groups of age and gender. According to logistic regression analysis after adjusting for multiple risk factors, odds ratio (95% CI) for low muscle strength (defined as the lower 10% on relative HGS) for the highest and lowest quartiles of the TyG index was 2.513 in male and 2.161 in female on total subjects. In group of subjects with mid-age (age between 40 to 64 years old), the prevalence of low muscle strength was positively correlated with increased the TyG index both in male and female. However, in the elderly groups (age over 65 years old), relationships between the increased the TyG index quartiles and prevalence of low muscle strength were not significant in all subjects. In conclusion, the TyG index was independently associated with relative HGS and low muscle strength in mid-aged subject and could have predictive value for sarcopenia and further metabolic disease.

Disclosure
S.Lee: None. Y.Choi: None. M.Kim: None.
535-P: Identifying and Addressing Educational Needs Regarding the Increased Risk of Complications Due to Influenza Infection in People with Diabetes
Authors: ROBINSON KATIE , CARSON BENJAMIN , SCAVONE JILLIAN L. , FREDERICK JENNIFER , ESGRO ROBERT A. 
Published: June 2023

Rationale: Compared with the general population, patients with diabetes are more likely to develop severe influenza and associated complications. Timely recognition and treatment of high-risk patients can improve patient outcomes, yet morbidity and mortality remain high in this population in part due to low awareness among patients and providers.
Methods: To address this, Vindico provided a comprehensive continuing education (CE) expert panel and e-monograph targeted to primary care providers (PCPs) who treat diabetes. Baseline knowledge and practice patterns as well as educational impact were assessed via pre- and post-test.
Results: A total of 1,989 PCPs participated, with complete datasets available for 978. At baseline, knowledge was low on all topics - burden of influenza in patients with diabetes (27% correct), risk factors for severe outcomes (34%), and management approaches (38%). Of note, 70% underestimated the risk of admission to the ICU in patients with diabetes and influenza. These knowledge gaps translated into practice gaps, with only 18% always reporting early identification and management of patients with diabetes and suspected influenza. Importantly, there was an average increase in knowledge of 46. At 60-day follow-up, 89% had implemented practice improvements and 23% had improved interprofessional care practices, which contributed to improved patient outcomes, including earlier patient identification and intervention.
Conclusion: In our dataset, PCPs who manage patients with diabetes had inadequate knowledge regarding increased risk for adverse outcomes due to influenza infection. These data demonstrate the benefit of targeted education to improve HCP knowledge and the translation of knowledge to practice improvements for enhanced patient outcomes.

Disclosure
K.Robinson: None. B.Carson: None. J.L.Scavone: None. J.Frederick: None. R.A.Esgro: None.

Funding
Genentech (G-90568)
540-P: Clinical Practice Gap Analysis of T1D Risk, Diagnosis, and Screening, and Emerging Therapies
Authors: LARKIN AMY 
Published: June 2023

Introduction: Understanding clinical practice gaps in the clinical understanding, diagnosis and staging, and emerging treatments for T1D can inform development of tools to improve physician practices. Methods: A survey instrument of 25 multiple choice, knowledge- and case-based questions allowed participants to assess their clinical knowledge with regard to T1D. The survey was available online to physicians without monetary compensation or charge. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. Initial data collection occurred from January 8, 2022 to April 6, 2022. Results: In total, 84 diabetologists/endocrinologists (D/Es) and 76 pediatricians completed the full assessment within the data collection period. Physicians demonstrated gaps in the following areas.
Conclusion: This educational research on assessment of physicians’ clinical practices yielded important insights into clinical gaps related to T1D risk, diagnosing and staging, and emerging treatments. Further studies are planned to assess the effect of medical education on decreasing these clinical practice gaps.

Disclosure
A.Larkin: None.

Funding
Dompe
549-P: Assessing Feasibility of a Diabetes Mellitus Program Using Behavioral Economics to Optimize Outreach and Self-Management Support with Technology—The DM-BOOST Project
Authors: AMANTE DANIEL J. , SHENETTE LISA L. , PUERTO GERALDINE , LEMON STEPHENIE , HARLAN DAVID M. , GERBER BEN S. 
Published: June 2023

Introduction: The DM-BOOST intervention was developed to enhance engagement with diabetes self-management training (DSMT). Participants received peer-written text message tips with nudges to reply with personal preferences. They then completed a video call with the DM-BOOST team to confirm patient portal access, review key functions, and set a diabetes behavior goal. This was later followed by receipt of a patient portal message with their goal, which they commit to sending to the DSMT provider they are scheduled to meet with.
Methods: Adults with poorly controlled type 2 diabetes (HbA1c ≥ 8) received mailed invitations and a recruitment phone call. Participants (n=60) were randomized (1:1) to usual care or DM-BOOST. All participants received assistance obtaining a DSMT referral and scheduling a DSMT appointment. The primary outcome of interest was the DSMT appointment no-show/cancellation rate.
Results: Enrolled participants (n=60) were 60.0% female with a mean age of 45.5 years (SD = 8.3). The average HbA1c at enrollment was 10.1% (SD = 1.8). All intervention participants (30/30) had a DSMT appointment scheduled compared to 86.7% of comparison participants (26/30). Intervention group participants had fewer DSMT no-shows/cancellations (3/30, 10%) compared to comparison group participants (10/26, 35%) (p = 0.01).
Conclusions/Discussion: Technology-based interventions guided by behavioral economics can increase initial engagement with DSMT. Several system-level barriers, including challenges in obtaining referrals and scheduling appointments, were identified. Secondary outcomes, including patient-reported changes in diabetes self-efficacy, self-management skills, and treatment satisfaction are being evaluated. Future research efforts include cultural adaption of DM-BOOST for Spanish-speaking patients and rigorous implementation evaluation.

Disclosure
D.J.Amante: None. L.L.Shenette: None. G.Puerto: None. S.Lemon: None. D.M.Harlan: Advisory Panel; Novartis, Vertex Pharmaceuticals Incorporated, Diabeloop SA, Other Relationship; Stability Health, Wolters Kluwer Health. B.S.Gerber: Other Relationship; Abbott.

Funding
National Center for Advancing Translational Sciences (KL2TR001455); National Institute for Diabetes and Digestive and Kidney Diseases (1K01DK131318)
557-P: Effect of MyPlate Nutrition and Diabetes Education Delivered by Promotoras de Salud in Low-Income Latinx Adults Living in Rural Communities
Authors: MARIN STEPHANIE C. , MARQUEZ IRIS , FLORES RICARDO R. , LEE DAVID , WRAICH DIMPY , DURAN HENRY , CHENEY ANN M. 
Published: June 2023

Background: Latinx individuals have over a 50% chance of developing type II diabetes within their lifetime compared to 40% of the general population1,2. Further, a lack of diabetes education significantly contributes to poor health literacy surrounding diabetes treatment and management among ethnic minorities3.
Methods: The study utilized a pre and posttest design using the General Nutrition Knowledge Questionnaire-Revised to assess changes in the nutrition knowledge of individuals 18 years or older, after receiving a tailored nutrition education presentation based on U.S. Department of Agriculture MyPlate's dietary guidelines. The difference between pre and posttest nutrition knowledge scores was measured using paired samples t-test for the overall survey and separately for three questions that assessed the diet-diabetes relationship.
Results: Most participants were Spanish-speaking Latinx/Hispanic females between the ages of 40-49, where 66% reported middle school education or lower, 26.4% reported being diagnosed with diabetes, and 56% had a family history of diabetes. The paired t-test of the pre and posttests (n=82) resulted in one and two-sided p-values &lt; 0.001. The comparative pre versus posttest analysis for the diabetes knowledge-related questions showed that the diabetes-related questions one, two, and three resulted in p-values &lt;0.227, &lt;0.02, and &lt;0.03, respectively.
Conclusion: Latinx individuals in rural communities face systemic barriers, including poor medical coverage, low health literacy rates, language and immigration barriers4. Our study brought together promotoras to create and deliver culturally-conscious, evidence-based nutrition education material through platicas. Increased access to nutrition and diabetes education contributes to improved patient health knowledge and addresses negatively impactful social determinants of health among rural Latinx American populations.

Disclosure
S.C.Marin: None. I.Marquez: None. R.R.Flores: None. D.Lee: None. D.Wraich: None. H.Duran: None. A.M.Cheney: None.

Funding
University of California, Riverside School of Medicine
567-P: Impact of Diabetes Prevention Education Program on Diabetes Knowledge among Adults with Prediabetes—A Cluster Randomized Controlled Trial in Nepal
Authors: SHAKYA PUSHPANJALI , SHRESTHA ARCHANA , KARMACHARYA BIRAJ M. , SHRESTHA ABHA , BAJRACHARYA MONISH , KULSENG BÅRD E. , SKOVLUND EVA , SEN ABHIJIT 
Published: June 2023

Background: Diabetes knowledge is important for diabetes prevention but has been less studied among people with prediabetes. This study aimed to assess the impact of a community-based lifestyle intervention program called Diabetes Prevention Education Program (DiPEP) on diabetes knowledge among adults with prediabetes in Nepal.
Method: This study is a part of a two-arm open cluster randomized controlled trial conducted from October 2019-September 2021 in two urban areas of Nepal. Participants of the intervention arm received four 1-hour weekly education sessions, follow-up for the next 5 months, diabetes prevention education brochure, exercise calendar and daily food logbook. The control arm received an education brochure at baseline and 1-hour education session after endline data collection. The change in diabetes knowledge was assessed using Nepali validated 24-items Diabetes Knowledge Questionnaire (DKQ), with higher score representing better disease knowledge. Linear mixed model was used to analyze the impact of the DiPEP on diabetes knowledge score with intent-to-treat approach.
Results: A total of 291 participants were recruited in the trial with mean age of 50.3±7.6 years and 67% were female. Only 290 participants had baseline DKQ (158 intervention, 132 control), out of these 258 completed the endline DKQ (139 intervention, 119 control). At baseline, mean DKQ score was 9.2 (SD 5.2) in intervention and 10.6 (SD 4.8) in control arm. After the intervention, mean change in the score between intervention and control group was 0.4 (95% CI -1.0-1.7) among those with good compliance to DiPEP. The results did not change from main analysis for those who attended ≥3 of all 4 sessions.
Conclusion: Diabetes knowledge did not improve significantly after the intervention among the participants. Regular and frequent engagement of participants might help to improve diabetes knowledge among the individuals.

Disclosure
P.Shakya: None. A.Shrestha: None. B.M.Karmacharya: None. A.Shrestha: None. M.Bajracharya: None. B.E.Kulseng: None. E.Skovlund: None. A.Sen: None.

Funding
Norwegian University of Science and Technology, Department of Public Health and Nursing (81850087)
577-P: A Novel Program to Help Teens Manage Type 1 Diabetes during Physical Activity—Diabetes Training Camp Teen Boot Camp
Authors: SIMMONS KIMBER M. , HALL JACOB D. , O'DONNELL HOLLY K. , DEBLOIS JACOB P. , TANNER BAILEY , FERRI CHRISTINE , ZAHARIEVA DESSI P. , POWELL ROBERT , CORCORAN MATTHEW H. 
Published: June 2023

Introduction: Physical activity (PA) has many health benefits in people with type 1 diabetes (T1D), yet adolescents with T1D engage in less PA than their peers and may struggle to employ strategies that allow them to participate fully and maintain glucose levels in target range. Diabetes Training Camp Teen Boot Camp (DTC-TBC) is an intensive 3-day program that includes education and workouts geared for teens with T1D and their parents/guardians. We aimed to determine if indicators of psychosocial (confidence in glucose management during PA, positive experience, barriers to PA) and health (HbA1c) changed after attending DTC-TBC in summer 2022.
Methods: DTC-TBC participants included 16 adolescents aged 13-18 years (HbA1c=7.3±1.4%; 25% female). Most used a continuous glucose monitor (93%) and insulin pump (69%) to manage T1D. Participants completed questionnaires on the first day of camp (baseline), last day of camp and 1 month after camp. Paired t-tests were used to compare 1) mean 7-point Likert scale scores for confidence in managing T1D (1 = not confident, 7= very confident) before and immediately post camp and 2) mean scores on the Barriers to PA in T1D and reported HbA1c before and 1-month post camp (n=11).
Results: Both parents and teens reported high satisfaction with the DTC-TBC experience; 100% of participants said they would recommend DTC-TBC. Confidence in managing T1D significantly increased (baseline 4.9±1.2 vs post-camp 6.0±0.6; p&lt;0.0001). Teens reported lower barriers to PA 1-month post-camp (baseline 25.0±14.3, 1 month 21.5±8.0; p=0.170). HbA1c decreased by 0.26% 1 month after camp (95% CI −0.18, 0.70; p=0.106).
Conclusions: Barriers to PA and HbA1c both trended towards significant reductions even with a small sample size, whereas confidence significantly increased. Follow-up at regular intervals and inclusion of future camp participants will help determine if DTC-TBC has a statistically significant positive impact on psychosocial and health outcomes.

Disclosure
K.M.Simmons: Advisory Panel; Provention Bio, Inc., Consultant; Dexcom, Inc., Provention Bio, Inc., Research Support; Novartis. J.D.Hall: None. H.K.O'donnell: None. J.P.Deblois: None. B.Tanner: None. C.Ferri: 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. R.Powell: None. M.H.Corcoran: Speaker's Bureau; Boehringer Ingelheim and Eli Lilly Alliance, Novo Nordisk.
58-OR: Glycemic Impact of Meal-Dosing Behavior in Users of the InPen Smart Insulin Pen (SIP) Paired with Continuous Glucose Monitoring (CGM)
Authors: MACLEOD JANICE , SMITH MADISON , HEUNGYONG IM GLEN , CORDERO TONI L. , VIGERSKY ROBERT A. 
Published: June 2023

Background: Data from connected insulin pen therapies are revealing both gaps and opportunities to significantly improve care for people on multiple daily insulin injections therapy. This real-world (RW) data analysis reports on the impact of meal-dosing behavior (missed and late) on glycemia in adult and pediatric InPen users with type 1 (T1D) or type 2 diabetes (T2D).
Method: The RW data from 5,153 deidentified individuals who used the InPen SIP and CGM for at least 30 days between January 2020 and December 2021, and who had dosing and CGM data between 30 and 59 days since first bolus date, were analyzed using a meal detection algorithm. Users with &lt;14 days of bolus data or inadequate CGM data (&lt;14 days of 70% or more SG data/day) were excluded.
Results: The impact of dosing behavior (≤2 versus &gt;3 doses/day) and missed dose frequency (&lt;20% versus ≥20%) on glycemia was analyzed (Table). A dosing frequency of &gt;3 (including correction-only doses) and a missed dose frequency of &lt;20% were associated with improved glycemic metrics. Overall, the frequency of on-time dosing was significantly correlated with user TIR (r=0.59, p&lt;0.001).
Conclusion: Real-world InPen with CGM use data provide insights into the impact of meal-dosing behavior on glycemic outcomes, which may inform counseling strategies for care teams and open the door to precision insulin injection management.

Disclosure
J.Macleod: Employee; Medtronic. M.Smith: Employee; Medtronic. G.Im: Employee; Medtronic. T.L.Cordero: Employee; Medtronic. R.A.Vigersky: Employee; Medtronic.