bluuebunny/crossref_metadata_2025_split huggingface dataset:
661-P: Associations of Food Security Status with Diet Quality and Glycemic Control over Two Years in Adults with Type 2 Diabetes on Medicaid
Authors: GU KRISTINE D. , CHENG JESSICA , MCGOVERN SYDNEY H. , MCCURLEY JESSICA L. , LEVY DOUGLAS E. , FUNG VICKI , CLARK CHERYL , THORNDIKE ANNE N. 
Published: June 2023

Background: Little is known about the association of food insecurity (FI) with changes in diet quality and hemoglobin A1c (HbA1c) over time in people with type 2 diabetes (T2D).
Methods: In an analysis of adults with Medicaid and T2D enrolled in a longitudinal cohort study in 2020, demographics, depression (Patient Health Questionnaire-8 [PHQ-8]), food security status (USDA Food Security Module), Healthy Eating Index-2015 (HEI-15) diet quality scores, and other social determinants of health were assessed with annual surveys. Primary outcomes were HEI-15 and HbA1c, obtained from electronic health records. Separate propensity-score adjusted linear mixed models with a random intercept were used to test associations of baseline FI with changes in HEI-15 and A1c over 2 years.
Results: Of 846 participants, 133 (16%) had T2D at baseline; 79 (59.4%) of those with T2D had FI. Those with baseline FI vs. food security had higher PHQ-8 scores and prevalence of housing instability, financial stress, and cost-related barriers to care (p&lt;0.05). Over 2 years, changes in HEI-15 (p=0.45) and HbA1c (p=0.86) did not differ by baseline food security status (Table 1).
Conclusion: In adults with T2D on Medicaid, diet quality remained low and HbA1c high over 2 years regardless of food security status, highlighting the importance of addressing nutrition when managing T2D in Medicaid patients.

Disclosure
K.D.Gu: None. J.Cheng: None. S.H.Mcgovern: None. J.L.Mccurley: None. D.E.Levy: None. V.Fung: Other Relationship; Vertex Pharmaceuticals Incorporated, Stock/Shareholder; Vertex Pharmaceuticals Incorporated. C.Clark: None. A.N.Thorndike: None.

Funding
National Institutes of Health (T32DK007028, 5T32HL098048, R01DK124145)
664-P: Efficacy of a Digital Diabetes Logbook for Reducing Treatment Burden—Results of a Randomized Controlled Trial
Authors: EHRMANN DOMINIC , HERMANNS NORBERT , SILBERMANN STEPHAN , KOBER JOHANNA , FINKE-GROENE KATHARINA , ROOS TIMM , VESPER IRIS , SCHAEFER VANESSA L. , KULZER BERNHARD 
Published: June 2023

The digital diabetes logbook mySugr is designed to help people with diabetes manage their diabetes and to reduce burden of diabetes management. To test the efficacy of the app, a randomized controlled trial (RCT) was conducted.
The RCT was designed as a multi-center, open-label, parallel study with a 3-month follow-up in Germany. Participants were randomized to either using the mySugr app or to the treatment-as-usual control group in a 2:1 ratio. Primary outcome was change in diabetes distress using the Problem Areas in Diabetes (PAID) questionnaire. Based on the power analysis, the recruitment goal was 396 participants, anticipating 15% drop-out it was planned to recruit 466 participants. Robust regression was used to analyze the data with follow-up scores as dependent variable, group as independent variable and controlled for respective baseline scores. Primary analysis was based on the intention-to-treat population with jump-to-reference approach for multiple imputation of missing data.
A total of 424 people with diabetes were randomized, 282 to the intervention and 142 to the control group (12.5% type 1 diabetes, 68.2% type 2 diabetes, 18.9% gestational diabetes, age: 51.7±15.2 years, 50% female, diabetes duration: 9.5±10.8 years, A1c: 7.1±1.5%, PAID: 21.6±17.4); 397 completed the 3-month follow-up. Intention-to-treat analysis revealed a significant between-group difference in the primary outcome (p = 0.0182). PAID scores at follow-up in the mySugr group were significantly lower than in the control group (Δ -2.20, 95% CI: -4.02 to -0.38). This was corroborated by the per-protocol analysis (Δ -2.43, 95% CI: -4.49 to -0.37, p = 0.0211).
Recruitment was successful and could be stopped earlier due to the very low drop-out rate (6.4%). Use of mySugr led to a significant improvement in diabetes distress after 3 months compared to the treatment-as-usual control group. Thus, the efficacy of mySugr regarding the reduction of diabetes distress could be demonstrated in the RCT.

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. S.Silbermann: Employee; Roche Diabetes Care. J.Kober: Employee; mySugr. K.Finke-groene: None. T.Roos: None. I.Vesper: None. V.L.Schaefer: Employee; Roche Diabetes Care. 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
Roche Diabetes Care GmbH (DC000097)
667-P: Enrollment Characteristics of Adults Aged 18–44 in the National Diabetes Prevention Program (National DPP)
Authors: BELL MIRIAM , PAPALII MICHELLE , VAN AACKEN SUSAN , ELY ELIZABETH 
Published: June 2023

The Centers for Disease Control and Prevention (CDC) estimates that 96 million adults aged 18 years or older had prediabetes in 2019. Of these, 32.2 million, or 33.5%, were aged 18-44, emphasizing the need for efforts to prevent or delay onset of type 2 diabetes within this population. CDC's National Diabetes Prevention Program (National DPP) is a partnership of public and private organizations collaborating to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes in adults with prediabetes or at high risk. While the mean age of participants in the LCP is 51 years, 31.6% of the participants enrolled as of October 2022 were in the 18-44 age group. When examining the characteristics of this age group, 52.1% of participants identified as non-Hispanic or Latino White, 18.4% identified as Hispanic or Latino, and 12.9% identified as non-Hispanic or Latino Black or African American. Overall, 71.4% of participants in this group enrolled in an online program and 81% participated through a worksite wellness program. For those who had the opportunity to complete the year-long LCP, the mean number of days spent in the program was 110. By comparison, among 45-64-year-olds, the mean number of days spent in the program was 161, and for those 65 and older, the mean number of days was 210. This is of note because participants who stay in the LCP longer are more likely to meet the risk reduction outcomes. Participants 18-44 met the programmatic risk reduction 5% weight loss goal at a lower rate (18.4%) than participants aged 45-64 (27%) and 65 and over (40.2%). These findings highlight the opportunity to develop strategies focused on supporting this younger adult population to enroll in and complete the LCP.

Disclosure
M.Bell: None. M.Papalii: None. S.Van aacken: None. E.Ely: None.
668-P: Exploring Attitudes toward Autoantibody Screening in People Living with T1D, Caregivers, and First-Degree Relatives
Authors: PETER MEGAN , CHAPMAN KATHERINE S.M. , DUNNE JESSICA L. , KELLY CAITLIN S. , WOLF WENDY 
Published: June 2023

Background: T1D autoantibodies can be detected months to years before disease onset, but few people undergo screening. We explored attitudes toward autoantibody screening in people with T1D and caregivers and relatives of people with T1D.
Methods: Participants were recruited from the T1D Exchange Registry or referred by an Online Registry participant. Guided by the Health Belief Model, we conducted 4 focus groups with 26 participants (11 adults with T1D with a child without T1D; 8 caregivers to a child with T1D and a child without T1D; 7 biological siblings to a person with T1D). Transcripts were analyzed using NVivo.
Results: Responses are summarized in Table 1. Most participants held positive attitudes toward screening. The most common perceived benefit was to obtain knowledge; the anticipated emotional burden of a positive screen was the most frequently reported barrier. Anxiety and relief were emotions associated with a positive and negative screen, respectively. Participants desired information about antibody screening and its interpretation and accuracy. A healthcare providers’ recommendation might prompt the decision to screen.
Conclusions: Participants expressed positive attitudes and perceived benefits of autoantibody screening but also reported barriers to screening, particularly the emotional burden of a positive result.

Disclosure
M.Peter: None. K.S.M.Chapman: None. J.L.Dunne: Employee; Janssen Research & Development, LLC. C.S.Kelly: None. W.Wolf: None.
669-P: Factor Analysis of the Diabetes-Specific Risk-Taking Inventory
Authors: MONZON ALEXANDRA , PIERCE JESSICA , WASSERMAN RACHEL M. 
Published: June 2023

Introduction: Adolescence is marked by increased risk-taking behaviors and challenges engaging in optimal type 1 diabetes (T1D) treatment. We developed the Diabetes-Specific Risk-Taking Inventory (DSRI) to assess risky adolescent T1D self-management behaviors. In the current study, we conducted confirmatory factor analyses (CFAs) for the DSRI and examined model fit.
Methods: We surveyed a national sample of 224 adolescents (age 15-18 years; M age 16.9 ± 1.1 years; 49% female, 11% identified as Black, Indigenous, or Persons of Color; 76.8% used insulin pumps; M HbA1c= 8.5% ± 1.3); from the T1D Exchange registry in a cross-sectional design. Participants completed the DSRI, and we collected the most recent HbA1c value from registry data. We performed CFAs in R using the Lavaan package to evaluate three models: 1) a one-factor structure, 2) a two-factor structure reflecting items higher and lower in risk (item level of risk assessed by surveying diabetes health care providers), and 3) another two-factor structure reflecting items that associate with higher HbA1c (&gt;9%) and lower HbA1c (&lt;9%).
Results: The DSRI measure contains 31 items; however, one item was removed from CFA analyses due to a nonsignificant factor loading value. The one-factor CFA model demonstrated poor fit χ2(399, n=224) =1714.94, p&lt;0.001, RMSEA=0.12, CFI=0.52, TLI=0.49, as did the two-factor structure differentiating between higher and lower HbA1c χ2(399, n=224) =1121.02, p&lt;0.001, RMSEA=0.090, CFI=0.72, TLI=0.69. The two-factor CFA reflecting higher and lower risk items model demonstrated improved fit χ2(399, n=224) =896.19, p&lt;0.001, RMSEA=0.085, CFI=0.77, TLI=0.75.
Conclusions: The DSRI is a valuable self-report measure that providers may use to screen for high-risk behaviors not routinely assessed in T1D clinical care. The results suggest that the high-risk vs. low-risk two-factor model is slightly better fitting than the one-factor model; however, additional factor structures should be assessed to identify a more robust structural model.

Disclosure
A.Monzon: None. J.Pierce: None. R.M.Wasserman: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (2016PG-T1D053); National Institutes of Diabetes and Digestive and Kidney Diseases (1K12DK097696)
670-P: Improving Diabetes Distress in Emerging Adults with Type 1 Diabetes—The AHEAD Program
Authors: MALIK FAISAL , HIRSCH IRL B. , PIHOKER CATHERINE , ROBERTS ALISSA J. , TAPLIN CRAIG , LOWRY SARAH J. , YI-FRAZIER JOYCE P. , MOSS ASHLEY , HUANG ALYSSA , EHRHARDT NICOLE M. , HOCH KATRINA , WEAVER KATHRYN 
Published: June 2023

Background: The Achieving Health in Emerging Adults with Diabetes (AHEAD) Program is designed to meet the health care transition and psychosocial needs of emerging adults (EA) with type 1 diabetes (T1D).
Objective: To evaluate the impact of the AHEAD Program on diabetes distress (DD) in EA with T1D.
Methods: DD was evaluated using the Problem Areas in Diabetes-Teen survey (PAID-T). Mixed-effects linear regression with a random effect for individual to account for repeated measures was used to evaluate change in DD over time. Models were adjusted for age, race, ethnicity, technology use, and insurance. We assessed whether improvement varied by age, technology use, insurance, or baseline (BL) elevated DD (PAID-T≥44).
Results: Sample included 489 EA with T1D (BL visit: mean age 20.3 years, 52% male, 75% Non-Hispanic White, 26% public insurance, 59% continuous glucose monitor use, 58% insulin pump use, 19% elevated DD). Overall mean PAID-T scores decreased from 31.4 at BL (95% CI: 30.1, 32.8) by 4.6 points (95% CI: -7.4, -1.7; p=0.001) at 2 years (Figure). By 2 years, mean PAID-T scores for patients with elevated DD at BL decreased by 16.2 points (95% CI: -22.9, -9.5; p&lt;0.001) compared to a 3.3 point (95% CI: -6.2, -0.5; p=0.02) decrease in those without elevated DD at BL. PAID-T improvement did not vary by age, technology use, or insurance (all p&gt;0.05).
Conclusion: The AHEAD Program offers a promising approach to reduce DD in EA with T1D.

Disclosure
F.Malik: None. N.M.Ehrhardt: Advisory Panel; Novo Nordisk, Dexcom, Inc., Consultant; Nestlé Health Science. K.Hoch: None. K.Weaver: None. I.B.Hirsch: Consultant; Abbott Diabetes, Lifecare, Inc., Hagar, Research Support; Beta Bionics, Inc., Insulet Corporation, Dexcom, Inc. C.Pihoker: None. A.J.Roberts: None. C.Taplin: Stock/Shareholder; Quest Diagnostics. S.J.Lowry: None. J.P.Yi-frazier: None. A.Moss: Other Relationship; American Diabetes Association. A.Huang: None.

Funding
Forest Foundation; Sequoia Foundation
673-P: Youth with Type 1 Diabetes and Elevated A1C during the Coronavirus Disease-2019 (COVID-19) Pandemic—Examination of Family, Caregiver, and Medical Team Factors
Authors: WAGNER DAVID V. , PERRY MEGAN , CLEMENTS MARK A. , WONG JENISE C. , NARANJO DIANA , REED ALISON , JENISCH CELESTE , CRUZ CRISTIAN , MITCHELL SUSANNE , YGLECIAS LOREN , FLORES GARCIA JAQUELIN , TORRES SANCHEZ ALEJANDRA , BONILLA OSPINA ANDREA , RAYMOND JENNIFER , HARRIS MICHAEL A. 
Published: June 2023

Introduction: A subset of youth with T1D experience avoidable health problems, but it is unclear how specific social factors relate to these problems, particularly during the COVID-19 pandemic. We examined how systemic factors (caregiver, family, medical team) were related to medical outcomes in youth with elevated A1c from five academic medical centers during the pandemic.
Methods: Youth 12-17 yrs with 1) T1D for ≥1 yr and 2) A1c≥10% in the past year were enrolled. Caregivers and youth completed measures of family conflict (Diabetes Family Conflict Scale-R); parent practices, stress, and health literacy (Alabama Parenting Questionnaire, Stress Index for Parents of Adolescents, BRIEF Health Literacy Scale); youth strengths and social support (Diabetes Strengths and Resilience, PROMIS); and family-medical team relationship (Quality of Healthcare Relationship) with EHR review including baseline A1c and acute complications (e.g., ED visits).
Results: Participants were 157 youth with mean age 14.6 ± 1.6 years and mean A1c 11.0% ± 1.9%. 51% self-identified as Non-Hispanic White. Caregiver, family, and relational factors were significantly (p&lt;.05) related to frequency of complications and A1c, with higher family conflict associated with higher A1c (r=.23) and more ED visits (r=.18). For caregivers, low health literacy (r=.17), inconsistent discipline practices (r=.20), and high parental stress related to low adolescent achievement (r=.26), were significantly (p&lt;.05) associated with acute complications, as was youth report of low social support (r=-.20, p&lt;.01). Positive family-medical team relationship was strongly related to lower A1c (r=-.30, p&lt;.01).
Discussion: Given these findings, screening and intervention efforts should emphasize targeting multiple systems and relationships with this population of youth, potentially with increased focus on the family-medical team relationship.

Disclosure
D.V.Wagner: None. L.Yglecias: None. J.Flores garcia: None. A.Torres sanchez: None. A.Bonilla ospina: None. J.Raymond: None. M.A.Harris: None. M.Perry: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. J.C.Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. D.Naranjo: None. A.Reed: None. C.Jenisch: None. C.Cruz: None. S.Mitchell: None.

Funding
JDRF
675-P: Coparenting Cooperation and Conflict Predict Parent Depressive Symptoms 1.5 Years after Young Child T1D Diagnosis
Authors: KANG LEYI , WANG CHRISTINE H. , HILLIARD MARISA E. , TULLY CARRIE , MONAGHAN MAUREEN , STREISAND RANDI 
Published: June 2023

Background: Managing T1D in a newly diagnosed young child significantly impacts family dynamics and is linked with elevated parental depressive symptoms. We examined the relationship among diabetes-related co-parenting cooperation and conflict soon after diagnosis with parent depressive symptoms 1 and 1.5 years later.
Method: Participants were 157 primary caregivers (91.7% female, 76.4% married, 62.2% non-Hispanic White) of young children age 1-6 years (Mage=4.41.7 years; 54.8% female, 61.5% non-Hispanic White) in a behavioral intervention trial after child T1D diagnosis (M=29 days). Parents self-reported on Cooperation and Conflict subscales of the Diabetes-Specific Co-parenting Questionnaire (DCQ) and the Center for Epidemiological Studies Depression Scale (CES-D; ≥16=clinical elevation). Multiple logistic regressions were used with elevated depression score as outcome. Subjective socioeconomic status (SSES) and treatment condition were included as covariates.
Results: Higher co-parenting conflict at baseline was associated with a 3.70 (OR=3.70, 95% CI=(1.68, 8.18) and 2.36 (OR=2.36, 95% CI=(1.13, 4.91)) higher odds of clinically elevated CES-D score risk at 1 and 1.5 years post-diagnosis, respectively. Higher co-parenting cooperation at baseline marginally reduced elevated CES-D odds by 0.58 (OR=0.58, 95% CI=(0.31, 1.10)) at 1.5 (but not 1) years post-diagnosis; higher SSES at baseline reduced depression odds by 0.97 (OR=0.97, 95% CI=(0.96, 1.00) at 1.5 (but not 1) years post-diagnosis.
Discussion: Increased parental disagreements following T1D diagnosis may predict higher burden of managing T1D in a young child over time and possibly contribute to later depressive symptoms. Parental care strategies and interventions at T1D diagnosis that enhance supportive cooperation and communication among caregivers may help support parent psychosocial functioning over time.

Disclosure
L.Kang: None. C.H.Wang: None. M.E.Hilliard: None. C.Tully: None. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None.

Funding
National Institutes of Health (1R01DK102561-01A1)
677-P: Exploring the Impact of CGM on Perceived Control of Non-Intensive Insulin Treated Type 2 Diabetes—“I liked keeping my line with as few spikes as possible”
Authors: CRAWFORD MARGARET A. , HICKS CHRISTIAN , GENGE PAUL , GREENAWALD KENNETH , TRESSLER MICHELLE , CHERÑAVVSKY DANIEL R. , SINGH HARSIMRAN 
Published: June 2023

Background and Aims: Progression of type 2 diabetes (T2D) demands complex treatment modalities, which may impair patients’ confidence and psychological health. Technologies allowing improved understanding of the dynamic disease process may improve engagement with therapy.
Methods: As part of a larger observational study, we previously reported findings highlighting the impact of using Dexcom G6 real-time CGM (rtCGM) with T2D adults (diverse therapies) and prediabetes over a 12-week period. We now explored qualitative data generated from a subsample of T2D participants (N=38) on non-intensive insulin therapy (Basal only=24%, No insulin=76%). Participants answered open-ended questions about their experiences using CGM including self-reported learnings and changes in behavior. Primary themes from qualitative data were derived using content analysis and confirmed with inter-coder reliability.
Results: Overall, most participants (&gt;90%) ended the study with high levels of perceived control (PC) of their diabetes. For further analysis, participants’ change in PC at study end were plotted based on low, medium, or high PC before CGM use. Interesting group differences emerged wherein fewer participants reporting medium PC at baseline reported high PC at study end (vs. others with low and high baseline PC). Qualitative themes around perceived illness severity, depressive symptoms, and self-efficacy along with differences in demographics and glycemic metrics helped translate these meaningful findings.
Conclusions: rtCGM use provided valuable improvements in participants’ engagement and understanding of their diabetes with potential for long-term clinical benefits. Future studies exploring relationships between perceived control of diabetes and progression of T2D may indicate potential areas for improved engagement with diabetes technology.

Disclosure
M.A.Crawford: Employee; Dexcom, Inc. C.Hicks: Employee; Dexcom, Inc. P.Genge: Employee; Dexcom, Inc. K.Greenawald: Employee; Dexcom, Inc. M.Tressler: Employee; Dexcom, Inc. D.R.Cherñavvsky: None. H.Singh: Employee; Tandem Diabetes Care, Inc., Dexcom, Inc.

Funding
Dexcom, Inc.
678-P: Impact of COVID-19 on Black Youth with T1D and Their Parents
Authors: HOWARD KELSEY R. , FELDMAN MARISSA , CARCONE APRIL I. , GARZA KIMBERLY P. , EVANS MEREDYTH A. , WEISSBERG-BENCHELL JILL , ELLIS DEBORAH A. 
Published: June 2023

Purpose: The COVID-19 pandemic has contributed to financial and psychosocial stressors, particularly among individuals from minoritized groups. The goal of the current study was to provide a description of the financial and emotional burdens experienced by Black youth with T1D and their parents during the pandemic.
Method: Data for the present study were obtained from a subset of families participating in a clinical trial providing an eHealth intervention to parents of Black adolescents with T1D. Adolescents (n = 63), young adults (n = 9), and their parents (n = 65) completed questionnaires on their experiences with emotional, social, and financial stressors during the pandemic.
Results: Parents reported changes in occupational and financial stress during the pandemic. Nearly half (45.2%) reported reduced work hours, involuntary job loss, or voluntary job loss to care for a family member. A third (31.2%) reported significant changes in household income, with 10.9% of parents indicating that they were unable to meet their basic needs, such as paying bills. Many (50%) parents reported that their child missed a diabetes-related appointment; of these, 59.4% reported missing an appointment for a pandemic-related reason (e.g. clinic was closed due to COVID; family canceled appointment to avoid being around other people). Adolescents and young adults reported a variety of emotional responses to the pandemic, including moderate to extreme stress (46%), anger (28%), and anxiety (36%).
Discussion: Families of Black youth with T1D experienced financial and emotional burden during the pandemic. Many also experienced disruptions in their diabetes care, as evidenced by missed appointments. Future studies should explore the relationship between these burdens and subsequent diabetes management.

Disclosure
K.R.Howard: Stock/Shareholder; Abbott, AbbVie Inc. M.Feldman: None. A.I.Carcone: None. K.P.Garza: None. M.A.Evans: None. J.Weissberg-benchell: Advisory Panel; Beta Bionics, Inc., Research Support; Beta Bionics, Inc. D.A.Ellis: None.

Funding
National Institutes of Health (3RO1DK110075-04S1)