bluuebunny/crossref_metadata_2025_split huggingface dataset:
1042-P: Qualitative Study—Provider Awareness and Attitudes towards Type 1 Diabetes Antibody Screening
Authors: OSPELT EMMA L. , HARDISON HOLLY , RIOLES NICOLE , NOOR NUDRAT , NELSON GRACE , LEVY CAROL J. , MCKEE ALEXIS M. , ANTAL ZOLTAN , WONG JENISE C. , OBRYNBA KATHRYN , EBEKOZIEN OSAGIE 
Published: June 2023

Background: This study explores awareness and attitudes of endocrinology providers toward type 1 diabetes (T1D) autoantibody screening and identifies perceived benefits and barriers to screening.
Methods: Three focus groups were conducted with thirteen eligible endocrinology providers recruited from the T1D Exchange Quality Improvement Collaborative. Focus groups were transcribed, coded, and analyzed using NVivo qualitative software. A force field analysis was conducted, analyzing high, medium, and low impact forces that were identified in the study.
Results: All providers considered themselves “pro-screening” and comfortable discussing autoantibody screening with patients. High impact driving forces included early diabetes management, DKA prevention at diagnosis, and clinical guidance and diagnosing abilities. Medium and low impact forces included awareness and clarity of diagnosis, opportunity to get involved in research, and results for insurance approval. High impact restraining forces included anxiety of diagnosis for patients and family members, cost of screening, and staffing or clinic limitations. Medium and low impact forces included time and coordination for patients and families, mildly invasive procedure, and insurance coverage.
Conclusion: Findings highlight perceived benefits and barriers to autoantibody screening, illustrating provider insight and awareness.

Disclosure
E.L.Ospelt: None. K.Obrynba: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. H.Hardison: None. N.Rioles: None. N.Noor: None. G.Nelson: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. A.M.Mckee: Advisory Panel; Medtronic, Novo Nordisk. Z.Antal: None. J.C.Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc.
1046-P: ELEGANT-DM2—Early Intervention Addressing Therapeutic Inertia in Diabetes Mellitus-2
Authors: BANDI ARCHANA , BECKER DANYA , SODDERS STEPHANIE , ZUPA MARGARET , MCCOY JENNIFER L. , PERTINACI NADINE M. , BOUDREAUX-KELLY MONIQUE Y. 
Published: June 2023

Primary care (PC) models for DM2 care driven by clinical pharmacists (CPs) have shown benefits, while access to a diabetologist (DCS) for patients with complex DM2 is limited. A prospective observational study at VA Pittsburgh Healthcare System studied the impact of a novel collaborative care model: ELEGANT-DM2 used a diabetes dashboard (DD) to identify patients with clinical therapy inertia (CTI) and weekly virtual huddles linking CPs in PC with a DCS for case review and recommendations. Using a DD, 103 patients with DM2 and A1c&gt;9% were enrolled between 09/2020 to 03/2021 and received the collaborative care intervention over 12 months. Patient demographics, comorbidities, A1c at 12-months (PRE-12) pre-enrollment, enrollment (E), and 12 months (PS-12) post-enrollment, and diabetes medications at E and PS-12 were extracted. A non-parametric test was used to compare continuous outcome measures (Mean+/-SD); categorical measures as percentages. McNemar test was used to conduct pre-post proportion comparisons in specific cohorts for SGLT-2i and GLP-1RA medications. The study cohort was mostly male (94%), white (90%), with a mean age of 69.3 years, had pre-existing CVD (91%), obesity (89%), HTN (87%), CKD (16%), and CHF (10%). A significant rise in A1c was noted from 9.3% (+/-1.4) at Pre-12 to 10.8% (+/-1.5) at E (p=.008). A significant decline was noted in A1c from 10.8% (+/- 1.5) at E to 8.2% at PS-12 (p=&lt;0.001). In patients with DM2 and CVD, use of SGLT-2i and GLP-1RA increased significantly (SGLT-2i: 16.5% at E to 29% at PS-12, p=0.009; GLP-1A: 20% at E to 36% at PS-12, p=.003). In patients with DM2 and obesity, GLP-1RA use increased from 18.2 % at E to 39.4% at PS-12 (p=.0008). A non-significant increase in the use of SGLT-2i was seen in cohorts with CKD and CHF. ELEGANT-DM2 identified CTI using DD, eliminated the traditional referral process, led to therapy optimization via virtual huddles between PC CPs and DCS, and delivered sustained improvement in DM2 control and uptake of new medications

Disclosure
A.Bandi: None. D.Becker: None. S.Sodders: None. M.Zupa: None. J.L.Mccoy: None. N.M.Pertinaci: None. M.Y.Boudreaux-kelly: None.

Funding
Office of Health Equity (SPRV-OHEA160)
1048-P: Assessing the Quality of Life of People with Diabetes Adhering to Telemedicine over 15 Years
Authors: KESAVADEV JOTHYDEV , SHANKAR ARUN , JOTHYDEV KRISHNADEV , KRISHNAN GOPIKA , BASANTH ANJANA , CHANDRAN GOPIKA B. , SANAL GEETHU , JOTHYDEV SUNITHA 
Published: June 2023

T2D is associated with personal, familial, social, and financial issues that substantially affect the quality of life (QoL). Telehealth interventions have ranked top at improving the QoL in patients with chronic illnesses. DTMS® (Diabetes Tele-Management System), developed in 1997, involves unique software & trained multidisciplinary diabetes team, communicating with patients via phone/email for slow, steady titration of drugs combined with frequent tele-counseling apart from 2-3 physical visits to the hospital. We assessed and compared QoL in T2D adhering and not-adhering to telemedicine over 15 years (Y).
A total of 451 T2D, (62.91 ± 11.64 Y; 37.8% females, duration of diabetes: 8.41 ± 2.78 Y) were de-identified. The treatment group [TG- 63.41±11.73 Y; 62.92% males; 8.04±1.82 Y of T2D] included T2D with ≥1F-F and ≥5 TM consultations per year. The propensity score-matched control group [CG-62.17±11.50 Y; 58.69% males; 7.98±2.96 Y of T2D] included T2D who were not on regular follow-up with compromised F-F and TM visits.
EQ-5D questionnaire (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) was administered annually as part of clinic SOP. The response collected at 15±5 Y was statistically analyzed and compared.
TG experienced a higher score for all the domains of QoL than CG (p&lt;0.001) (Figure 1).
With improvements in QoL, TM deserves more acceptance as an add-on to in-person visits.

Disclosure
J.Kesavadev: None. A.Shankar: None. K.Jothydev: None. G.Krishnan: None. A.Basanth: None. G.B.Chandran: None. G.Sanal: None. S.Jothydev: None.
1049-P: Pros and Cons of Telemedicine in Diabetes—Survey among Doctors and Allied HCPs
Authors: KESAVADEV JOTHYDEV , SHANKAR ARUN , SABOO BANSHI D. , JOSHI SHASHANK R. , BASANTH ANJANA , KRISHNAN GOPIKA , JOTHYDEV SUNITHA 
Published: June 2023

An acceleration in the adoption and use of telemedicine (TM) was necessitated by the COVID-19 pandemic. A more nuanced view emerged, including the importance of accommodating patient choice, appropriately matching encounter type to visit the platform, acknowledging the hazards associated with care delivered remotely, and adapting existing models of advanced team-based care. We have been practicing TM in diabetes since 1997. Diabetes Tele Management System, [DTMS®] is a structured diabetes management program integrated with electronic medical records, that enables telecommunication via telephone, email, and internet. To study the pros and cons of TM across a wider group a web-linked survey was conducted among doctors, allied healthcare professionals (aHCPs). The link was sent to doctors, aHCPs across India (Sept 2022-December 2022) via email and WhatsApp. The survey received 654 responses, 65% being doctors and HCPs out of which 89% had not received training prior to engaging in telemedicine consultations. Summary of responses from doctors and HCPs in Table 1. Though the majority of patients may be satisfied with TM, the prevailing practices should be periodically evaluated and upgraded incorporating the feedback from the users. It is essential to understand both pros and cons of TM in the view of doctors and aHCPs, to enable the policymakers to devise policies that enhance the scope of quality patient care.

Disclosure
J.Kesavadev: None. A.Shankar: None. B.D.Saboo: None. S.R.Joshi: Advisory Panel; Biocon, Zydus Cadila, Torrent Pharmaceuticals Ltd, Franco India, Consultant; Glenmark Pharmaceuticals, Twin Health, Speaker's Bureau; Abbott Nutrition, Sanofi, Abbott, Novo Nordisk, Lupin Pharmaceuticals, Inc. A.Basanth: None. G.Krishnan: None. S.Jothydev: None.
105-OR: Omega-3 Polyunsaturated Fatty Acids in the Treatment of Diabetic Peripheral Neuropathy—Is the Source Important?
Authors: YOREK MARK A. 
Published: June 2023

Introduction: We have shown that omega-3 polyunsaturated fatty acids (PUFA) derived from fish oil (FO) was an effective treatment for diabetes vascular and neural complications. However, is FO the best source of omega-3 PUFA for treating diabetic peripheral neuropathy (DPN)?
Methods: To address this question we used a rat model of type 2 diabetes and a late intervention protocol. After 10 weeks of hyperglycemia, diabetic rats were treated for 12 weeks via diet with omega-3 PUFA derived from a variety of sources including menhaden (fish) oil (MO), krill oil (KO), oils derived from algae that produce primarily eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) or combination of EPA and DHA, or commercial ethyl esters of EPA, DHA or combination of EPA and DHA. Primary endpoints were motor (MNCV) and sensory (SNCV) nerve conduction velocity, intraepidermal and cornea nerve fiber density, thermal and cornea sensitivity, and vascular reactivity of epineurial arterioles that provide circulation to the sciatic nerve. The omega-3 index, and serum fatty acid levels were also determined.
Results: The dose of each omega-3 PUFA supplement was customized to create a healthy omega-3 index. Defined as the sum of EPA and DHA as a percentage of total fatty acids in red blood cells, range for healthy level 8 - 12%. Following 22 weeks of untreated diabetes neural and vascular endpoints were significantly impaired compared to control rats. Treatment with MO provided the greatest improvement for all neural endpoints followed by KO and algal oils or ethyl esters containing a combination of EPA and DHA. Algal oil or ethyl ester of EPA alone was the least effective. The greatest improvement in vascular reactivity of epineurial arterioles to acetylcholine was realized following treatment with MO with less benefit from the other omega-3 PUFA sources.
Conclusion: These pre-clinical studies suggest that in a clinical trial for DPN the best outcome may be obtained by using FO as the source for omega-3 PUFA.

Disclosure
M.A.Yorek: Consultant; Novo Nordisk.

Funding
U.S. Department of Veterans Affairs (RX003826-01)
1050-P: Implementation of Professional Continuous Glucose Monitoring in VA Primary Care Clinics
Authors: SAREN KATHLEEN , RAULERSON APRIL L. , FINCH SYLVIA , LEEY JULIO A. 
Published: June 2023

Background: Professional continuous glucose monitoring (proCGM) can be used sporadically for patients who do not meet criteria for Personal CGM. The interdisciplinary nature of primary care teams from Veterans Affairs Community Based Outpatient Clinics (CBOCs) represents a good opportunity for implementation of proCGM technology to improve glycemic control. Objectives: To assess treatment changes prompted by proCGM implementation.
Methods: Veterans with suboptimal glycemic control (A1c &gt;7.5% or hypoglycemia) who did not qualify for a personal CGM had a proCGM placed during office visit. Two weeks later, the proCGM was downloaded during a follow-up visit and changes were implemented as needed.
Results: Thirty-eight sensors were placed in 36 patients (two patients repeat after sensor fell off) seen by clinical pharmacists from 5 CBOCs from North Florida/South Georgia VA Health System. Baseline A1c was 8.1% (SD 1.3), proCGM data was available in 91% of patients. Mean duration of sensors was 13 days (SD 3.3). In 36% of patients, there was insulin de-intensification, mainly because of hypoglycemic events. In 6% of patients, an oral agent was discontinued because their time in range was above 90% and side effect profile (weight gain). About 18% of veterans needed insulin intensification, either adding short acting insulin or increasing basal insulin. Overall, significant treatments changes were implemented in 60% of patients, thus, avoiding clinical inertia. High glucose variability (% coefficient of variation &gt;33%) was present in 45% of veterans and two thirds of them required de-intensification of their insulin regimen due to hypoglycemia.
Conclusions: Implementation of proCGM in primary care clinics led to treatment changes in 60% of patients. This improvement project demonstrated feasibility of deploying new diabetes technologies in primary care setting.

Disclosure
K.Saren: None. A.L.Raulerson: None. S.Finch: None. J.A.Leey: None.

Funding
U.S. Department of Veterans Affairs Office of Rural Health
1056-P: Impact of Individualized HbA1c Target Setting on Diabetes-Distress, Self-Efficacy, Well-Being, and HbA1c
Authors: WESTALL SAMUEL J. , WATMOUGH SIMON , PRAKASH NARAYANAN RAM , IRVING GREG , FURLONG NIALL J. , LEWIS GEMMA A. , HARDY KEVIN J. 
Published: June 2023

American Diabetes Association guidelines emphasize the importance of individualized HbA1c target setting in glycemic management, but little is known of the impact of target-setting on patient well-being. We randomized 50 adults (type 1 or 2) to receive HbA1c targets 5 mmol/mol (0.5%) above or below current value and evaluated impact on health-related quality of life: EQ-5D-5L, EQ-VAS, diabetes distress: Problem Areas in Diabetes, PAID, self-efficacy: Diabetes Empowerment Scale Long Form, DES-LF, well-being: Wellbeing Questionnaire-12, W-BQ12 and HbA1c (%) at baseline and 3 months; with thematic analysis of semi-structured interviews in a subset of 14 people. Tabulated results for 33 completers:

We hypothesized that individualized target-setting, especially stretch targets, might worsen diabetes distress and compromise wellbeing. Multiple validated questionnaires and thematic analysis of semi-structured interviews showed no evidence of any significant deterioration. Indeed, the process of explicit individualized target setting was associated with improvements in all wellbeing measures except EQ-5D-5L and there were significant improvements in diabetes distress and psychosocial efficacy in the relaxed target group. Our data suggest that the process of setting explicit individualized HbA1c targets is a positive one, regardless of whether the target is ‘relaxed’ or ‘stretch’.

Disclosure
S.J.Westall: None. S.Watmough: None. R.Narayanan: None. G.Irving: Research Support; Graphnet, Takeda Pharmaceutical Co., Ltd. N.J.Furlong: None. G.A.Lewis: None. K.J.Hardy: Other Relationship; Sanofi, Speaker's Bureau; Napp Pharmaceuticals Limited.
1057-P: Improvement in Hypoglycemia Rates with EndoTool IV
Authors: ALOI JOSEPH , PRICE CATHERINE E. , USOH CHINENYE O. , DUNN KELLI 
Published: June 2023

Health systems are utilizing insulin dosing algorithms (IDA) within the EMR to adjust IV insulin (IVI). EndoTool IV (ETIV) is IDA software for blood glucose (BG) management which evaluates BG values to recommend IV insulin/dextrose doses to adjust the BG level within a target range. ETIV was integrated with our EMR as part of a quality project to reduce hypoglycemia in IVI patients. The tool was started in two of our ICUs that treat our DKA admissions. Dashboards capture BG values defined as hypoglycemia BG less than 70 mg/dL, severe hypoglycemia BG less than 40 mg/dL, and length of hospital stay for diabetic ketoacidosis (DKA LOS). Dosing modalities were available for hyperglycemia, HHS or DKA; 90% of ordering providers selected the hyperglycemia mode. We report results on the first 437 patient runs. The population was 60 % type 2 DM, 16 % type 1 and the remainder unknown. Average BG at IVI start was 221.5 mg/dL with an average time to goal of 4.7 hours. This translated to an average time on IVI of 15.5 hours for the group studied. Adoption of ETIV was associated with an approximate 5-fold reduction in hypoglycemic BG values, elimination of observed severe hypoglycemic BG values and a reduction in length of stay for DKA LOS. We conclude that ETIV is effective in reducing hypoglycemic events in persons treated with IVI and may reduce DKA LOS. Hospital systems considering a quality improvement project to reduce inpatient hypoglycemia for IVI should consider adopting an IDA.

Disclosure
J.Aloi: Research Support; Abbott Diabetes, Medtronic. C.E.Price: None. C.O.Usoh: None. K.Dunn: None.
106-OR: Degludec-Like Insulin Analog Improves Peripheral Neuropathy More than Control Insulin Independent of Glycemic Control in a Rat Model of Type 2 Diabetes
Authors: ÅKERSTRÖM THORBJÖRN C.A. , JUL ANDREASEN LAURA , NISHIMURA ERICA , YOREK MARK A. 
Published: June 2023

Current treatments for type 2 diabetes fail to prevent the development of peripheral neuropathy. To examine insulin degludec’s effect on peripheral neuropathy in rats, we tested insulin 700, an analog identical to insulin degludec with the same pharmacokinetic (PK) and pharmacodynamic (PD) characteristics, but with the absence of the terminal threonine on the B-chain. Rats were fed a high fat diet for 8 weeks and then treated with a low dose of streptozotocin to induce hyperglycemia. After 2 weeks, diabetic rats were treated with I700 or a control basal insulin (IC) with similar PK twice daily for 18 weeks. A healthy reference group fed a chow diet and not subjected to streptozotocin treatment was also included. The endpoints evaluated included sensory and motor nerve conduction velocity, allodynia using von Frey’s test, thermal sensitivity using Hargreaves test and corneal sensitivity. We evaluated innervation of sensory nerves using corneal confocal microscopy and, in the skin, using histological methods. We also tested vascular reactivity of epineurial arterioles using pressure myography. The insulin analogues were equally effective at correcting hyperglycemia as determined by HbA1C levels of 4.1±0.1 and 4.1±0.1% for I700 and IC, respectively. Both insulin analogues improved all neuropathy related parameters. However, I700 was more effective in that by the end of the treatment period there was no difference in thermal sensitivity, corneal sensitivity, corneal nerve fiber length and sensory and motor nerve conduction velocity between the group treated with I700 and the healthy reference rats. Interestingly, vascular relaxation to acetylcholine improved more with IC treatment. In conclusion, this study demonstrates that I700 (a degludec-like insulin analog) is a more effective treatment for diabetic peripheral neuropathy than a comparable control insulin, independent of glycemic control.

Disclosure
T.C.A.Åkerström: Employee; Novo Nordisk. L.Andreasen: Employee; Novo Nordisk. E.Nishimura: Employee; Novo Nordisk A/S. M.A.Yorek: Consultant; Novo Nordisk.
1061-P: Food Recording and HbA1c Improvement —GluCare.Health Remote Monitoring Program Compared with Traditional Care in Patients with Obesity
Authors: DEMIRCAN BEGUM , CACCELLI MILENA , SAID YOUSEF , MUNIRATHINAM VISWANATHAN , PALSKY CAROLYN , ALMARZOOQI IHSAN , HASHEMI ALI 
Published: June 2023

Introduction: Technology is intended to assist with diagnosing, treating, and monitoring patients remotely. All studies reported positive findings between technology and weight loss. Food record has been used to monitor patients with obesity, but its impact on outcomes is still little known (1). The GluCare Health care model is centered on the use of Continuous Metabolic Monitoring (CMM) and behavioral change to address metabolic diseases in a continuous manner. The app also allows for nutrition intervention through meal logging and feedback from dietitians to improve understanding of macronutrient quality and quantity. Overall, the GluCare CMM program aims to provide continuous patient supervision and support through personalized lifestyle coaching and behavioral change.
Material and Methods: Thirty participants were enrolled during 2022 at GluCare Health, Dubai (UAE). Participants were male and female aged 18 years or older with a starting body mass index (BMI) of &gt;25kg/m². All the participants were on treatment using the GLP-1 analogue. Fifteen participants opted for the GluCare Health program and fifteen opted for traditional care.
Outcomes: BMI and HbA1c reduction in each group after 3 months follow-up and description of number of food logs per opt-in patient. Results : On opt-in GluCare program, BMI average reduction was 2.89 kg/m² and mean HbA1c reduction was statistically significant (p= 0.002) with mean difference of 17% of reduction meanwhile on the opt-out group, BMI average reduction was 1.21 kg/m² and the HbA1c reduction was not statistically significant (p= 0.117) with 3.4% of reduction. The average of food records per opt-in patient/monthly was 71.29.
Conclusion: Food monitoring and personalized dietary remote orientation by specialist healthcare providers are relevant tools to reduce HbA1c and manage obesity effectively.

Disclosure
B.Demircan: None. M.Caccelli: None. Y.Said: None. V.Munirathinam: None. C.Palsky: None. I.Almarzooqi: None. A.Hashemi: None.
1062-P: Impact of COVID-Related Clinic Disruption in Patients with Type 2 Diabetes
Authors: WILLIAMS VANESSA , THIEDE JILL , BOTCHWAY ALBERT , BUHNERKEMPE MICHAEL , JAKOBY MICHAEL G. 
Published: June 2023

State of Illinois stay-at-home orders March 21-August 31, 2020 required a shift to telehealth appointments. Behaviors during COVID lockdowns adverse to glycemic management are documented, but studies of clinic disruptions on glycemic control are lacking. This is a retrospective study of adults (N = 171, age ≥ 18 y) with insulin-treated type 2 diabetes mellitus managed for at least one year prior to stay-at-home orders. Patients were seen at least once in the following intervals: Baseline 1 (March 21-August 31, 2019, 1-y before lockdown), Baseline 2 (September 1-November 30, 2019, 1-y before end of lockdown), Study 1 (March 21-August 31, 2020, lockdown), and Study 2 (September 1-November 30, 2020, immediately after lockdown). Primary endpoint was glycemic control measured by HbA1c. Nearly all appointments (97.6%) during Baseline 1, Baseline 2, and Study 2 were in-person, and appointments during Study 1 were both in-person (67.8%) and telehealth (32.2%) [P &lt; 0.0001 for comparison of Baseline 1, Baseline 2, and Study 2 to Study 1]. HbA1c improved from Baseline 1 (8.9 ± 1.7%) to Baseline 2 (8.5 ± 1.8%) to Study 1 (8.3 ± 1.6%), with P = 0.004 for the trend. HbA1c increased to 8.6 ± 1.9% during Study 2 (P = 0.07 compared to Study 1). Study 1 in-person and telehealth appointment subgroups had equivalent increases in HbA1c from Study 1 to Study 2. There was no difference in insulin dose adjustments or use of non-insulin therapeutics between the Study 1 subgroups. Other clinical parameters were similar between subgroups; however, systolic blood pressure (SBP) during Study 2 was significantly lower for patients seen in-office during Study 1 compared to Study 1 telehealth patients (128.9 ± 17.7 mm Hg vs. 137.0 ± 18.1 mm Hg, P = 0.008). There was no significant effect of telehealth appointments during pandemic lockdown on glycemic control compared to patients seen in-office, though patients seen in-office had significantly better control of SBP than telehealth patients.

Disclosure
V.Williams: None. J.Thiede: None. A.Botchway: None. M.Buhnerkempe: None. M.G.Jakoby: None.