bluuebunny/crossref_metadata_2025_split huggingface dataset:
679-P: Impact of Diabetes Distress on Glycemic Control, Diet Behaviors, and Diabetic Complications in Type 2 Diabetes Mellitus
Authors: CHO YONGIN , KIM YOUNGJOON , HEA SEO DA , HEE AHN SEONG , HONG SEONGBIN , HUN KIM SO 
Published: June 2023

Background: We investigated the clinical features of patients with high diabetes distress, focusing on changes in glycemic control, dietary behaviors, and risk of diabetic complications.
Methods: From the Korean National Diabetes Program data, we investigated 1,862 individuals with type 2 diabetes mellitus (T2DM) who completed the Korean version of the Problem Areas in Diabetes Survey (PAID-K). A total score ≥40 was considered indicative of high distress.
Results: Individuals with high distress (n=589) had significantly higher levels of glycated hemoglobin (HbA1c) than those without distress, and this trend persisted for three years. In a subgroup of individuals with HbA1c &lt;6.5% at baseline, patients with high distress were less likely to maintain HbA1c &lt;6.5% after three years of follow-up (41.2% vs. 60.6%, p=0.007). Higher PAID-K scores were associated with younger age, longer duration of diabetes, higher HbA1c level, higher carbohydrate intake, and lower fiber intake (all p&lt;0.05). There was a significant association between high distress and diabetic neuropathy (adjusted odds ratio, 1.63; p=0.002), but no significant association was found with other complications, including retinopathy, albuminuria, and carotid artery plaque.
Conclusion: High diabetes distress was associated with uncontrolled hyperglycemia, a high-carbohydrate and low-fiber diet, and higher odds of diabetic neuropathy.

Disclosure
Y.Cho: None. Y.Kim: None. D.Seo: None. S.Ahn: None. S.Hong: None. S.Kim: None.
681-P: Insulin Pump Use in Teens with Executive Function (EF) Problems and Type 1 Diabetes Is Associated with Lower A1C
Authors: VITALE REBECCA J. , VOLKENING LISA K. , TINSLEY LIANE J. , LAFFEL LORI M. 
Published: June 2023

Aim: Providers may avoid offering pump therapy to teens with EF challenges (planning, organization). We assessed whether the association of pump use and A1c is modified by EF status, adjusting for relevant factors.
Methods: EF was assessed by parent proxy-report using Behavior Rating Inventory of Executive Function (BRIEF). T-score ≥60 defined risk of EF problems for Global Executive Composite (GEC), Behavioral Regulation Index (BRI), and Metacognition Index (MI). Parents also completed the Diabetes Family Conflict Scale (DFCS). T-tests stratified by EF status compared A1c by pump use and non-use. Generalized linear models were adjusted (Tukey) for variables with p&lt;.1 in univariate analysis.
Results: Teens (N=169, 54% male) had mean age 14.9±1.3 yrs, diagnosis age 7.5±3.6 yrs, A1c 8.5±1%, 69% pump use, 9% CGM use, and 31% with GEC ≥60. With GEC &lt;60, A1c was similar in pump users and non-users (8.3 vs 8.6%, p=.25); with GEC ≥60, A1c was lower in pump users vs non-users (8.5 vs 9.2%, p=.009). Similar A1c patterns were seen when stratified by EF problems in BRI or MI. In multivariate analysis, with GEC &lt;60, A1c did not differ in pump users vs non-users (8.4 vs 8.6%, p=.36), adjusting for DFCS; a similar pattern was seen with BRI &lt;60 (p=.26) and MI &lt;60 (p=.25). With GEC ≥60, there was a trend towards lower A1c in pump users vs non-users (8.1% vs 8.7%, p=.07), adjusting for income and CGM use. With BRI ≥60, A1c was lower in pump users vs non-users (7.8 vs 8.4%, p=.03), adjusting for CGM use and DFCS score. With MI ≥60, A1c was not significantly different in pump users vs non-users (8.0% vs 8.4%, p=.25), adjusting for income, CGM use, and DFCS score. With elevated GEC, BRI, or MI scores in above multivariate analyses, A1c was lower in CGM users vs non-users (all p&lt;.05).
Conclusion: The association of diabetes technology use with lower A1c in those with elevated BRIEF scores suggests a need to re-evaluate provider reluctance to recommend use of diabetes technologies in teens presenting with potential EF problems.

Disclosure
R.J.Vitale: None. L.K.Volkening: None. L.J.Tinsley: None. L.M.Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape.

Funding
National Institutes of Health (P30DK036836, R01DK095273); JDRF (2-SRA-2014-253-M-B); Iacocca Family Foundation
69-LB: Sex-Specific Dynamics of GLP-1R and GIPR Expression in the Hypothalamus and the Amygdala of Mice
Authors: HOFMANN SUSANNA M. , ZHANG SHIQI , TOM ROBBY , MÜLLER TIMO D. , TSCHÖP MATTHIAS H. 
Published: June 2023

GIPR:GLP-1R co-agonism improves obesity and cardio-metabolic disease with superior efficacy in both male and female mice compared to mono-agonism. We detected sex-specific differences in metabolic phenotypes, which may point to differing sensitivity for GLP-1R and/or GIPR in areas of the hypothalamus regulating energy balance (ARC, VMH, DMH) and in areas of the amygdala regulating cardiovascular functions. To optimize future therapeutic benefits and minimize side effects from a perspective of sex differences, we investigated whether GLP1R and GIPR expression levels in specific cell populations of the hypothalamus and the amygdala regions are co-determined by sex and diet. Female and male C57Bl6 mice were fed normal chow or 58% high fat diet (HFD) for 21 days (n = 4, total mouse number 16). Spatial transcriptomics by in-situ hybridization method RNAscope™ was combined with immunofluorescence staining for neurons (NeuN), astrocytes (GFAP) and microglia (iba1) to identify cell type specific gene expression patterns of GLP1R and GIPR in female and male brains. In the hypothalamus, both sexes, gene expression of GLP-1R was higher compared to GIPR (ARC, VMH and DMH). In our studies GLP-1R and GIPR were mostly expressed in neurons, marginally in microglia and not observed in astrocytes in both sexes. HFD exposure reduced GLP-1R and GIPR gene expression in males only. In the Amygdala, neuronal GIPR gene expression levels were higher compared to GLP-1R in both sexes. HFD reduced GIPR and GLP-1R gene expression in males only. In females, HFD induced a slight increase of GIPR gene expression specifically in the central and basolateral amygdala. Our results reveal sex-specific dynamics in GLP-1R and GIPR expression patterns in metabolically relevant areas of the hypothalamus and the amygdala induced by HFD exposure. This may imply sex-specific dosing regimens of GIP:GLP-1R co-agonists for future treatments of cardio-metabolic disease

Disclosure
S. M. Hofmann: None. S. Zhang: None. R. Tom: None. T. D. Müller: Research Support; Novo Nordisk A/S, Speaker's Bureau; Eli Lilly and Company, AstraZeneca, Mercodia AB, Stock/Shareholder; Novo Nordisk A/S, Eli Lilly and Company. M. H. Tschöp: Consultant; Boehringer Ingelheim Pharma GmbH&Co. KG.
69-OR: Multiancestry Genome-Wide Association Study Reveals Distinct Biological Pathways and Cell Types Driving Type 2 Diabetes Risk with Heterogeneous Effects across Diverse Populations
Authors: SUZUKI KEN , HATZIKOTOULAS KONSTANTINOS , SOUTHAM LORRAINE , YIN XIANYONG , LORENZ KIMBERLY , MANDLA RAVI , TAYLOR HENRY J. , HUERTA ALICIA , RAYNER NIGEL W. , CONSORTIUM DIAMANTE , MILLION VETERAN PROGRAM VA , MEIGS JAMES B. , MCCARTHY MARK I. , MAHAJAN ANUBHA , MERCADER JOSEP M. , SPRACKLEN CASSANDRA , BOEHNKE MICHAEL , VUJKOVIC MARIJANA , ROTTER JEROME I. , VOIGHT BENJAMIN F. , ZEGGINI ELEFTHERIA , MORRIS ANDREW , 2 DIABETES GLOBAL GENOMICS INITIATIVE TYPE 
Published: June 2023

The Type 2 Diabetes Global Genomics Initiative aggregated genome-wide association studies (GWAS) of type 2 diabetes (T2D) in 428,452 affected individuals and 2,107,149 controls from five major ancestries (39.7% non-European ancestry) to enhance power for locus discovery and improve understanding of the pathophysiological basis of the disease. We identified 1,289 independent association signals (P &lt; 5 x 10-8) at 611 loci, of which 145 were previously unreported. We applied K-means clustering to the signals based on their associations with 37 cardiometabolic traits and identified eight clusters with distinct profiles. Three clusters were related to insulin secretion and had a positive, negative, or no effect on proinsulin levels. These clusters were significantly enriched (P &lt; 0.05/222, Bonferroni correction for the number of cell types) for epigenomic annotations from single-cell ATAC-seq data in pancreatic islets but had different enrichment in pancreatic ductal cells and intestinal endocrine cells. The remaining five clusters related to insulin resistance (IR) physiology: increased body fat; unfavourable fat distribution (decreased gluteofemoral fat and increased visceral fat); obesity (increased body mass index); lipodystrophy (increased fasting insulin and decreased body fat); and liver lipid metabolism (increased liver fat and liver enzymes). IR clusters showed more diverse patterns of enrichment: obesity in adrenal cells; fat distribution in endothelial cells and pericytes in blood vessels; and lipodystrophy in adipocytes. T2D signals were more strongly enriched for ancestry-correlated heterogeneity in effect sizes in insulin secretion clusters than IR clusters. These data demonstrate distinct clusters of T2D association signals representing different trajectories to disease with observable differences in effect sizes across ancestry groups.

Disclosure
K.Suzuki: None. Diamante consortium: n/a. Va million veteran program: n/a. J.B.Meigs: Consultant; Quest Diagnostics. M.I.Mccarthy: Employee; Genentech, Inc., Stock/Shareholder; Roche Pharmaceuticals. A.Mahajan: Employee; Genentech, Inc. J.M.Mercader: None. C.Spracklen: None. M.Boehnke: None. M.Vujkovic: None. J.I.Rotter: None. K.Hatzikotoulas: None. B.F.Voight: None. E.Zeggini: None. A.Morris: None. Type 2 diabetes global genomics initiative: n/a. L.Southam: None. X.Yin: None. K.Lorenz: None. R.Mandla: None. H.J.Taylor: None. A.Huerta: None. N.W.Rayner: None.
693-P: Diabetes Distress Is Common in Newly Diagnosed Families in the 4T Study and Families Are Receptive to Psychological Services
Authors: SCHNEIDER-UTAKA AIKA , PANG ERICA , CORTES-NAVARRO ANA L. , BALISTRERI ILENIA , LOYOLA ALONDRA , ARRIZON-RUIZ NORA , ALAMARIE SELMA A. , 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

Psychosocial states significantly impact T1D care and management for youth and their families. As part of a clinical pragmatic study, we report the number of elevated Patient Reported Outcomes (PROs) in newly diagnosed families and track their progress to psychological care. Parents/guardians (PG, n=125/133 4T Study 1 participants) and youth ≥11 years (n=60) were eligible to complete baseline, 3-, and 6-month PROs. PG completed Diabetes Distress Scale - Parent (DDS-P) and youth completed Diabetes Distress Scale (DDS-2) and PROMIS Pediatric Global Health Scale (PGH). Elevated PROs were based on published guidelines and were referred to the clinic's psychological services. Survey completeness was verified by staff to identify false flags. Staff reapproached the participant's psychologist for re-flagged PROs &gt;3 months after the last visit.
Over the three study time periods, a total of 99 PROs flags were evaluated (Table). At baseline, there were 32% flagged PROs, which decreased to 27% and 23% at 3 and 6 months, respectively. Elevated DDS-P was the most common reason for referral (75%). Early psychological intervention may explain the reduction in elevated PROs over the study period.
With the implementation of systematic PROs in this new onset population, we observed it was common to have diabetes distress and families were receptive to psychological services.

Disclosure
A.Schneider-utaka: 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. I.Balistreri: None. A.Loyola: None. N.Arrizon-ruiz: None. S.A.Alamarie: None. V.Ritter: None. B.Shaw: None.

Funding
National Institutes of Health (R18DK122422)
695-P: Emotional Burden of Diabetes Varies by Demographic Factors, Management Strategies, and Duration of Diabetes
Authors: COX EVELYN , ZENG ALISON , LIN EMILY , XU EMILY , BELL TREVOR , BRISTOW TRACY L. 
Published: June 2023

The impact of diabetes on emotional well-being is well founded in the literature, though research on who experiences the brunt of this burden is lacking. The present study aims to quantify the emotional burden of diabetes and investigate the relationship between demographic factors, diabetes management, and severity of diabetes burden.
From October-December 2022, 10,338 adults living with diabetes in the U.S., Canada, France, Germany, Italy, Netherlands, Sweden, and U.K. took an online survey in which they reported their diabetes technology and therapy usage and demographic information. Respondents also answered four 7-point questions about the effort and motivation behind their diabetes management and the degree to which they feel overwhelmed or burnt out by their diabetes. These items were averaged to create a composite variable on emotional burden (α = 0.85, M= 3.43, SD = 1.51). Subsequent responses were analyzed using SPSS; all significant findings are reported at p&lt;0.05.
Severity of emotional burden varies across several health-related and demographic factors. Respondents with T1D experience higher levels of emotional burden relative to those with T2D. Emotional burden is lowest among those who have had diabetes for 20 years or more and among those with an A1c ≤ 7%. People with diabetes in Canada report the highest severity, while those in Germany report the lowest. Emotional burden also varies by therapy and technology usage.
CGM users experience greater emotional burden than non-users; however, there were no differences among pump users. Additionally, T2s on insulin experienced a greater degree of emotional burden than T2s not on insulin therapy.
This research reveals several disparities in the mental burden of diabetes and suggests a link between intensity and duration of diabetes management and burden severity. Additional research is needed to identify avenues for support and burden reduction, targeted towards at-risk groups.

Disclosure
E.Cox: Employee; dQ&A. A.Zeng: Employee; dQ&A. E.Lin: Employee; dQ&A. E.Xu: Employee; dQ&A. T.Bell: Employee; dQ&A. T.L.Bristow: Employee; dQ&A.
697-P: How Does Daily Experience of Social Determinants of Health (SDOH) Impact Diabetes Self-Management and Glycemic Control in Underserved Young Adults (YA) with Type 1 Diabetes (T1D)?
Authors: CRESPO-RAMOS GLADYS , SCHECHTER CLYDE , FINNAN MOLLY , HOOGENDOORN CLAIRE J. , GONZALEZ JEFFREY S. , AGARWAL SHIVANI 
Published: June 2023

Background: While it is recognized that SDOH can impact diabetes self-management and glycemic control in underserved YA with T1D, the real-time dynamic interplay among these variables within a given individual is poorly understood, which limits intervention potential.
Methods: We recruited 61 underserved YA with T1D (ages 18-30 yo) from the Bronx, New York. We administered 14 days of 3 times daily Ecological Momentary Assessment (EMA) surveys via smartphone, paired with blinded continuous glucose monitoring (CGM). Young adults reported twice daily on their experience of SDOH and once daily on their diabetes self-management. Using dynamic structural equation modeling, we evaluated within-person direct and indirect effects of SDOH on glycemic control, mediated through self-management.
Results: We included 51 YA with complete data (mean age 23 yo, 36% Black, 54% Hispanic, 73% Medicaid-insured, mean A1c 8.6%). Within an individual, on days when reported, presence of SDOH predicted lower time in range (TIR, 70-180 mg/dl) by 0.8% and increased mean blood glucose by 1.7 mg/dl that same day, but only when diabetes self-management was affected (indirect pathway). Separately, on days when daily self-management rating was higher, regardless of whether SDOH were experienced, TIR (+6.3%) and mean blood glucose (-14 mg/dl) improved that same day.
Conclusions: We examined the daily dynamic interplay of changes in SDOH, self-management, and glycemia in a novel way in underserved YA with T1D. While experiencing daily SDOH negatively affected glycemic control, it was only when self-management was also impacted. Just-in-time self-management support delivered in the context of daily SDOH experiences offers a new approach to timely targeted intervention. Interrupting the chronic cycle of cumulative effects of daily SDOH on glycemia could affect long-term outcomes.

Disclosure
G.Crespo-ramos: None. C.Schechter: None. M.Finnan: None. C.J.Hoogendoorn: None. J.S.Gonzalez: Consultant; Virta Health Corp. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc.

Funding
NY-Regional Center for Diabetes Translational Research (5P30DK111022-08); National Institute for Diabetes and Digestive and Kidney Diseases (K23DK115896-05)
70-LB: Tirzepatide Reduces the Predicted Risk of Developing Type 2 Diabetes—Post Hoc Analysis of the SURMOUNT-1 Trial
Authors: HANKOSKY EMILY R. , WANG HUI , NEFF LISA M. , KAN HONGJUN , WANG FANGYU , AHMAD NADIA , STEFANSKI ADAM , TIMOTHY GARVEY W. 
Published: June 2023

Background: The effect of tirzepatide (TZP) on the risk of developing type 2 diabetes (T2D) in people with obesity or overweight is unknown. We aimed to assess the impact of TZP treatment on T2D risk in the Phase 3 SURMOUNT-1 trial through predictive modelling.
Methods: Cardiometabolic Disease Staging, a validated robust tool providing 10-year risk estimates of T2D, was applied to the SURMOUNT-1 trial to derive risk scores at baseline, 24, and 72 weeks. Mean risk scores and change from baseline to week 72 were calculated from a mixed model.
Results: A total of 2539 participants were randomized 1:1:1:1 to TZP 5/10/15 mg and placebo (PBO) (mean age=45 years; female=68%; White=71%). Mean risk scores at baseline ranged from 23-24% and did not differ between groups. Mean risk scores for TZP 5, 10, 15 mg, and PBO groups were 13%, 11%, 11%, and 21% at week 24 and 11%, 9%, 9%, and 23% at week 72, respectively. At week 72, the absolute mean risk reductions from baseline were 12%, 14%, 15%, and 1% for TZP 5 mg, 10 mg, 15 mg, and PBO groups, corresponding to median relative risk reductions of -60.3%, -68.3%, -69%, and -10.8%, respectively. This resulted in significantly greater risk reduction between TZP groups vs. PBO (5 mg: 12%, 10 mg: 14%, 15 mg: 14%; p&lt;0.001).
Conclusion: Treatment with TZP significantly reduced the 10-year predicted risk of developing T2D compared to PBO; most of the reduction in predicted risk was achieved by week 24.

Disclosure
E. R. Hankosky: Employee; Eli Lilly and Company, Other Relationship; Eli Lilly and Company. H. Wang: None. L. M. Neff: Employee; Eli Lilly and Company, Research Support; Aegerion Pharmaceuticals, Stock/Shareholder; Eli Lilly and Company. H. Kan: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. F. Wang: None. N. Ahmad: Employee; Eli Lilly and Company. A. Stefanski: Employee; Eli Lilly and Company. W. Garvey: Advisory Panel; Boehringer-Ingelheim, Novo Nordisk, Eli Lilly and Company, Merck & Co., Inc., Alnylam Pharmaceuticals, Inc., Fractyl Health, Inc., Inogen, Research Support; Novo Nordisk, Eli Lilly and Company, Epitomee, Pfizer Inc., Neurovalens.

Funding
Eli Lilly and Company
702-P: Similarities and Differences in Type 1 and Type 2 Diabetes Diagnosis Stories
Authors: PUGH ANDREW M. , BEVERLY ELIZABETH A. 
Published: June 2023

Background: Research on the diagnosis of diabetes portrays it as a functional process of adapting to the condition. People experience variations in physical and psychosocial responses to their diagnosis. No known research has compared diagnosis experiences between people with type 1 diabetes (T1D) and type 2 diabetes (T2D). The purpose of this study was to identify similarities and differences in T1D and T2D diagnosis stories.
Methods: We conducted in-depth interviews with adults with T1D and T2D. Two researchers coded the interviews, met to resolve discrepancies, and agreed on themes using NVivo software.
Results: A purposive sample of 48 adults participated (mean A1C=7.7±1.8%; mean duration=13.4±12.9 years, mean age=45.8±21.7 years). Nineteen (39.6%) reported a diagnosis of T1D and 29 (60.4%) reported a diagnosis of T2D. Qualitative analysis revealed three themes: 1) Similar Emotional Reactions to Diagnosis: Both participants with T1D and T2D expressed feelings of frustration, depression, fear, and denial in their diagnosis experiences. Interestingly, only T2D participants expressed worry for long-term complications, with some individuals equating their diagnosis to a “death sentence.” 2) Similar Experiences with Diagnosis as a Major Life Event: Both T1D and T2D participants described their diagnosis as a significant life event, with several noting that their life will never be the same. 3) Different Perceptions of Diagnosis as a Surprise: Participants with T1D described their diagnosis as a surprise, whereas participants with T2D did not. Those with T1D expressed initial feelings of denial, while those with T2D referred to their diabetes as inevitable.
Conclusion: T1D and T2D participants shared similar emotional reactions, and both described their diagnosis as a major life event. Differently, T1D participants perceived their diagnosis as a surprise, while T2D participants expected their diagnosis. This information may assist clinicians in supporting people with diabetes at diagnosis.

Disclosure
A.M.Pugh: None. E.A.Beverly: None.