bluuebunny/crossref_metadata_2025_split huggingface dataset:
544-P: Effect of Organization Type on Priority Population Outcomes in the National Diabetes Prevention Program (National DPP)
Authors: BOWEN SHELLY-ANN , LANDAU ERIN O. , ELY ELIZABETH 
Published: June 2023

In 2012, the CDC Diabetes Prevention Recognition Program approved its first recognized organization. Since then, it has recognized 4,000+ organizations to deliver the National DPP lifestyle change program to 600,000+ participants at type 2 diabetes risk. This analysis examined data from 624,422 participants to determine the impact of 5 organization types on priority population outcomes: community centers, higher education, government, healthcare providers, and for-profit/insurers. Most participants (65.7%) enrolled in for-profit/insurer organizations. Community centers enrolled the highest percentage of participants who identified as Hispanic/Latino (20.8%) and Native Hawaiian/other Pacific Islander (3%), and government organizations the highest percentage of Black/African American (17.7%) and American Indian/Alaska Native participants (10.8%). Higher education organizations enrolled the highest percentage of Asian/Asian American participants (3.4%). Men primarily enrolled in for-profit/insurer organizations (25.3%), and those aged 65+ enrolled mainly in healthcare-based programs (30.6%). Time in the program is associated with type 2 diabetes risk reduction. Those enrolled in higher education organizations stayed in the program the longest, with a mean of 233 days. Community centers and government organizations, which lead in the enrollment of some priority populations, had means of 196 and 218 days, respectively. Native Hawaiian/other Pacific Islander participants stayed in community center programs above the mean of 226 days. In government organizations, Black/African American and American Indian/Alaska Native participants remained for an average of 227 and 219 days, respectively. Understanding which types of organizations better serve priority populations, and assisting them in recruitment and retention, is key to reducing the risk of developing type 2 diabetes among these groups and reducing disparities in outcomes.

Disclosure
S.Bowen: None. E.O.Landau: None. E.Ely: None.
545-P: Impact of Participant Characteristics on Weight Loss in the National Diabetes Prevention Program (2012–2021)
Authors: ZHU RONGSHUN , LANDAU ERIN O. , ELY ELIZABETH 
Published: June 2023

The 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. A risk reduction outcome for the LCP is weight loss of at least 5%. This analysis used multivariate logistic regression to assess the association between participant characteristics and 5% weight loss for 470,238 enrolled participants who had the opportunity to attend the 12-month LCP in 2012-2021. Analysis shows that 59% of participants attended the LCP online, 35% in-person, and 6% via distance learning or combination delivery. With respect to demographics, 77% were women, 55% of whom were aged 45-64 and 32% aged 18-44; 61% identified as White, 12% identified as Black or African American, and 12% identified as Hispanic or Latino. The odds of meeting the goal for those aged 65+ and 45-64 were 1.6 and 1.2 times greater than those 18-44, respectively. Those who identified as White had higher odds of meeting the goal than those who identified as Hispanic or Latino, Black or African American with odds ratios (ORs 1.3), or Asian or Asian American (ORs 1.2). Compared with participants enrolled in in-person programs, online participants had the lowest odds of reaching the goal (ORs 0.5), and distance learning participants had odds similar to those of in-person participants (ORs 1.0). The 5% weight loss success was significantly higher among those who attended &gt; 16 sessions (ORs 2.9) for the study population. Women were less likely to meet the goal than men (ORs 0.8). Results of this analysis indicate that participant characteristics strongly impact whether someone meets the 5% weight loss goal. Program delivery strategies tailored to specific populations could be effective in helping participants achieve programmatic goals.

Disclosure
R.Zhu: None. E.O.Landau: None. E.Ely: None.
547-P: Impact of the COVID-19 Public Health Emergency on Delivery of the National Diabetes Prevention Program Lifestyle Change Program
Authors: ELY ELIZABETH 
Published: June 2023

In January 2020, the Department of Health and Human Services (HHS) declared the COVID-19 pandemic to be a public health emergency (PHE). As a result of this declaration, organizations delivering the National DPP lifestyle change program (LCP) had to decide whether to hold program sessions virtually, in socially distanced spaces, or discontinue (temporarily or permanently). This analysis looks at how CDC-recognized organizations chose to deliver, or not deliver, the LCP during this time. As of data submitted by October 2022, 1,810 organizations had delivered at least one session since 2019, the year leading up to the PHE. At the start of 2020, 1,370 organizations were active: 1,251 in-person, 28 online, 44 distance learning, and 47 combination. The remaining 440 were either approved during the PHE or had gone inactive before the start of it. Of those active at the start of 2020, 219 (16%) had not submitted data on sessions held on or after this time, indicating a pause in delivery. Since the PHE began, 373 new organizations have been approved, 357 of which are still active. Of these new organizations, 241 have been mainly focused on delivery with at least one virtual component. Approval of new organizations in 2020 decreased for those delivering in-person, whereas approval of new online, distance learning, and combination organizations increased by 207%, 158%, and 122%, respectively. Data submitted by in-person organizations in 2020 and 2021 indicated that many of them delivered only virtual sessions during that time, which might explain the large increases in approval of virtual organizations. New enrollment after the start of 2020 among these organizations was 185,596 as of October 2022: 62,217 in in-person organizations, 99,688 in online, 14,859 in distance learning, and 8,832 in combination. As we move out of the PHE, we are mindful of the need to help organizations delivering the LCP adapt to more flexible delivery to accommodate participants’ evolving needs.

Disclosure
E.Ely: None.
55-LB: “Older patients manifest it differently”—HCP Perspectives of People Aging with Type 1 Diabetes
Authors: UDDIN KASHIF , STUCKEY HEATHER L. , HUGHES ALLYSON 
Published: June 2023

In the last decade, people with type 1 diabetes (T1D) are living longer due to advancements in diabetes technology. However, there is little research on treating this population. This study examined health care professionals’ (HCPs) experiences in treating older adults with T1D to identify clinical and practical differences. Participants were recruited from T1D Exchange (an online diabetes community) and 11 HCPs (average time in practice: 21.5 years) were interviewed. Interview questions focused on their clinical experiences, challenges that older people experienced, and needs of this aging population that might be different from other age groups. The interviews were recorded, transcribed, independently coded by 2 coders and thematically analyzed. Themes included treatment recommendations for older adults with T1D, diabetes education, post-severe hypoglycemic event recommendations, fear of hypoglycemia, insurance, and polypharmacy. As older adults with diabetes continue to live longer, new recommendations for this age group should be considered. Specifically, treatment recommendations amongst older adults differ in glycemic target goals and HbA1c range. These recommendations are made to combat any severe hypoglycemic episodes prone to this population. There is a greater degree of neurocognitive decline which poses a greater risk for life threatening emergencies, not only in older adults but also older adults with T1D. It is the HCPs duty to prepare this population for the risks of developing certain complications associated with T1D as well as the possible dangers if the more emergent situations are not addressed promptly.

Disclosure
K. Uddin: None. H. L. Stuckey: Consultant; Eli Lilly and Company. A. Hughes: None.
551-P: Healthy Lifestyle Behaviors as Predictors of Initiation of Hemodialysis (HD) in People With and Without Diabetes Mellitus (DM)
Authors: OSAWA TAEKO , FUJIHARA KAZUYA , YAMADA MAYUKO H. , YAGUCHI YUTA , SATO TAKAAKI , KITAZAWA MASARU , MATSUBAYASHI YASUHIRO , YAMADA TAKAHO , KODAMA SATORU , SONE HIROHITO 
Published: June 2023

Breslow’s Health Practice Index (HPI) includes recommendations for a healthy lifestyle and is composed of 7 simple lifestyle factors (never smoking, regular physical activity, moderate or no use of alcohol, 7-8 hours sleep regularly, maintaining proper weight, eating breakfast, and not eating between meals). Cardiovascular health metrics (CVHMs), defined by the American Heart Association are composed of lifestyle factors and clinical laboratory values (smoking, weight, physical activity, diet, cholesterol, blood pressure, and blood glucose). To clarify the impact of HPI or CVHMs on incident HD according to DM, we analyzed a nationwide claims-based database of 294,647 people included from 2008-16 (DM- 277,935, DM 16,712). Risk for HD were analyzed according to DM and HPI/CVHMs based on the number of unfavorable lifestyle factors in the HIP and unfavorable lifestyle factors and clinical values in the CVHM (Table). Multivariate Cox regression analysis showed that DM increased the risk of dialysis 5- to 6-fold and DM and CVHMs synergistically increased the risk of HD. Results indicated that factors similar to those used to predict cardiovascular disease would also be useful to predict HD. These approaches might be helpful in clinical practice and patient education.

Disclosure
T.Osawa: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. M.H.Yamada: None. Y.Yaguchi: None. T.Sato: None. M.Kitazawa: None. Y.Matsubayashi: None. T.Yamada: None. S.Kodama: None.
552-P: Disparities in Preventive Reproductive Health Services in Women with Type 1 and Type 2 Diabetes
Authors: TREASURE MADELINE , NOURBAKHSH POURANDOKHT S. , OSUNA-GARCIA ANTONIA , ESTEVES SARA C. , KRANSDORF LISA N. , WISK LAUREN E. 
Published: June 2023

About 50% of (~13 million) reproductive aged women with Type I or II diabetes receive any preconception care. Even fewer receive contraceptive counseling, or other vital reproductive health services. This scoping review aimed to explore if reproductive aged women with diabetes receive adequate preventative reproductive health services compared to women without diabetes. A systematic search strategy of the published literature was built and applied in multiple databases (PubMed, Web of Science, Cochrane). Interventional and observational studies describing access to reproductive health services among reproductive-aged women with compared to those without diabetes were included. The Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines were followed. The search strategy identified 6785 unique records. A two reviewer method was used to screen abstracts, with 41 studies identified to be relevant. These studies were separated into the domains of contraception counseling (N=20), cervical cancer screening (N=12), counseling/screening for sexually transmitted infections (N=3), and preconception counseling (N=12). We did not include studies focusing on prenatal care, pregnancy, menstrual irregularities, sexual dysfunction, or breast cancer screening. While a vast amount of literature exists related to diabetes and pregnancy, this scoping review draws attention to the lack of research focused on the reproductive health of women with diabetes prior to pregnancy. The majority of available literature focuses on contraception and preconception management, consistently demonstrating that women with diabetes lack adequate preventative reproductive healthcare compared to their nondiabetic counterparts. Far less evidence exists for sexually transmitted infection risk assessment and screening. It is imperative that future research focus on ways to mitigate disparities in access to reproductive health services for women with diabetes.

Disclosure
M.Treasure: None. P.S.Nourbakhsh: None. A.Osuna-garcia: None. S.C.Esteves: None. L.N.Kransdorf: None. L.E.Wisk: None.
560-P: Examining Characteristics of CDC-Recognized Organizations Delivering the National Diabetes Prevention Program—Full and Full-Plus Recognition
Authors: LLOYD KAYLA R.K. , ELY ELIZABETH 
Published: June 2023

Organizations that deliver the National Diabetes Prevention Program (National DPP) lifestyle change program (LCP) can earn CDC-recognition (Pending/ Preliminary/ Full) from the Diabetes Prevention Recognition Program (DPRP). The highest levels of recognition are Full (awarded when risk reduction and eligibility requirements are met) and Full Plus (awarded when retention thresholds are met in addition to achieving Full). As of October 2022, 860 organizations were actively in one of these statuses. The objective of this analysis was to examine the characteristics associated with organizations that achieve the highest levels of recognition.
Examining delivery modes, in-person programs achieved Full/Full Plus at a higher rate than organizations using other delivery modes. Of the organizations eligible to advance (those who submitted data for evaluation), in-person organizations moved into Full/Full Plus at a rate of 65.3%, with distance learning, online, and combination organizations achieving these recognition levels at rates of 53.1%, 56.4%, 46.4%, respectively. While under the COVID-19 public health emergency (PHE), many in-person organizations continued to deliver virtually. Organizations classified as Cooperative Extension Sites or Hospitals/Healthcare Systems/Medical Groups/Physician Practices had the highest rate of advancing to Full or Full Plus, 85.7% and 72.4%, respectively.
On average, organizations in Full Plus enrolled a higher percentage of participants who identified as non-Hispanic or Latino/Black or African American than organizations in Full at 24% and 20%, respectfully. On average, organizations in Full/ Full Plus enrolled similar percentages of men and women. Organizations in Full Plus enrolled a higher percentage of participants aged 65+.
Examining characteristics of organizations provides insight of the recognition trajectory and can shape future support of all recognized organizations.

Disclosure
K.R.K.Lloyd: None. E.Ely: None.
563-P: Outcomes of the Dulce Digital–COVID Aware (DD-CA) Discharge Texting Platform for U.S./Mexico–Border Hispanics with Diabetes
Authors: SPIERLING BAGSIC SAMANTHA R. , PADILLA NEELY OLIVIA M. , SANDOVAL HALEY , BASTIAN ALESSANDRA , BELASCO REBEKAH , ORENDAIN NATALIA , SORIANO EMILY , TALAVERA LAURA , FORTMANN ADDIE L. , PHILIS-TSIMIKAS ATHENA 
Published: June 2023

Hispanic individuals are disproportionally impacted by type 2 diabetes (T2D) and COVID-19 compared to non-Hispanic White individuals. Notably, T2D is associated with greater COVID-19 disease severity and mortality; however, with good glucose control, prognosis improves. During the COVID-19 pandemic, N=172 Hispanic patients with T2D hospitalized near the US/Mexico border in California were randomized to receive Dulce Digital-COVID Aware (DD-CA) texting platform or usual care. The DD-CA program provides culturally tailored, educational, and motivational text-messaging related to diabetes management and COVID prevention, remote glucose monitoring, and automated, tailored feedback on behavioral and glucose metrics for 6 months post-discharge. Participants were on average 58 ± 13 years, 52% male, 9.3% COVID+, with a mean BMI of 32.7 ± 8.2 and mean baseline HbA1c of 9.6% ± 2.2%. In unadjusted analyses, DD-CA did not reduce 30- or 90-day hospital readmission rates compared to usual care (28% vs 15%, p = 0.06; and 37% vs 35%, p = 0.9, respectively). Follow up HbA1c completion rates were low; however, HbA1c improvement was significantly greater among those in DD-CA compared to usual care at 3 months (n=56; −2.69% vs. −1.45%, p=0.05), with slight attenuation of effect at 6 months (n=64; −2.03% vs −0.91%, p=0.07). Given the reduction of in-person clinical care and emphasis on staying at home amid the pandemic, DD-CA represented an alternative pathway for delivering diabetes- and COVID-related education and support to high-risk individuals during this time. While the DD-CA intervention did not significantly impact readmission rates, it was effective in achieving a clinically significant, &gt;1% greater improvement in HbA1c relative to usual care post-hospital discharge. Additional analyses will be presented on clinical and patient-reported outcomes.

Disclosure
S.R.Spierling bagsic: None. A.Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH − National Institutes of Health. O.M.Padilla neely: None. H.Sandoval: None. A.Bastian: None. R.Belasco: None. N.Orendain: None. E.Soriano: None. L.Talavera: None. A.L.Fortmann: Employee; Dexcom, Inc.

Funding
National Institutes of Health (R01DK112322-05S1)
565-P: A Case of Atypical Diabetes, Monogenic Diabetes
Authors: ATTAH RALUCHUKWU 
Published: June 2023

A Case of Atypical Diabetes, Monogenic Diabetes, Monogenic diabetes formerly known as maturity onset diabetes of the young (MODY) is typically diagnosed in younger patients, usually age &lt;25 years. It is a heterogenous disorder and typically accounts for 2-5% of diabetes. Clinical findings tend not to be reliable in determining the underlying etiology, hence patients may be misdiagnosed as type 1 or type 2 diabetes mellitus (DM). Patient is a 42-year-old non-obese male (BMI 21.9) with past medical history of type 2 diabetes mellitus who presented to establish care. He was diagnosed at age 25 with type 2 diabetes. At presentation, he had a hemoglobin A1c of 12.4% and was being managed with metformin, glimepiride and semaglutide by his primarry care physician. He has never been developed diabetes ketoacidosis or been on insulin. Also, his BMI has always been &lt;25. He endorsed an extensive family history of DM but none of them require insulin or are overweight. His father, mother, brother, paternal grandfather and grandmother all have type 2 DM, most mainly diagnosed in their twenties and thirties. Laboratory studies including c-peptide and islet cell autoantibody screen panel were obtained which were low-normal (0.7ng/ml) and negative respectively. Repeat C-peptide was normal at 3.1ng/ml. Given these findings and his extensive family history of DM in non-obese persons, MODY was suspected. Hence genetic testing was done and revealed a heterogenous mutation, ABCC8 Variant in KATPase consistent with MODY12. This variant is typically sulfonylurea responsive. No screening test currently exists for monogenic diabetes. This case demonstrates the misdiagnosis of monogenic diabetes and the need for updated screening guidelines to aid with early diagnosis to prevent the associated comorbidities. Also, early diagnosis will prompt genetic testing in patients off springs and aid in adequate treatment. Finally, the value of a comprehensive history cannot be overemphasized in aiding to make a diagnosis of monogenic diabetes

Disclosure
R.Attah: None.
566-P: SEE-Diabetes in a Different Light—Content Validation of a Patient-Centered Diabetes Self-Management Education Aid for Older Adults
Authors: DEJHANSATHIT SIROJ , NARINDRARANGKURA PLOYPUN , DAY MARGARET A. , BOREN SUZANNE A. , KHAN UZMA Z. , SIMOES EDUARDO J. , KIM MIN 
Published: June 2023

Diabetes self-management education and support (DSMES) is a significant component of diabetes care. However, our previous study indicated a lack of patient-centered DSMES during clinic visits. Therefore, we developed a patient-centered DSMES education aid named SEE-Diabetes (Support-Engage-Empower-Diabetes) to facilitate providers and patients in making shared decisions (Figure 1). We aimed to validate the content of SEE-Diabetes by interviewing 11 diabetes patients aged 65 and older, and 8 providers. Participants were asked to evaluate SEE-Diabetes statements incorporated in the Patient Education section by answering focused questions. The participants were asked if the statements were easy to read, helpful, and if they provided additional value to address the concerns, needs, and preferences of older people with diabetes. They were also asked if they would use SEE-Diabetes to improve their diabetes care. Thematic analysis revealed most participants agreed that it was easy to read and understand. Most of them found it very helpful, added value to the clinic note, and would use it to help take care of their diabetes. However, one patient shared it was unnecessary for long-term diabetes patients. Some providers shared concerns about lack of time. Future studies will evaluate the usability and feasibility of SEE-Diabetes as an educational tool in clinical practice.

Disclosure
S.Dejhansathit: None. P.Narindrarangkura: None. M.A.Day: None. S.A.Boren: None. U.Z.Khan: None. E.J.Simoes: None. M.Kim: None.
576-P: Local Muscle Microenvironment, Instead of Training Status, Affects Resting IMTG Turnover
Authors: CHOW LISA S. , BANTLE ANNE , ALVEAR ALISON C. , MASHEK DOUGLAS G. , JENSEN MICHAEL D. 
Published: June 2023

Intramyocellular triglyceride (IMTG) level correlates with insulin resistance. Paradoxically, trained humans and obese, sedentary, insulin-resistant humans have high IMTG levels despite discrepant clinical phenotypes. We hypothesize that higher IMTG turnover in trained humans explains this paradox.
Methods: Obese, insulin-resistant subjects [n=47, mean (SD), BMI:36.2 kg/m2(5.7), VO2max 25.4 ml/kg/min (5.7)] and lean trained subjects [n=15, BMI:22.2 kg/m2(1.8), VO2max 55ml/kg/min (10.1)] were fasted overnight. Two muscle biopsies (Bx) were acquired during a pulse-chase experiment using [U-13C]palmitate and [9-2H]palmitate infusions (6 h each), overlapping by 1 hour. Bx#1 was performed during the infusion overlap [last hour of 6 h [U-13C]palmitate infusion, 1 hour after starting [9-2H]palmitate. Bx#2 was performed at study conclusion [last hour of [9-2H]palmitate infusion, 6 hours after stopping [U-13C]palmitate]. Palmitate enrichment and concentration were measured. [9-2H]palmitate IMTG incorporation at Bx#1 and [U-13C] IMTG loss at Bx#2 indicated the interplay between plasma and muscle fatty acids.
Results: Palmitate IMTG incorporation positively correlated between measures of IMTG turnover and negatively with insulin sensitivity. No correlation seen for VO2max/BMI.
Conclusion: Muscle-level IMTG measures dictates higher resting IMTG turnover more than training related phenotype.

Disclosure
L.S.Chow: Research Support; Dexcom, Inc. A.Bantle: None. A.C.Alvear: None. D.G.Mashek: None. M.D.Jensen: Other Relationship; Novo Nordisk, Elsevier.

Funding
National Institutes of Health (R01DK098203)