bluuebunny/crossref_metadata_2025_split huggingface dataset:
627-P: Cortisol-Based Measures of Stress Are Associated with Fasting Blood Glucose but Not Perceived Stress in Adolescents
Authors: SANOGO FATIMATA , WATANABE RICHARD M. , WEIGENSBERG MARC , RUTH AVAION 
Published: June 2023

Objective: We previously showed that mind/body practices improve glycemic control in people with type 2 diabetes presumably by reducing stress and lowering stress biomarkers thereby reducing glycemia. The relationship between subjectively experienced stress and stress biomarkers and subsequent glycemic effects is not understood. Our objective was to determine if subjective stress predicts cortisol levels.
Methods: We examined 232 healthy, primarily Latino, adolescents (mean age=15.8 years, 70 males, all BMI categories). Stress was assessed using the 14-item questionnaire of perceived stress scale (PSS). Serum cortisol (sCOR) was measured at fasting. Salivary cortisol was measured 3 times daily (awakening, 30-min post-awakening, and evening) to assess Cortisol Awakening Response (CAR= 30-minute post-awakening - awakening) and Diurnal Cortisol Slope (DCS= evening-awakening). We performed multivariate regression to test association between PSS and sCOR and mixed effects regression to test association between PSS and CAR and DCS. Analyses were adjusted for age, sex, and BMI. Additional covariates (e.g. SES, ethnicity, etc.) gave similar results. Multivariate regression was used to assess association between PSS and fasting blood glucose (FBG), biomarkers of stress and FBG, a biologic outcome affected by stress.
Results: There was no association between PSS and sCOR (p= 0.40), CAR (p =0.26), DCS (p =0.38), or FBG (p = 0.47). There was a significant association between sCOR and FBG (β=0.02, p &lt;0.001).
Conclusion: We found no evidence of association between PSS and biomarkers of stress. We further show an association between sCOR and FBG, but no association between PSS and FBG, suggesting PSS may measure a different aspect of stress than reflected in sCOR and diurnal cortisol patterns.

Disclosure
F.Sanogo: None. R.M.Watanabe: None. M.Weigensberg: None. A.Ruth: None.
64-OR: Trends in Racial, Ethnic, and Socioeconomic Inequalities in Diagnosed Diabetes Prevalence and Incidence among U.S. Adults, 2008–2021
Authors: SAELEE RYAN , HORA ISRAEL A. , PAVKOV MEDA E. , IMPERATORE GIUSEPPINA , BENOIT STEPHEN R. , HOLLIDAY CHRISTOPHER S. , BULLARD KAI M. 
Published: June 2023

We examined national trends in racial, ethnic, and socioeconomic status (SES) inequalities for diagnosed diabetes prevalence and incidence. Self-reported data were from adults aged ≥18 years in the National Health Interview Survey 2008-2021. Annual prevalence and incidence estimates were age-standardized to the 2010 U.S. Census population. Absolute measures of inequality in diagnosed diabetes prevalence and incidence included between-group variance (BGV) for race and ethnicity (nominal categories) and the slope index of inequality (SII) for SES (educational attainment and family poverty-to-income ratio (PIR) ordinal categories). We calculated BGV and SII for each year along with the average annual percent change (AAPC) to assess trends in inequalities over time. PIR inequalities in diabetes prevalence increased (AAPC for SII: -1.7%, p=.010) while racial and ethnic (AAPC for BGV: -10.9%, p=.010) and education (AAPC for SII: 5.8%, p=.001) inequalities in diabetes incidence decreased over time (Figure). From 2008-2021, racial, ethnic, and education inequalities in diagnosed diabetes incidence improved but persisted. Income-related inequalities in diagnosed diabetes prevalence worsened over time. To close these gaps, future research could focus on identifying factors driving these trends including the contribution of morbidity and mortality.

Disclosure
R.Saelee: None. I.A.Hora: None. M.E.Pavkov: None. G.Imperatore: None. S.R.Benoit: None. C.S.Holliday: None. K.M.Bullard: None.
640-P: Coping Strategies, Quality of Life, and Glycemic Control among Adolescents with Diabetes Distress
Authors: STRATON EMMA , INVERSO HAILEY , STREISAND RANDI , JASER SARAH S. 
Published: June 2023

Objective: Up to half of adolescents with type 1 diabetes (T1D) experience diabetes distress (DD) which has been associated with lower health-related quality of life (HRQOL) and suboptimal glycemic control. The ways in which adolescents respond to DD may serve as a risk or protective factor for these outcomes, but few studies have examined the coping strategies adolescents use to manage DD.
Methods: Participants included 198 adolescents with elevated DD who completed baseline data for a randomized controlled trial (Mage 15.3±1.4, 58% female, 58% Non-Hispanic White, MT1D duration 6.4±3.7 years, MA1c = 9.2±2.2%). Adolescents completed the Responses to Stress Questionnaire, assessing coping strategies related to diabetes stressors. Subscales include primary control engagement coping (e.g., problem solving), secondary control engagement coping (e.g., positive thinking), and disengagement coping (e.g., avoidance). Adolescents also completed the Type 1 Diabetes and Life (T1DAL) measure of HRQOL. HbA1c data were gathered from medical records or at-home kits. The association of coping strategies with HRQOL and HbA1c was examined among adolescents experiencing DD.
Results: Bivariate correlations revealed that higher use of primary and secondary engagement coping strategies was associated with higher HRQOL (r=0.58; r=0.58, respectively), while higher use of disengagement coping strategies was associated with lower HRQOL (r=−0.51). Higher use of primary engagement coping strategies was associated with lower HbA1c (r=−0.21) while higher use of disengagement strategies was associated with higher HbA1c (r=0.17); all p&lt;0.05.
Discussion: Among a diverse group of adolescents experiencing DD, the use of engagement coping strategies was significantly correlated with higher HRQOL and lower HbA1c. These results highlight the value in promoting engagement coping strategies and discouraging the use of disengagement coping strategies among adolescents experiencing DD.

Disclosure
E.Straton: None. H.Inverso: None. R.Streisand: None. S.S.Jaser: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121316)
643-P: Engagement of Young Adults with Type 1 Diabetes (T1D) in a Virtual Young Adult Diabetes Clinic as a Component of Transition from Pediatric to Adult Diabetes Care
Authors: PANDHARPURKAR TEJAL H. , TWEET RYAN D. , PARK JULIE J. , HEYERMAN TESS , O'NEIL KELLY , GUTTMANN-BAUMAN INES , JOARDER FARAHNAZ 
Published: June 2023

Objectives: Young adults with Type 1 Diabetes (T1D) face unique challenges with engaging in care as they transition from the pediatric to the adult setting. The Young Adult Diabetes Clinic (YADC) is a multidisciplinary clinic that includes a group clinic, combining endocrinology, diabetes education, and behavioral health. Due to the COVID-19 pandemic, the need for a virtual YADC group clinic arose. We sought to understand how this virtual setting could impact engagement as compared with the in-person model.
Methods: We conducted a retrospective cohort study comparing in-person to virtual engagement, characterized by three central measures: rates of scheduled group visits after referral, rates of attended group visits after scheduling, and rates of follow-up after attending a group visit. A z-test was used to compare proportions of no-shows and lost-to-follow-ups between the in-person and virtual attendees.
Results: Two hundred and seventy-one patients were referred to the YADC between December 2017 and December 2022. Out of those, 149 (54%) scheduled a group visit. Subsequently, 112 scheduled patients attended a group visit. Sixty-one (54%) attended a virtual group visit, compared to 51 (46%) in-person. Out of these attendees, 45 (62%) in-person attendees followed-up subsequently with a member of the care team, and 28 (38%) virtual attendees. No-show rates were significantly higher in the virtual population at 35% vs. 4% in-person (P=.002). Lost-to-follow-up rate was 27% in the virtual population and 12% in-person, (P=.07).
Conclusions: Young adults with T1D face significant barriers to engagement that virtual medicine may help overcome. This data illustrates the continued challenges with engaging young adults in the virtual setting, and need for further understanding of what other factors may influence follow-up in this patient population.

Disclosure
T.H.Pandharpurkar: None. R.D.Tweet: None. J.J.Park: None. T.Heyerman: None. K.O'neil: None. I.Guttmann-bauman: None. F.Joarder: None.
644-P: Experiences of Community and Health Care Organizations Delivering the National DPP Lifestyle Change Program
Authors: FORMAGINI TAYNARA , REZWAN ARIBA , RODRIGUEZ DAPHNEE , PENG NG BOON 
Published: June 2023

The CDC National DPP lifestyle change program (LCP) is delivered by community and healthcare organizations nationwide to prevent or delay the onset of type 2 diabetes in adults with prediabetes. CDC recognition status assures fidelity and quality in delivering the program but receiving and maintaining it can be challenging. Using a pilot online semi-structured questionnaire, we explored the experiences of community and healthcare organizations delivering the National DPP LCP in receiving and maintaining CDC recognition. Participants were recruited from organizations delivering the National DPP LCP, prioritizing organizations in counties with low socioeconomic status. Participants were asked to discuss the challenges and facilitators their organizations faced in delivering the LCP and in achieving and maintaining CDC recognition. Thematic analysis was used to analyze and report emerging themes. A total of 25 participants completed the questionnaire (all from low SES counties). Our results indicate funding availability was the main facilitator in delivering the program, along with strong partnerships with community organizations and a dedicated team. Barriers to achieving and maintaining CDC recognition to deliver the program included difficulties recruiting and retaining participants, and issues securing funding to cover program costs. Participants reported that easing requirements to achieve/maintain recognition, increasing training opportunities, advocating for better reimbursement, and supporting network development between community organizations can increase the program's sustainability. Our findings highlighted barriers/facilitators related to the success of delivering the National DPP LCP and achieving/maintaining CDC recognition. Strategies to reduce those barriers and promote those facilitators should be considered.

Disclosure
T.Formagini: None. A.Rezwan: None. D.Rodriguez: None. B.Ng: None.

Funding
University of Central Florida
647-P: Patient Preferences Informing Choice of Second-Line Type 2 Diabetes Medications
Authors: GOLEMBIEWSKI ELIZABETH , GARCIA ANDREA E. , POLLEY ERIC , UMPIERREZ GUILLERMO , GALINDO RODOLFO J. , BRITO JUAN , MONTORI VICTOR M. , MICKELSON MINDY , MCCOY ROZALINA G. 
Published: June 2023

Available second-line glucose-lowering medications for type 2 diabetes (T2D) have variable efficacy and side effect profiles, administration requirements, and impacts on short-term and long-term health outcomes. Therefore, medication choice is informed by each patient's clinical needs and personal preferences. However, patient rationale for selecting a second-line medication for T2D is not well understood. In this mixed methods study, 40 adults with T2D across 2 health systems in the U.S. completed an individual ranking activity, sorting 16 health outcomes and 8 medication attributes by relative importance and providing context on ranking decisions. Participants were between 45-64 years old (38%), non-Hispanic White (50%) or Black (38%), 15% Hispanic, and 55% women. For health outcomes, the highest proportion of patients ranked blindness (63%), death (60%), heart attack (48%), or heart failure (48%) as very important. For medication attributes, most participants indicated that greater efficacy with respect to lowering hemoglobin A1c was very important (68%), followed by oral administration (45%) and absence of gastrointestinal side effects (38%). Combinations of outcomes and attributes ranked as very important were highly heterogeneous across individual participants, with only 2/40 patients ranking the same combination. Qualitative findings indicated that outcome importance is a function of perceived severity, susceptibility, personal relevance, preventability, and potential life impacts. For medication attributes, most participants emphasized the primary importance of lowering blood glucose and hemoglobin A1c, while treatment processes and side effects were secondary and largely idiosyncratic to the patient's lifestyle, prior experiences, and preferences. Findings underscore the importance of engaging patients in conversations about goals and preferences for care and contextualizing therapeutic decisions in patient-described priorities for T2D management.

Disclosure
E.Golembiewski: None. A.E.Garcia: None. E.Polley: None. G.Umpierrez: Research Support; Abbott, Dexcom, Inc., Baxter. R.J.Galindo: Consultant; Novo Nordisk, Eli Lilly and Company, Sanofi, Pfizer Inc., Bayer Inc., WW (Weight Watchers), Research Support; Novo Nordisk, Eli Lilly and Company, Dexcom, Inc. J.Brito: None. V.M.Montori: None. M.Mickelson: None. R.G.Mccoy: Consultant; Emmi.

Funding
Patient-Centered Outcomes Research Institute (DB-2020C2-20306)
649-P: Preliminary Outcomes of a Transition Intervention with Adolescents and Young Adults (AYAs) with Type 1 Diabetes (T1D)
Authors: MONAGHAN MAUREEN , BRYANT BREANA L. , WANG CHRISTINE H. , BOST JAMES E. , STREISAND RANDI 
Published: June 2023

Introduction: The transition from pediatric to adult diabetes care is particularly risky for AYAs with T1D. We evaluate preliminary outcomes of a behavioral intervention targeting AYA health communication, T1D self-care, and transition readiness.
Methods: 52 AYAs (48.1% male; 48.1% non-Hispanic White; M age=20.63±1.10 yrs) enrolled in Planning, Reflecting, and Engaging with Providers for Diabetes Care (PREP-DC) and were randomized to intervention (Int; n=26) or standard care (SC; n=26) groups. AYAs reported on communication, T1D self-care, and transition readiness at baseline and 4 mos (1 mo post-intervention); A1c was taken from medical records. AYAs rated satisfaction with PREP-DC participation (1-5; 5=extremely satisfied). T-tests examined change from baseline to follow-up and by group.
Results: At follow-up, 51 AYAs (98%) completed questionnaires and 37 (71%) had A1c data. AYAs reported improvements in communication, T1D self-care, and transition readiness (Table 1), with few group differences. Both groups reported high satisfaction with participation (Int M=4.41±.59; SC M=4.45±.60).
Discussion: AYAs were engaged in a behavioral trial promoting health communication; the Int group did not demonstrate significant improvements as compared to SC. Future analyses will evaluate final follow-up outcomes (8 mos post-intervention), including transfer to adult care.

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

Funding
American Diabetes Association (1-18-ACE-27 to M.M.)
652-P: Understanding the Impact of Insulin Affordability Challenges across Demographic Groups and on Mental Well-Being in the U.S.
Authors: XU EMILY , ZENG ALISON , BELL TREVOR , BRISTOW TRACY L. 
Published: June 2023

Over 30% of people with diabetes (PWD) in the United States require insulin to manage their diabetes, and the rising cost of insulin over the past two decades has put a large financial burden on many of these PWD. This study aimed to understand differences in insulin affordability challenges across demographic groups and their association with mental well-being.
In 2022, 2,794 insulin-using adult PWD in the U.S. responded to three online questionnaires in which they reported challenges affording their insulin in the past 6 months and the mental health burden of their diabetes. Respondents also answered the 5-item WHO-5 Well-being Index. Results were analyzed across demographic groups (58% type 1, 66% female, 85% white).
The prevalence of insulin affordability challenges was highest among Black/African American PWD (20%) compared to Hispanic/Latinx (12%) and white PWD (11%). Among those who had challenges affording insulin, non-white respondents were more likely to experience these challenges “all of the time” compared to white respondents (39% vs. 23%, p=.015).
PWD who struggled to afford their insulin were more likely to have a poor well-being score as measured by the WHO-5 compared to those who did not (p&lt;.001). They were also more likely to agree that diabetes management takes too much effort (p&lt;.01) and that they felt overwhelmed by their diabetes (p&lt;.001), unmotivated to manage their diabetes (p&lt;.001), and burned out by their diabetes (p&lt;.001).
PWD who struggle to afford their insulin have a higher prevalence of poor well-being and mental burden from their diabetes. These issues may disproportionately affect certain racial minority groups, among whom insulin affordability challenges are higher in prevalence and frequency. As new legislation capping insulin out-of-pocket costs come into effect this year, it will be important to understand how they impact inequalities in access to medical needs and quality of life for PWD.

Disclosure
E.Xu: Employee; dQ&A. A.Zeng: Employee; dQ&A. T.Bell: Employee; dQ&A. T.L.Bristow: Employee; dQ&A.
653-P: Associations between Anxiety and Depression Levels and Hypoglycemia Awareness and Beliefs in Long-Term Advanced Diabetes Technology Users with Type 1 Diabetes (T1D)
Authors: KUEI LIN YU , AIKENS JAMES E. , YE WEN , PIATT GRETCHEN , FISHER SIMON , BUSUI RODICA 
Published: June 2023

The information characterizing anxiety and depression levels and associated factors in long-term T1D advanced diabetes technology users is sparse. A cross-sectional observational study in T1D adults using continuous glucose monitors (CGMs) ≥1 year was conducted in a tertiary academic medical center. The Hospital Anxiety and Depression Scale was used to evaluate anxiety levels (HADS-A) and depression levels (HADS-D). CGM % of time with glucose &lt;70 mg/dL, hypoglycemia awareness (measured with Gold questionnaire), hypoglycemia beliefs (with Attitude to Awareness of Hypoglycemia questionnaire) and demographic information were collected. Multivariable linear regression was used to identify factors associated with higher HADS-A and HADS-D. Among 196 participants (63% female; mean±SD age 47±16; 91% non-Hispanic Caucasian; 80% using insulin pumps with 55% closed-loop pump users), mean±SD HADS-A was 6.5±4.0 (40% scores≥8), HADS-D was 4.1±3.1 (15% score≥8), and % of CGM time &lt;70 mg/dL was 2.0±3.0%; 34% had impaired hypoglycemia awareness. Higher HADS-A was independently associated with less time with glucose &lt;70 mg/dL, female sex, younger age, lower hypoglycemia awareness, weaker hypoglycemia concern minimization, and stronger hyperglycemia avoidance prioritization (P&lt;0.05). Higher HADS-D was independently associated with less time with glucose &lt;70 mg/dL, lower hypoglycemia awareness, and stronger hyperglycemia avoidance prioritization (P&lt;0.05).
In summary, clinically significant anxiety and depression presented in 40% and 15% of T1D patients using advanced diabetes technologies, respectively. Hypoglycemia awareness and hypoglycemia beliefs, rather than time spent in hypoglycemia, were associated with greater anxiety and depression levels. Attention to hypoglycemia awareness, hypoglycemia beliefs and mental health are needed to improve overall outcomes in T1D advanced technology users.

Disclosure
Y. Lin: None. J.E. Aikens: None. W. Ye: None. G. Piatt: None. S. Fisher: None. R. Busui: Board Member; American Diabetes Association. Consultant; Averitas Pharma, Inc., Lexicon Pharmaceuticals, Inc., Nevro Corp. Research Support; Novo Nordisk. Consultant; Novo Nordisk, Roche Diagnostics. Research Support; Medtronic, National Institutes of Health. Consultant; Procter & Gamble.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK129724); Michigan Center for Clinical and Translational Research (P30DK092926)
66-LB: Poor Sleep Is Correlated with Higher Parenting Stress in Women Who Have Had Gestational Diabetes
Authors: PARK MINSUN , SONG YOUNGKWAN , CHU MINSEUNG , QUINN LAURIE T. 
Published: June 2023

Background: Theoretically, women who have had GDM are likely to have increased stress levels following pregnancy related to parental stress exacerbated by concerns about personal health (e.g., development of T2DM). Such stress may negatively impact sleep, however, the relationship between parenting stress and sleep in women who have had GDM has not been well investigated. Therefore, the purpose of the study was to explore the correlations between sleep and parenting stress in people who have had GDM.
Methods: Twenty-six woman (ages: 34.22 ± 3.51 years; ethnicity: African American [38.46%], Hispanic [30.77%], Caucasian [19.23%], and Asian [11.54%]; A1C: 5.78 ± .98 %; BMI: 36.28 ± 10.70; age of child from GDM pregnancy: 6.07 ± 3.95 months; number of children: range1-6; months of postpartum: 6.06 ± 3.96) who had GDM on the previous pregnancy completed self-reported questionnaires. These included Parenting Stress Index (PSI-4, SF), PROMIS Global Health-Physical (v.1.2;2a), PROMIS Fatigue (v.1.0;8a), PROMIS Sleep Disturbance (v.1.0;8b), and PROMIS Sleep-Related Impairment (v.1.0;8a). The Spearman’s correlation was used to analyze data using STATA 17.0.
Results: The mean total score on the Parenting Stress Index was positively correlated with PROMIS Fatigue (Spearman’s r = 0.61, p &lt; .01); PROMIS Sleep Disturbance (r = 0.61, p &lt; .001); and PROMIS Sleep-Related Impairment (r= 0.57, p &lt; .001). On the other hand, the mean total score on the Parenting Stress Index was negatively correlated with PROMIS Global Health-Physical (r = -0.58, p &lt; .01), and was not correlated with A1C and BMI.
Conclusion: In this glucose intolerant group of women with previous GDM, parenting stress was correlated with fatigue alone with sleep disturbances and impairments. In addition, parenting stress was negatively correlated with individuals’ assessment of their health. Finding suggested that it is necessary to explore the associations between parenting stress, sleep, and glucose metabolism in women who have had GDM.

Disclosure
M. Park: None. Y. Song: None. M. Chu: None. L. T. Quinn: None.