bluuebunny/crossref_metadata_2025_split huggingface dataset:
632-P: Glycemic Control in Diabetes Camp Attendees Remotely Monitored and Nonadjunctively Managed with CGM
Authors: GLEICH SARAH E. , TECCA HEATHER R. , GIBSON-NORTH NATHANIEL D. , ANDRADE SARAH B. , WELSH JOHN , SCHUSTER ERIKA , WALKER TOMAS C. 
Published: June 2023

Remote monitoring of CGM data of children and youth attending diabetes camp has been shown to reduce overall and nocturnal hypoglycemia, compared to treatment decisions based on self-monitored blood glucose (SMBG) values. However, some diabetes camps still require regular SMBG testing. We compared at-home versus at-camp glucose control where CGM data were used as the basis for diabetes treatment decisions. Thirty-four campers with T1D (mean±SD age 12±3 years, A1C 7.5±1.2%) were eligible for inclusion if they were using Control-IQ technology (Tandem Diabetes Care) prior to and during their attendance at Camp Buck, a diabetes-focused facility near Lake Tahoe. At camp, their CGM data (Dexcom G6) were integrated with the CampViews EMR system (Nevada-California Diabetes Association). CGM data from at-home and at-camp intervals were compared. As shown in the Table, mean glucose and overall time in range (TIR, 70-180 mg/dL) improved at camp, with statistical significance in the overnight (10PM-6AM) interval. Although time in Level 1 hypoglycemia increased at camp, there were no significant changes between at-home and at-camp levels of Level 2 hypoglycemia. CGM data can be used nonadjunctively in the camp setting to maintain or improve glycemic control. Centralized remote monitoring of glucose data allows camp attendees and staff to safely reduce or eliminate SMBG testing.

Disclosure
S.E.Gleich: Research Support; Dexcom, Inc. H.R.Tecca: Employee; Dexcom, Inc. N.D.Gibson-north: None. S.B.Andrade: Employee; Dexcom, Inc. J.Welsh: Employee; Dexcom, Inc. E.Schuster: Employee; Dexcom, Inc. T.C.Walker: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc.
635-P: Health Disparities among People With and Without Diabetes during 24 Months of the COVID-19 Pandemic
Authors: MYERS BARBARA A. , KLINGENSMITH RACHEL , ANWAR FARRAH , GONZALEZ CASANOVA INES G. , DE GROOT MARY 
Published: June 2023

This study describes the mental health of US adults with (PWD) and without (ND) diabetes during the COVID-19 pandemic. A 24-month web-based survey was administered from May 2020 (baseline, n=2,176) to June 2022 (24MO; n=1,172; 5 time points). Demographics, pandemic experiences, diabetes distress (DDS-17), depression (PHQ-8) and anxiety (GAD-7) symptoms, perceived stress (PSS-10), and resilience (BRS) were collected. On average, 24MO completers (53.1%) were 53 years (SD=16.4), primarily female (80.9%) and White (91.3%), highly educated (45.0% post-master’s degree), homeowners (72.7%), with an annual household income of ≥ $60,000 (62.2%). They were less likely to have a diagnosis of depression compared to non-completers (all p&lt;0.05). Mental health score means (SD) were DDS= 2.2 (1.0; moderate), PHQ=4.9 (5.0; mild), GAD=4.0 (4.7), PSS=13.3 (8.0). At 24MO, type 2 diabetes (TD2) prevalence was 14% (167), prediabetes 7% (82), and type 1 4% (52; T1D). PWD showed higher levels of financial worry/distress compared to ND (all p&lt;0.05). Similarly, PWD reported COVID as a greater personal health threat (range of means= 4.3-4.8) compared to ND (M=3.7, SD=1.8; p&lt; 0.001). Greatest pandemic burnout was reported by T1D (M=2.9, SD=2.0) and lowest among T2D (M=2.0, SD=2.1; p&lt;0.05). Across the 5 time points, measures of depression, anxiety, perceived stress and diabetes distress improved (all p&lt;0.001). At 24MO, rates of personal COVID infection (33.0%), knowing someone with (93.7%) or who died from COVID (41.4%) increased compared to 12MO (first time point queried; 10.2%, 81.3%, and 34.1%, respectively; all p&lt;0.001). However, financial concerns worsened. Difficulty paying bills increased (11.8% at 24MO v. 6.1% at baseline; p&lt;0.001) and worsening financial appraisal increased (25.4% at 24MO vs. 17.1% at baseline; p&lt;0.05). These data show that, despite improvements in mental health from the height of the pandemic to summer 2022, financial concerns persisted, particularly in those with diabetes.

Disclosure
B.A.Myers: None. R.Klingensmith: None. F.Anwar: None. I.G.Gonzalez casanova: None. M.De groot: Consultant; Barbara Kenner Family Foundation, Medscape, Mediflix, Inc.
646-P: Improved Metabolic Outcomes in Individuals with Type 2 Diabetes and Nonalcoholic Fatty Liver Disease after a Digital Intervention
Authors: BJORNSDOTTIR SIGRIDUR , ÚLFSDÓTTIR HILDIGUNNUR , DOBIES BARTOSZ , GUDMUNDSSON ELIAS F. , SVEINSDOTTIR KOLBRUN , ISBERG ARI P. , BJORNSDOTTIR GUDLAUG , SIGURDSSON SIGURDUR , GUDNASON VILMUNDUR 
Published: June 2023

Nonalcoholic fatty liver disease (NAFLD) is a common comorbidity among individuals with type 2 diabetes mellitus (T2DM). The aim of this study was to test the feasibility and efficacy of a digital intervention to improve metabolic outcomes for patients with T2DM and NAFLD.
A single-arm study was conducted in Iceland. Participants were provided with a 12-week digital behavioral intervention via the Sidekick app, focused on health education and lifestyle coaching, reducing carbohydrate intake, increasing physical activity, and improving mental health. Individuals with NAFLD and either BMI&gt;30, metabolic syndrome, or T2DM were recruited; here we present a sub-analysis of participants with T2DM. The primary outcome was feasibility, as measured by user retention and engagement; secondary outcomes were changes in anthropometric and clinical measures from baseline to post-program.
Out of 38 recruited participants, 19 (50%) had T2DM (mean age 61.1 (SD 10.8) years, 10 (53%) female) and 18/19 (95%) completed the program. The 19 participants were active for a median of 7 days/week (IQR 4.76-7.0). Mean weight reduction was 3.9 kg (SD 4.1, p&lt;0.001) and the average fat mass reduced by 2.4 kg (SD 2.9, p=0.002); a 4.9% relative change (SD 6.3). The median decrease in HbA1c levels was 4.0 mmol/mol (IQR -0.5, 5.0, p=0.05), fasting insulin decreased by 4.8 µU/ml (SD 9.2, p=0.03), and HOMA-IR by 2 mmol/L (SD 3.7, p=0.03). Mean systolic blood pressure reduced by 9.1 mmHg (SD 16.6, p=0.03), and relative liver fat by 18.6% (SD 25.3, p&lt;0.01). These changes were not explained by changes in prescriptions or dosages, nor by self-reported medication adherence, and were not different between patients with or without T2DM.
At the end of the 12-week digital intervention, participants with T2DM had improved glucose metabolism, liver fat values and body composition, suggesting that this digital intervention can help individuals with T2DM and NAFLD achieve better metabolic outcomes.

Disclosure
S. Bjornsdottir: Research Support; Sidekick Health, Reykjavik, Iceland. H. Úlfsdóttir: Employee; Sidekick Health. B. Dobies: Employee; Sidekick Health. E.F. Gudmundsson: Employee; Sidekick Health. K. Sveinsdottir: Employee; Sidekick Health. A.P. Isberg: Employee; Sidekick Health. G. Bjornsdottir: None. S. Sigurdsson: None. V. Gudnason: None.
65-LB: Social Determinants of Health Predict Self-Care in Type 1 Diabetes
Authors: MATUS AUSTIN M. , RIEGEL BARBARA , RICKELS MICHAEL R. 
Published: June 2023

Social determinants of health (SDH), or the conditions in which people live, learn, work, play, and age strongly influence health inequities among adults with type 1 diabetes (T1D). Diabetes self-care, or daily behaviors performed to maintain health (maintenance), monitor for changes (monitoring), and manage illness (management), is essential for T1D management, but may also be impacted by SDH. We aimed to determine if SDH predicted self-care maintenance, monitoring and management, and if so, identify which SDH items were the most salient predictors. A diverse sample of adults with T1D (n=200, 27% Black, 61% female, median age: 35 years, disease duration: 19 years) completed an SDH risk assessment (PRAPARE tool; Risk Tally Scoring Method applied to 14 items to yield a composite risk score) and self-care assessment (Self-Care of Diabetes Inventory [SCODI]; 3 self-care [maintenance, monitoring, and management] and 1 confidence scale). A multivariable linear regression model of each self-care scale was built with SDH risk and confidence as predictors of self-care. For each self-care scale exhibiting a significant association with SDH risk, an exploratory multivariable model was built to determine which of the 14 SDH items were the most salient predictors. SDH risk was a significant predictor of self-care maintenance. For every 1 unit increase in SDH risk, maintenance was estimated to decrease by 1.14 units (p&lt; .01). Exploratory multivariable analysis revealed employment insecurity and material insecurity to be the most salient SDH risk predictors of maintenance. Participants who were not employed full-time were estimated to have maintenance scores 5.15 ± 2.27 units (p&lt;.05) less. For every 1 unit increase in material insecurity (score range:0 - 7), estimated maintenance decreased by 2.6 ± .89 units (p &lt; .01). Those with higher SDH risks are less likely to perform behaviors to maintain health. Providers may facilitate self-care of patients by assessing SDH risks and offering self-care guidance considerate of SDH risks.

Disclosure
A. M. Matus: None. B. Riegel: None. M. R. Rickels: Consultant; Sernova, Corp., Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Dompé.

Funding
National Institutes of Health (31NR020137, R01DK091331)
65-OR: Differences in the Use of Diabetes Medications with Cardiorenal Benefits between Rural and Urban America
Authors: STEIGER KYLE , SWARNA KAVYA , HERRIN JEPH , MCCOY ROZALINA G. 
Published: June 2023

Rural Americans are more likely than urban Americans to have poorly controlled diabetes and to die from diabetes-related complications. This is due to multiple biopsychosocial factors, including poor access to primary and specialty care. Previous studies found disparities in the use of newer glucose-lowering medications with cardiovascular and renal benefits (GLP-1RA and SGLT2i) by women, Black patients, and low-income patients. Whether there are disparities in the use of GLP-1RA and SGLT2i based on rurality is unknown. Using a de-identified dataset of commercially insured and Medicare Advantage beneficiaries with type 2 diabetes, we examined diabetes medication use across the spectrum of rurality: urban (population &gt;50,000), small town (population 2500-50,000), and rural (population &lt;2500). Patients with type 2 diabetes and vascular disease (rural n=25,684, small town n=147,045, urban n=810,647) were prescribed the preferred GLP-1-RA (rural 6.6%, small town 7.2%, urban 6.5%) and SLGT2i (rural 4.6%, small town 5.3%, urban 4.5%) less often than non-preferred sulfonylureas (rural 28.7%, small town 29%, urban 27.4%). Patients with heart failure (rural n=8,818, small town n=50,489, urban n=247,621) were prescribed preferred SGLT2i (rural 3.7%, small town 4.3%, urban 3.5%) less often than non-preferred DPP4i (rural 10.3%, small town 11.8%, urban 12%) and sulfonylurea (rural 27.4%, small town 27.7%, urban 26.0%). Patients with stages 3-4 chronic kidney disease (rural n=7444, small town n=43,483, urban n=236,982) were prescribed preferred GLP-1-RA (rural 7.6%, small town 8%, urban 7.2%) and SGLT2i (rural 3.4%, small town 3.7%, urban 3.3%) less often than non-preferred sulfonylureas (rural 29.9%, small town 30.8%, urban 30%). Given these data, interventions to improve prescribing of diabetes medications with cardiorenal benefits are needed in all areas of the US. Rural disparities in diabetes outcomes do not appear to be driven by differences in medication use alone.

Disclosure
K.Steiger: None. K.Swarna: None. J.Herrin: Consultant; Johnson & Johnson Medical Devices Companies. R.G.Mccoy: Consultant; Emmi.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK114497)
650-P: Qualitative Findings from D-COPES Emerging Adult Peer Connectors Pilot Study
Authors: ALLEN NANCY A. , BLANCHETTE JULIA E. , SHAH NAZEEN , GONZALES BRUNO , MARIE MORAITIS ANN , HILLIARD MARISA E. , LITCHMAN MICHELLE L. 
Published: June 2023

Background: Emerging adults with Type 1 Diabetes (T1D) undergo transitions that necessitate a strong social support system. The Diabetes Connecting Online Peers To Enhance Support (D-COPES) pilot intervention was designed by a multidisciplinary group of researchers and people with T1D to engage emerging adults in small-group discourse with “peer connectors” through virtual biweekly sessions and in-between text communication. The purpose of this study was to determine the peer connector's acceptability of the D-COPES intervention.
Methods: Five peer connectors with T1D (age 18-30) were trained to deliver D-COPES via 6 biweekly 1-hour group sessions, with text messaging between. Peer connector guides (n=24) included topic-specific discussion questions and resources. Topics addressed included disclosing T1D to others, diabetes burnout, and relationships with food. Semi-structured interviews with peer connectors were conducted at the end of the 12-week pilot study to learn about the acceptability of training, group dynamics, resources, and any areas for improvement. Data were transcribed and analyzed using a qualitative descriptive approach.
Results: Key themes included 1) benefits of training, suggestion to include 1 additional training meeting; 2) variety of peer connector guides, suggestion for additional topics (e.g., menstruation, intimate relationships); 3) positive group dynamics resulting from group matching and desire to stay connected after the intervention, though group size could be increased; and 4) peer connector benefits of increased knowledge, social support and opportunity to pay it forward.
Conclusion: D-COPES pilot was acceptable and will be revised (e.g., increased training and materials, larger groups) to be evaluated in a fully powered trial.

Disclosure
N.A.Allen: Consultant; Diathrive Health, Dexcom, Inc. J.E.Blanchette: Advisory Panel; LifeScan Diabetes Institute, Cardinal Health/Edgepark, Provention Bio, Inc., Board Member; JDRF, Consultant; WellDoc, Other Relationship; Tandem Diabetes Care, Inc., Research Support; Association of Diabetes Care & Education Specialists, Speaker's Bureau; Insulet Corporation. N.Shah: None. B.Gonzales: None. A.Moraitis: None. M.E.Hilliard: None. M.L.Litchman: None.

Funding
Franklin S. Ivory and Rachael C. Ivory Foundation
654-P: Characterizing Mental Health Status and Service Utilization in Chinese Americans with Type 2 Diabetes
Authors: SHI YUN , WU BEI , ISLAM NADIA , ANN SEVICK MARY , SHALLCROSS AMANDA , BAO HAN , XU XINYI , JIANG YULIN , HU LU 
Published: June 2023

Objectives: Mental health issues are common in people with type 2 diabetes (T2D). Yet, the mental health burden of Chinese immigrants with T2D remains unknown. This study examined mental health status, mental health-seeking behaviors, and service utilization among Chinese immigrants with T2D.
Methods: We conducted a telephone-based cross-sectional survey among 66 Chinese immigrants with T2D recruited from the diabetes registry in NYC. Participants’ mental health status including anxiety, depressive symptoms, general stress, and diabetes-specific distress were measured using the Hospital Anxiety and Depression Scale-Anxiety subscale, Patient Health Questionnaire-9, Perceived Stress Scale, and Diabetes Distress Scale, respectively. Information related to mental health-seeking behaviors and service utilization was also collected. Descriptive statistics were used.
Results: Most participants (mean age 56.1±10.5 years) were female (57.6%), currently married (80.3%), foreign born (100%), high school graduate or less (77.3%), with annual household income &lt; $25,000 (50.8%), and limited English proficiency (95.5%). About 9%, 25.7%, and 23.7% reported moderate or higher depressive symptoms, general stress, and diabetes-specific distress, respectively. Only 11.5% with elevated symptoms have ever seen a mental health professional and 3.8% were currently seeking mental health services. Not seeking mental health services was attributed to no need (92.4%), not knowing where to find Chinese-speaking providers (4.5%), cost (1.5%), and time (1.5%).
Conclusions: Mental health issues, especially general stress and diabetes-specific stress were high among Chinese immigrants with T2D. However, very few of them have ever sought or are currently seeking mental health services. Future research needs to gain a better understanding of the barriers and design culturally tailored programs to serve the needs of this minority group.

Disclosure
Y.Shi: None. B.Wu: None. N.Islam: None. M.Sevick: None. A.Shallcross: None. H.Bao: None. X.Xu: None. Y.Jiang: None. L.Hu: None.

Funding
National Institutes of Health (P50MD017356)
656-P: COVID-19 Exposure and Perceived Impact Associated with Poor Psychosocial, Behavioral, and Physical Health
Authors: YI-FRAZIER JOYCE , O'DONNELL MAEVE B. , ELLISOR BRITNEY M. , GARCIA PEREZ SAMANTHA , MALIK FAISAL , ROJAS YULIANA , DESALVO DANIEL , PIHOKER CATHERINE , SCOTT SAMANTHA R. , BRADFORD MIRANDA , ZHOU CHUAN , ROSENBERG ABBY , HILLIARD MARISA E. 
Published: June 2023

Aim: To describe the exposure and impact of COVID-19 in teens with T1D and associations with health outcomes.
Methods: In the first month of an intervention trial to reduce distress in teens with T1D, COVID-19 emerged. Thus, in addition to planned surveys (Table), participants reported on COVID-19 exposure and perceived impact of the pandemic. Subscales assessed: 1) COVID-19 exposure - a tally of whether teen/important contact was diagnosed, hospitalized, or died, 2) Pandemic-impact - overall worry/feelings about the pandemic (range: 2-10), and 3) T1D-impact - pandemic effect on diabetes care (range: 13-65). Higher scores indicated more exposure or perceived impact. Pearson correlations described all associations.
Results: Of the 172 teens (A1C M=8.7%±2.0%, 56% female, 73% White, 19% Hispanic), 50% reported no exposures, 23% reported 1, 24% 2-3, and 2% 4-7 exposures. Mean pandemic-impact score was 5.6±1.6 (range=2-10), while mean T1D-impact was 36.8±6.9 (range=18-54). Table summarizes associations of subscales with A1C and behavioral markers.
Conclusions: COVID-19 exposure and perceived impact were consistently linked with worse psychosocial and behavioral metrics and A1C for teens with T1D. In particular, associations with T1D-impact were strong. These findings suggest the impact of stressful life events should be monitored within the context of T1D management.

Disclosure
J.Yi-frazier: None. M.Bradford: None. C.Zhou: None. A.Rosenberg: None. M.E.Hilliard: None. M.B.O'donnell: None. B.M.Ellisor: None. S.Garcia perez: None. F.Malik: None. Y.Rojas: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation. C.Pihoker: None. S.R.Scott: None.

Funding
National Institutes of Health (R01DK121224)
659-P: The Effectiveness of Lifestyle, Metformin, or Dietary Supplements for the Prevention of Gestational Diabetes Mellitus (GDM) by Intervention Characteristics—A Systematic Review and Meta-analysis
Authors: TAKELE WUBET W. , UKKE GEBRESILASEA G. , JOSEFSON JAMI L. , VESCO KIMBERLY K. , REDMAN LEANNE M. , GRIEGER JESSICA A. , HABIBI NAHAL , QUINTEROS ALEJANDRA , LEUNG GLORIA , ZHOU SHAO J. , TAYLOR RACHAEL , PATHIRANA MALEESA , LIU KAI , BONHAM MAXINE P. , CHEN MINGLING , FAWCETT ANDREA J. , CHIVERS SIAN C. , LIM SIEW 
Published: June 2023

Systematic reviews examining the effectiveness of interventions for GDM prevention have reported inconsistent results. Intervention characteristics such as intervention type, provider, delivery mode (individual, group or both), the use of theory, intervention location (home- or centre-based), duration, frequency, monitoring (supervised or unsupervised) and other characteristics have not been thoroughly investigated and likely impact intervention efficacy. This study was a systematic review and meta-analysis of controlled trials on lifestyle (diet and/or exercise), metformin and dietary supplementation. The impact of intervention characteristics on GDM prevention was conducted using the ‘Template for Intervention Description and Replication framework’. Overall, 116 studies were included. For lifestyle interventions (n=92), lower risks of GDM were observed in studies with supervised sessions (n=13, RR 0.63, 95% CI 0.50-0.79, p=0.04) compared with those with unsupervised sessions, with group-only delivery (n= 17, RR 0.61, 95% CI 0.51-0.74, p=0.04) compared with those with a combination of individual and group delivery, and in low-middle income countries (n=7, RR 0.58 95% CI 0.42-0.8, p=0.03) compared with studies conducted in middle or high-income countries. Lifestyle intervention effect sizes did not differ by any other intervention characteristics. No significant effect of intervention characteristics was seen in metformin studies (n=13). For dietary supplementation studies (n=12), lower risks of GDM were observed with myoinositol (n=7, RR 0.38, 95% CI 0.23-0.65) but not with probiotics (n=5, RR 0.88, 95% CI 0.52-1.47). Country setting, delivery mode, session supervision may be important characteristics determining the effectiveness of GDM prevention. Further research is needed to tailor these intervention approaches for specific populations.

Disclosure
W.W.Takele: None. S.J.Zhou: None. R.Taylor: None. M.Pathirana: None. K.Liu: None. M.P.Bonham: None. M.Chen: None. A.J.Fawcett: None. S.C.Chivers: None. S.Lim: None. G.G.Ukke: None. J.L.Josefson: None. K.K.Vesco: Research Support; Pfizer Inc. L.M.Redman: Research Support; Dexcom, Inc., Abbott Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Stock/Shareholder; ABGIL, Teladoc Health. J.A.Grieger: None. N.Habibi: None. A.Quinteros: None. G.Leung: None.
66-OR: The Lasting Effects of Redlining on Diabetes Rates—A Tri-city Statistical Analysis
Authors: SHAH SHILP R. , MARTHESWARAN TARUN , SHAH SAHIL R. , KUMAR ASHVIN 
Published: June 2023

Introduction: The relationship between redlining and diabetes prevalence has been understudied. Residents of redlined tracts experience risk factors (inadequate diet, lack of exercise, etc.) at higher rates, which can precipitate increases in diabetes cases, especially in low-income neighborhoods. We observe the statistical association between redlining regions and diabetes prevalence and establish causality through access quantification.
Methods: Historic Redlining Scores (HRS) were collected from the Inter-university Consortium for Political and Social Research. HRS were weighted averages of HOLC A, B, C, and D grades from the 1930s. Through connection with the U.S Census Tract, we obtained diabetes rates from Houston, Miami, and Cleveland, cities with prevalent adult diabetes cases and discriminatory housing policies. Generalized Linear Regression (LR) computed the correlation between HRS and diabetes rates from 2018-2020. USDA Food Access Research Dataset was used to deduce access disparity for low-income residents in the three cities.
Results: LR models for 2018-2020 demonstrated a significant positive association between HOLC grade and diabetes rate of 3.35, 3.22, and 3.17 (all p &lt; 2e-16), respectively. Furthermore, there is a 35% decrease in food accessibility for low-income residents within a half-mile for grade C/D tracts compared to grade A/B tracts, with over half (54%) of residents in C/D tracts without access to supermarkets within a half-mile.
Conclusion: The significant positive relationship between historic redlining rates and diabetes rates strongly suggests the effects of discriminatory policies continue to adversely affect minority communities. We believe the lack of adequate healthy food access results in minority demographics more heavily relying on processed and fast food, predisposing them to a higher risk of diabetes. Increasing infrastructure for healthy food access presently may alleviate diabetes rates in the next few decades.

Disclosure
S.R.Shah: None. T.Martheswaran: None. S.R.Shah: None. A.Kumar: None.