bluuebunny/crossref_metadata_2025_split huggingface dataset:
525-P: Droid Audio Visual Educator–Diabetes Nutrition (DAVE-DN) Randomized Controlled Trial
Authors: O'CONNOR SADHBH , BIRDIE SHI QI ONG JANE , WAY WERN LIM BRYAN , COLEMAN SEAN , WORLIKAR HEMENDRA , CONNOLLY CORNELIA , MCGAREL SIAN E. , O'BRIEN TIMOTHY , O'KEEFFE DEREK T. 
Published: June 2023

Background: Worldwide, demand for health care services far outpaces the availability of staff. The use of robots in healthcare has advanced in recent years as robots are seen as a viable solution to address the shortage of healthcare staff. We propose the use of a humanoid robot to provide basic nutritional education to patients with diabetes in the waiting room, hence freeing up time for dieticians to address more complex issues. We hypothesize that use of this intervention will be more effective than the current standard of care i.e. A leaflet, in educating and empowering patients with diabetes.
Methods: We conducted a single-centre, randomized controlled trial to determine whether a humanoid robot would improve patient’s knowledge of nutrition. The primary outcome of the trial is improvement in patient knowledge score based on 36 items from a validated nutrition questionnaire. Each patient’s prior knowledge of nutrition was assessed by a validated questionnaire prior to the intervention. Patients were randomized to current standard of care i.e. physician-led education plus a leaflet (n=40) or standard of care plus Droid Audio Visual Educator (n=40). Following the trial, both groups had their knowledge of nutrition reassessed using the same validated questionnaire. The performance of patients in each group was compared and effectiveness of the intervention in improving education objectively determined.
Results: A total of 90 patients underwent randomization. 10 withdrew before completion. The mean age was 53.7 years. The change in score in the intervention group was 3.2 of 36 points higher than control group on average (95% confidence interval [CI] 0.9 to 5.4; P= 0.006).
Conclusions: This trial suggests there is potential for humanoid robots to deliver basic nutritional education

Disclosure
S.O'connor: None. J.Ong: None. B.Lim: None. S.Coleman: None. H.Worlikar: None. C.Connolly: None. S.E.Mcgarel: None. T.O'brien: None. D.T.O'keeffe: None.

Funding
Health Services Executive, Intern Network Academic Track
529-P: A Tale of Two States—Lessons Learned from Diabetes in School Health (DiSH) Telementoring Collaborative Sessions
Authors: POLLOCK ALLISON J. , BEATON WHITNEY N. , BURGESS BOBBI A. , EITEL KELSEY B. , LOGEL SANTHI , ONDECK LYNNETTE J. , SUNDBERG ERIN 
Published: June 2023

School nurses are central to the health of children with diabetes (DM). In two states, a novel telementoring program, Diabetes in School Health (DiSH), was designed to support DM education for school nurses. Aims were to increase school nurse knowledge & comfort with routine DM care, and to build a network for sharing experiences & challenges with DM care. Sessions include brief didactic presentations followed by practical discussion and sharing of scenarios to collaborate and learn strategies to improve DM care. Recruitment of school nurses was via email. DiSH sessions started in Jan 2020 (WI) & Apr 2021 (WA) and are ongoing. This study reviewed the first 3 years of data from 25 DiSH-WI & 16 DiSH-WA sessions. Session attendance: mean 58 WI & 108 WA school health personnel, mostly nurses. Qualitative data included highlights from sessions’ didactics and discussions. In both WI and WA, recurrent themes included importance of communication, building relationships, and meeting students where they are. Table 1 reports challenges shared and lessons learned. Regional differences include applying regulations governing care in school. DiSH, a novel format for DM education of school nurses, provides a platform for locally relevant discussion of complex yet practical themes, which can be difficult to address in traditional educational modules. Dissemination of DiSH programs to other states is underway.

Disclosure
A.J.Pollock: None. W.N.Beaton: None. B.A.Burgess: None. K.B.Eitel: None. S.Logel: None. L.J.Ondeck: None. E.Sundberg: None.
530-P: Capillary Blood Ketone Level and the Prediction of Future Diabetic Ketoacidosis Risk in Type 1 Diabetes
Authors: SONG CIMON , DHALIWAL SHARON , BAPAT PRIYA , BAKHSH ABDULMOHSEN M.K. , BUDHRAM DALTON R. , SCARR DANIEL , WEISMAN ALANNA , FRALICK MICHAEL , IVERS NOAH , CHERNEY DAVID , MUMFORD DOUG , TOMLINSON GEORGE , ERIK LOVBLOM LEIF , PERKINS BRUCE A. 
Published: June 2023

Identification of those at risk of diabetic ketoacidosis (DKA) in T1D is challenging. Rather than during illness while DKA is developing, we aimed to determine if levels of routine point-of-care capillary blood ketones could predict DKA months prior to the event. In exploratory analysis, we examined 484 participants randomly assigned to placebo in an adjunct-to-insulin medication trial program (NCT02414958 and NCT02580591). Participants provided morning fasted capillary blood ketone levels twice per week via electronic logbook, and we calculated the maximum and mean level for each individual during a 2-month baseline period. Outcome was the 6 to 12-month occurrence of trial-adjudicated DKA. Area under the Curve (AUC) for the Receiver Operator Characteristic curves were generated. In sensitivity analysis we applied supervised machine learning methods (gradient-boosted trees). Participants had median age 43 [IQR 33, 54], mean HbA1c 8.2±0.6 percent, and provided 2 [1, 4] ketone measurements per week. Twelve DKA events occurred at median 105 [43, 199] days. Maximum and mean ketone levels were higher at baseline for the 12 cases compared to controls (for example, maximum ketone level 0.8 [0.6, 1.2] compared to 0.3 [0.2, 0.7] mmol/L, p=0.002). Maximum ketone level had AUC of 0.769 (95% CI 0.655-0.883). Maximum ketone ≥0.8 mmol/L had sensitivity 64%, specificity 78%, and likelihood ratios positive and negative of 2.9 and 0.5. Machine learning methods outperformed the single-metric analyses. Results provide proof-of-concept that routine capillary ketone surveillance can identify individuals at high-risk of future DKA. Simple or complex machine learning algorithms could be implemented in ketone meters or in future continuous ketone measurement technology.

Disclosure
C.Song: None. D.Cherney: Other Relationship; Boehringer Ingelheim-Lilly, Merck, AstraZeneca, Sanofi, Mitsubishi-Tanabe, Abbvie, Janssen, Bayer, Prometic, BMS, Maze, Gilead, CSL-Behring, Otsuka, Novartis, Youngene, Lexicon and Novo-Nordisk, Research Support; Boehringer Ingelheim-Lilly, Merck, Janssen, Sanofi, AstraZeneca, CSL-Behring and Novo-Nordisk. D.Mumford: None. G.Tomlinson: None. L.Lovblom: None. B.A.Perkins: Advisory Panel; Dexcom, Inc., Insulet Corporation, Novo Nordisk, Sanofi, Vertex Pharmaceuticals Incorporated, Other Relationship; Abbott, Medtronic, Sanofi, Research Support; Novo Nordisk, Bank of Montreal (BMO). S.Dhaliwal: None. P.Bapat: None. A.M.K.Bakhsh: None. D.R.Budhram: None. D.Scarr: None. A.Weisman: None. M.Fralick: None. N.Ivers: Consultant; Novo Nordisk Canada Inc., IQVIA Inc.

Funding
Diabetes Canada (OG-3-21-5572-BP)
531-P: The Multidisciplinary Team Education for Subjects with DKD Could Affect the Prevention of eGFR Decline
Authors: HITOMI MAMIKO , HIKI NAOKI , SAKAMOTO UMEKO , USUI YUURI , MIYATSUKA TAKESHI , MORIYA TATSUMI 
Published: June 2023

Background: It still remains unclear as to whether or not multidisciplinary individual team approach (MTA) affects the decline of kidney function in persons with diabetic kidney disease (DKD). We examined the effects of MTA on 24 DKD subjects compared with effects on 24 control subjects with DKD who are managed by dietitian approach alone (DA) between January 2012 and December 2021.
Methods: The team was composed of doctors, nurses (CDE, RN) and dietitians (CDE, RD). The team provided broad education, including advice on medication, medical diet therapy, management of home blood pressure, SMBG, weight measurement, self-check of edema, foot care, giving information of stage of DKD and medical examinations.
Results: There was no significant difference in types of diabetes (types 1 and 2; 2/22 vs. 1/23), gender (men/women; 15/9 vs.18/6), duration of diabetes (15 ± 9 vs. 19 ± 11 yrs.), observation period (7.9 ± 1.3 vs. 7.3 ± 2.4 yrs.) between MTA and DA. MTA is significantly younger (57 ± 12 years old) than DA (67 ± 9 years old) (p=0.002). Number of interventions per year were 3.6 ± 1.4 vs. 2.6 ± 1.9 times between MTA and DA (p=0.046). Also the initial eGFR (61.0 ± 26.6 vs. 60.1 ± 19.4 mL/min/1.73m2) and albuminuria levels (246 (33-1923) vs. 382 (35-2008) mg/g•Cr) were comparable between the groups. Annual eGFR decline rate in MTA group (−1.38 ± 2.11 mL/min 1.73m2) was significantly lower than that in DA group (−3.89 ± 6.34). Two subjects were initiated hemodialysis only in the DA group (likelihood ratio 2.86, p=0.091). Four subjects died in only the DA group (likelihood ratio 5.91, p=0.015).
Summary: It is possible that MTA affects the prevention of renal function decline compared with the intervention provided by DA alone. Subjects with DKD, even with normal renal function, may be recommended to have MTA to prevent the progression of renal failure.

Disclosure
M.Hitomi: None. N.Hiki: None. U.Sakamoto: None. Y.Usui: None. T.Miyatsuka: Speaker's Bureau; Eli Lilly Japan K.K., Novo Nordisk, Sanofi K.K., Mitsubishi Tanabe Pharma Corporation, Sumitomo Dainippon Pharma Co., Ltd., Teijin Pharma Limited, Sanwa Kagaku Kenkyusho, Daiichi Sankyo. T.Moriya: None.
533-P: The Physiological Effects from Type 2 Diabetes Self-Management Program in a Municipal Setting
Authors: HELGSTRAND LINE A. , HVIDBERG ALBERTE D. , GLÜMER CHARLOTTE 
Published: June 2023

There is a lack of knowledge showing the real-life effects of person-centered type 2 diabetes (T2DM) Management programs offered in a municipal setting. The aim of this study is to determine the effectiveness of individualized T2DM management programs for patients with T2DM in a municipal setting on HbA1c and blood pressure (BP). Based on a person-centered and differentiated approach, the intervention consists of education, physical training, cooking classes and/or individual consultations.
Methods: The study was conducted during 2018 to 2021 with citizens referred consecutively for T2DM management programs. A total of 308 patients were included. Of these 308, 172, and 131 completed questionaries and physiological measurements at baseline, at end of the program and at 6 months follow-up, respectively. All physiological data was collected by selected health care professionals trained in standard operations procedures. Results: Respondents consist of 60% men, age range primarily from 55-79, 57% have a short education level. At baseline mean HbA1c was 58.5 mmol/mol (IQR: 48.0-64.0). At end of the program, a statistically significant decrease of −6.5 mmol/mol (95% CI: −9.0; −4.1, p&lt;0.001) was observed. At 6 months follow-up this decrease was unchanged as it was showing a decrease of −5.8 mmol/mol (95% CI: −8.8; −2.8, p&lt;0.001) compared to baseline. At baseline mean systolic and diastolic BP was 147.5 mmHg (IQR: 134.2-158.0) and 86.2 mmHg (IQR: 79.6-93.3), respectively. At end of the program and at 6 months follow-up a significant decrease of −10.7mmHg (95% CI: −15.0; −6.3, p&lt;0.001) and −11.8 mmHg (95% CI: −16.4; −7, 2, p&lt;0.001), respectively, was observed for systolic BP when compared to baseline.
Conclusion: Person-centered T2DM management programs in a large municipal setting significantly reduce HbA1c and BP on long and short term. These results may be caused by person-centered care and a holistic approach.

Disclosure
L.A.Helgstrand: None. A.D.Hvidberg: None. C.Glümer: None.
534-P: Evaluating the Impact of a Simulation Module on Empathy Development in Nursing Students
Authors: EDSTROM GRETCHEN L. 
Published: June 2023

Empathetic behaviors by nurses have been shown to improve both patient satisfaction and health outcomes. However, there has been a documented decline in empathy levels among the undergraduate population, including nursing students. For these reasons educators have sought ways to improve empathy development in nursing students. This quasi-experimental study used a pre/posttest design to evaluate the effectiveness of a simulation intervention using an expert patient (EP) with diabetes to enhance empathy in nursing students with the intention of providing a foundation in empathy development early in their nursing careers. The intervention included a prerecorded interview with an EP, a person who has diabetes for more than 30 years, presentation of five facts about diabetes and the importance of empathy, and a guided debriefing session regarding feelings for people with diabetes. The scripting for the interview was based on the Diabetes Distress Tool and reviewed by the expert panel. However, the answers provided by the EP were her own experiences, thoughts, and feelings. Batson’s Eight Components of Empathy, Kolb’s Experiential Learning Theory, and Jeffries Simulation Theory provided a theoretical foundation for the study. Demographic data related to gender, race, age, work experience in healthcare, and closeness to a person with diabetes did not show any statistically significant influence on empathy development. But, there was a documented increase in levels of empathy as measured by the Comprehensive State Empathy Scale after the teaching intervention. The paired t-test reported a significant difference between the pretest total (M = 103.7; SD = 17.98) and posttest scores (M = 110.1; SD = 21.11) t(67) = 3.23, p = 0.001, with a small to medium effect size (d = .39 95% CI [2.46 - 10.44]). The core findings of this research contribute to the scholarship of nursing education and theory-based teaching interventions by validating a successful teaching strategy for enhancing empathy in nursing students.

Disclosure
G.L.Edstrom: None.
537-P: Virtual Patient Simulation Assesses the Levels of Competency and Improves Performance of Advance Practice Providers in the Field of Diabetes and Cardiometabolic Medicine
Authors: IANCU IGAL , SHENTAL RACHEL , ZEHAVI LIRON , DRAZNIN BORIS 
Published: June 2023

Introduction: A high level of medical knowledge of Advanced Practice Providers is extremely important to secure their role in the contemporary healthcare environment. Continuing Medical Education is the key element in improving their skills and level of competency.
Hypothesis: We hypothesized that a mobile and desktop VPS application that provides a self-propelled simulation of disease progression and the effects of treatments, would allow precise assessment of providers’ medical knowledge.
Methods: We used the Edocate® virtual patient simulation (VPS) platform to compare the level of competency in treating patients with type 2 diabetes and cardiovascular problems in two groups of nurse practitioners: diabetes-trained (DNP) and family medicine-trained (FNP). All participants completed the same VPS case before being asked to address a second case with similar problems, thus enabling us to assess improvement in their knowledge as well. For each case, the NPs received personalized and detailed feedback on their actions. Results: DNP were significantly more likely to achieve good glycemic control (78.6% vs. 46.8% in the FNP cohort), control of hyperlipidemia (57.1% vs. 40.0%), control of blood pressure (78.5% vs. 46.6%), and were more likely to use SGLT2i or GLP1 RA in patients with cardiovascular problems (78.4% vs. 66.7%). Both groups improved their performance markedly while working with their second patient, reaching levels of competency in key clinical areas between 83 and 100% in both groups.
Conclusion: Working with the VPS, DNP demonstrated a higher level of medical knowledge in diabetes and cardiovascular disease management than FNP. However, training with the VPS platform significantly improved the levels of competency in both groups supporting the notion that virtual simulation provides excellent tools for enhancing providers’ knowledge, critical for their real practice skills.

Disclosure
I.Iancu: None. R.Shental: None. L.Zehavi: None. B.Draznin: None.
538-P: Use of Real-Time Continuous Glucose Monitoring Supports Behavior Modification in Gestational Diabetes Mellitus—Results from an Ongoing Pilot Study
Authors: CEDENO BRIAN , FAY EMILY , EHRHARDT NICOLE M. , FONDA STEPHANIE J. 
Published: June 2023

Gestational diabetes mellitus (GDM) is common, with 14% of women developing GDM. Although real-time continuous glucose monitoring (RT-CGM) has been shown to support behavioral/lifestyle modifications in patients living with type 1 and type 2 diabetes, no studies to date have assessed RT-CGM as a behavior modification tool for patients with GDM.
Participants diagnosed with GDM [prior to gestational age 24 weeks (early) or between 24-30 weeks (typical)] were randomized to use RT-CGM or continue self-monitoring of blood glucose (SMBG) using finger-sticks and wore 3 serial blinded CGM over the remainder of the pregnancy. Both groups continued their routine obstetric care. After delivery, RT-CGM participants completed a 44-question survey adapted from the Joslin Diabetes Center CGM questionnaire plus our published 8-question survey on behavior modification and CGM use.
To date, 70 participants have enrolled; 31 were randomized to RT-CGM. Twenty-four (4 early and 20 typical) have completed the post-delivery surveys. Demographics: 42% were Caucasian, 63% reported annual incomes of &gt;$50,000, and 79% had achieved at least a bachelor’s degree. From RT-CGM use: 71% excluded or limited sugared beverages (29% never drank sugared beverages), 78% excluded or limited white rice (13% never ate white rice), 67% started reading labels for fiber content (17% of participants already read labels for fiber content), and 92% would walk or increase activity after a meal if they saw their glucose rising. Overall, 92% of participants felt like RT-CGM contributed to a healthier lifestyle during pregnancy. Sixty-three percent wanted to continue using RT-CGM.
Our study suggests that women with GDM perceive that RT-CGM supports improved lifestyle choices during pregnancy. Studies are ongoing to assess whether RT-CGM improves maternal and/or fetal outcomes, but advocacy is needed now to improve accessibility of RT-CGM in GDM.

Disclosure
B.Cedeno: None. E.Fay: None. N.M.Ehrhardt: Advisory Panel; Novo Nordisk, Dexcom, Inc., Consultant; Nestlé Health Science. S.J.Fonda: Research Support; Dexcom, Inc.

Funding
Dexcom, Inc. (IIS-2019-101)
542-P: Socio-clinical Correlations with Threat Perception and Self-Efficacy in People with T2D
Authors: HU JIANLI , CHEN SOPHIA K. , KIM SARAH , KELLY PATRICK J. , HOADLEY ARIEL , ZISMAN-ILANI YAARA , SWAVELY DEBORAH A. , BASS SARAH B. , RUBIN DANIEL J. 
Published: June 2023

Interventions are needed to address health disparities among racial and ethnic minorities with type 2 diabetes (T2D).
In a novel application, the Extended Parallel Processing Model (EPPM) was used to categorize 168 adults with T2D from urban safety-net clinics and the local community by self-efficacy and perceived threat from T2D and cardiovascular disease based on validated measures. The EPPM groups were high threat (HT)/high efficacy (HE), low threat (LT)/low efficacy (LE), HT/LE, and LT/HE. Socio-clinical characteristics were compared across EPPM groups, threat level, and self-efficacy level.
HT/LE people had the lowest medication adherence and T2D management score, the highest A1C (p=0.10), and most microvascular complications relative to other EPPM groups. Gender, Race/Ethnicity, education, and health insurance did not vary by EPPM group.
HT people were younger, had lower medication adherence, more diabetic complications, more blood pressure medications, and more insulin use (p=0.08) than LT people.
LE people had lower medication adherence, lower T2D management score, and higher A1C (p=0.07) than HE people.
The EPPM is associated with clinical outcomes and self-management behaviors. This model may be useful to target people with T2D for behavioral intervention. Moving people from HT/LE to LT/HE may improve T2D management and outcomes.

Disclosure
J.Hu: None. S.K.Chen: None. S.Kim: None. P.J.Kelly: None. A.Hoadley: None. Y.Zisman-ilani: None. D.A.Swavely: None. S.B.Bass: None. D.J.Rubin: Research Support; AstraZeneca.
548-P: The Effects from Type 2 Diabetes Management Programs on Mental Health and Diabetes Distress
Authors: GLÜMER CHARLOTTE , HVIDBERG ALBERTE D. , HELGSTRAND LINE A. 
Published: June 2023

Impaired mental health among patients with type 2-diabetes (T2DM) constitutes a major challenge as it has negative influence on T2DM self-management, HbA1c and complications. Inclusion of mental health issues in municipal rehabilitation is important as patients need to cope both physical, practical, and mental aspects of a life with T2DM. The aim of this study was to assess whether T2DM management program influences mental health including diabetes distress and overall wellbeing. Methods: During 2018-2021, all patients referred for T2DM management programs were invited to the study. Included patients completed a series of validated questionnaires including WHO-5, PAID-1 and PAID-5 at baseline, at end of the program and at 6 months follow-up. A total of 131 completed all three questionnaires and were included in the study. Based on a person-centered and differentiated approach to diabetes management programs, the intervention consists of teaching, physical training, cooking and/or individual conversations. Results: The study population consist of 60% men, age range primarily from 55-79, 57% have a short education level. At baseline, mean WHO-5 score was 61.6 points (IQR: 48.0-80.0). At end of rehabilitation a statistically significant increase of 4.6 points (95%CI: 1.1-7.8, p=0.003) was observed. At 6 months follow-up the WHO-5 score was leveled and unchanged when compared to baseline. According to PAID-5, 47% of included patients had diabetes distress at baseline. This was reduced to 30% and 26% at end of the program and at 6 months follow-up, respectively. Conclusion: T2DM management programs has a positive effect on mental health including general well-being and diabetes distress. Nonetheless there is still room for improvement which is why we have now initiated a project in collaboration with a research institute, aiming to improve identification of individuals and develop interventions targeting patients with moderate to high degrees of diabetes distress.

Disclosure
C.Glümer: None. A.D.Hvidberg: None. L.A.Helgstrand: None.