bluuebunny/crossref_metadata_2025_split huggingface dataset:
691-P: Characteristics of People with Type 1 Diabetes Who Consider Fear of Hypoglycemia a Barrier to Their Diabetes Management
Authors: TALBO MERYEM K. , LEROUX CATHERINE , HILL LEE , BRAZEAU ANNE-SOPHIE 
Published: June 2023

Hypoglycemia is a common side effect of insulin therapy, the constant threat of hypoglycemia symptoms and consequences may lead people with type 1 diabetes (T1D) to develop fear of hypoglycemia (FOH). This analysis aims to explore the characteristics of people who consider FOH as a barrier to managing diabetes.
Methods: Self-reported data from an online T1D registry were analyzed to compare participants who consider FOH a barrier to those who do not (a registry-specific yes/no question) using χ2 test for categorical variables (gender, diabetes technology use, and hypoglycemia history) and the Mann-Whitney Test for age, T1D duration, Hypoglycemia Fear Survey (HFS-II), Hypoglycemia Confidence Survey (HCS), and Diabetes Distress Scale (DDS) scores.
Results: Among 780 adults, 65% women, aged 44±15 years, had T1D for 25±15 years, 35% reported HbA1c≤ 7%, and 45% perceived FOH as a barrier. The prevalence of FOH as a barrier was higher in women, participants with history of symptomatic nocturnal or level 3 hypoglycemia, higher HbA1c, higher HFS and DDS scores, and lower HCS scores (Table 1).
Conclusion: A significant proportion of adults, in particular women and those with a challenging T1D management (high HbA1c, history of hypoglycemia, diabetes distress, and low hypoglycemia confidence), consider FOH to be a barrier in T1D management, thus it needs to be considered as part of clinical follow-up.

Disclosure
M.K.Talbo: None. C.Leroux: None. L.Hill: None. A.Brazeau: Other Relationship; Dexcom, Inc., Diabète québec, Ordre des diététistes nutritionnistes du Québec, Research Support; Canadian Institutes of Health Research, Fonds de recherche du Québec en Santé.
7-OR: Evaluation of Saroglitazar’s Effects on Small Dense LDL and Non-HDL Cholesterol Particles in Diabetic Dyslipidemia Patients
Authors: DINKAR JYOTI , RANJAN RAJEEV , CHANDRA ABHISHEK 
Published: June 2023

The dual PPAR α/γ agonist Saroglitazar is used to treat diabetic dyslipidemia (DD) that cannot be managed with statins. Due to its association with high triglycerides (TG), high small dense LDL (sdLDL), and low HDL-C, DD is extremely atherogenic. The efficacy and safety of saroglitazar have been assessed in this prospective multi-centric research in patients with type 2 diabetes and triglycerides (TG) 200 mg/dL following stable statin medication for at least 3 months and a steady lifestyle. A total of 104 patients (78% of whom were men) were enrolled, with a mean age of 59.1 ± 11.4 years. Saroglitazar 4 mg was administered to each subject once daily for 24 weeks. Using a paired t-test, the effects of saroglitazar were assessed after 24 weeks. 73 patients' six-month follow-up data are available. Non-HDL-C and sdLDL levels both significantly decreased at 24 weeks, with non-HDL-C dropping from 138 ± 51 mg/dL to 113 ± 44 mg/dL and from 31.7 ± 11.8 mg/dL to 26.0 ± 11.9 mg/dL, respectively. The values of HDL-C, TG, HbA1c and total cholesterol among the secondary end goals also considerably improved after 24 weeks (Table). No significant adverse event was reported during the investigation. This is the initial investigation on how saroglitazar affects sdLDL in DD patients. According to the findings, saroglitazar effectively lowers non-HDL-C and sdLDL particles while being safe and well tolerated.

Disclosure
J.Dinkar: None. R.Ranjan: None. A.Chandra: None.
700-P: Outcomes of a Diabetes Support Coach Intervention Implemented during the COVID-19 Pandemic
Authors: MAIZEL JENNIFER , HALLER MICHAEL J. , MAAHS DAVID M. , ADDALA ANANTA , LAL RAYHAN , FIGG LAUREN , HECHAVARRIA MELANIE , MALDEN KEILECIA G. , SHEEHAN ELENI , WESTEN SARAH C. , HOOD KOREY K. , WONG JESSIE J. , DIXON BRITTNEY , FILIPP STEPHANIE L. , GURKA MATTHEW J. , WALKER ASHBY F. 
Published: June 2023

During the COVID-19 pandemic, people with diabetes reported increased diabetes distress and difficulty maintaining glycemic control. These challenges were exacerbated for racial minorities and those with low socioeconomic status. As part of a Project Extension for Community Healthcare Outcomes (ECHO) program, an intervention using 28 diabetes support coaches (DSCs), adults with diabetes who served as peer mentors and healthcare navigators, was implemented with underserved patients with type 1, type 2, and other forms of diabetes at 41 federally qualified health centers in FL and CA (intervention n=74, control n=363). Patients self-enrolled and engaged with DSCs via 1-1 weekly text messages, phone calls, or virtual meetings. Patients’ HbA1c was measured at baseline and 6-month follow-up. The Diabetes Distress Scale (DDS-17), Coronavirus Anxiety Scale (CAS-19), and a survey of diabetes technology use and COVID-19 outcomes were also administered. Descriptive statistics were computed for all metrics (n, %; median IQR for skewed data). Between-group comparisons were evaluated via Chi-Square tests for categorical data and t-tests for continuous data. Diabetes distress was significantly lower among the intervention group [DDS-17 score median=1.6] than controls [DDS-17 score median=2.1] (p=.0077). More patients in the intervention regularly used a continuous glucose monitor (CGM) (69.9% vs. controls: 38.8%, p&lt;.001). There were no significant differences between groups in insulin pump use, HbA1c, COVID-19 anxiety, or other COVID-19 outcomes. The latter results were likely due to the COVID-19 survey evaluating structural outcomes like financial stability that were beyond the scope of the DSC intervention. Overall findings demonstrate that DSCs reduced diabetes distress and improved CGM use among underserved patients with diabetes. Support coaching is valuable for this population; further research is needed to improve their HbA1c levels and COVID-19 outcomes.

Disclosure
J.Maizel: None. S.C.Westen: None. K.K.Hood: Consultant; Cecelia Health. J.J.Wong: None. B.Dixon: None. S.L.Filipp: None. M.J.Gurka: None. A.F.Walker: None. M.J.Haller: Board Member; SAB Biotherapeutics, Inc., Consultant; Sanofi, MannKind Corporation. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. A.Addala: None. R.Lal: Advisory Panel; Provention Bio, Inc., Consultant; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Deep Valley Labs, Gluroo, Tidepool, PhysioLogic Devices, Morgan Stanley. L.Figg: None. M.Hechavarria: None. K.G.Malden: None. E.Sheehan: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust (G-2005-03934)
703-P: Community-Based Peer Support for Diabetes Management—Impacts Relative to Comparison Communities
Authors: LIU YUEXING , CAI CHUN , WU XIAOYU , TANG PATRICK Y. , COUFAL MUCHIEH M. , SHEN LI , FISHER EDWIN B. , JIA WEIPING 
Published: June 2023

Community-based Peer Leader (PL) program in 12 PL communities (PLCs) was compared to 4 Comparison Communities (CCs) in Shanghai, China from 2019 to 2021. Key collaborators included district and sub-district health promotion offices, community health centers (CHCs), community self-management groups, and neighborhood committees. Implementation assessment indicated community adaptation of standardized intervention components: public education about diabetes, neighborhood activities, diabetes education classes, diabetes management meetings, follow-up with individuals and families, and online communication via WeChat due to COVID disruptions.
Among those with baseline and follow-up data (n = 1066), PLCs (n = 799) and CCs (n = 267 in 4 CCs) differed significantly on age (66.4 vs 63.7 years), gender (56.8% vs 46.4% female), diabetes duration (8.0 vs 6.5 years), and BMI (25.3 vs 26.0 kg/m2) (all ps ≤ 0.009). Controlling for these and baseline levels of HbA1c, reductions of HbA1c favored the PLCs (-0.06±1.27 vs 0.22±1.56, p &lt; 0.001). Parallel analyses showed significant reductions favoring PLCs for FPG (-0.04±2.50 vs 0.76±2.84, p &lt; 0.001), a 4-item measure of diabetes distress (-0.07±0.41 vs 0.06±0.37, p = 0.004), and depressive symptoms (PHQ-8) (-0.49±3.21 vs 0.54±2.73, p = 0.002). Among those with elevated baseline levels, greater reductions for PLC vs CC were observed for those with HbA1c ≥ 8% at baseline (-0.76±1.56 vs -0.41±2.09, p = 0.038) and those with FPG &gt; 7 mmol/L (-0.54±2.93 vs -0.06±2.95, p = 0.007). Significant PLC vs CC differences were not observed for SBP, DPB, or general quality of life (EQ5D). A slight difference in change of LDLc favored CCs (-0.28±0.90 vs -0.38±0.86, p = 0.042) but only for those with elevated LDLc ≥ 2.6 mmol/L.
Community organization of PL for diabetes management implemented through community groups and CHCs showed greater changes in glucose control, diabetes distress, and depressive symptoms compared with comparison groups.

Disclosure
Y.Liu: None. C.Cai: None. X.Wu: None. P.Y.Tang: None. M.M.Coufal: None. L.Shen: None. E.B.Fisher: Advisory Panel; Eli Lilly and Company, Research Support; Merck Sharp & Dohme Corp. W.Jia: None.

Funding
Chinese Academy of Engineering (2022-XY-08); Shanghai Municipal Science and Technology Commission (22692114600); Shanghai Municipal Grant (GWIV-3.1); Shanghai Municipal Health Commission (20194Y0141, JKKPYC-2022-12); Merck Foundation; Sanofi China; National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK092926)
706-P: Lived Experiences of Diverse Muslim Women with Type 2 Diabetes Who Live in the U.S.
Authors: ALI ASMA , CHEWNING BETTY A. 
Published: June 2023

Objective: To explore lived experiences of a diverse group of Muslim American women in managing type 2 diabetes in the US.
Methods: We conducted a one hour one-on-one qualitative interview with first generation immigrant or refugee Muslim American women. Interviews were conducted in-person or via phone, and were audio recorded. Interpretation services were provided for participants who speak Dari, Rohingya, and Urdu. The interviewer speaks Arabic and English, so no interpretation was needed for these interviews. Two trained researchers conducted inductive thematic analysis using NVivo.
Results: A total of 13 women who come from 6 different countries in the Middle East (Palestine, Egypt) and Asia (Afghanistan, India, Pakistan, Burma) were interviewed. Mean age was 58 years, only three women had a college education or higher, and 11 women had an income &lt; $25,000. Results are presented in Figure 1. Themes include: 1) Patient-provider communication; 2) Factors influencing exercising; 3) Access to care. The third theme was common within the two refugee groups (Rohingya and Afghan).
Conclusion: This research presents experiences and preferences for Muslim women who come from diverse cultures. Clinicians and researchers need to understand and respond to these preferences while not judging patients for their preferences. A patient-centered approach is important to help women achieve better health outcomes and overall quality of life.

Disclosure
A. Ali: None. B.A. Chewning: None.

Funding
Health Resources and Services Administration (T32HP10010); Department of Family Medicine and Community Health
707-P: Motivation for Maternal Healthy Lifestyle Behaviors—Implications for the Perinatal Period
Authors: BROWN SUSAN D. , HEDDERSON MONIQUE M. , MILLMAN ANDREA , DAREDIA SAHER , SERRATO BANDERA HILLARY , QUESENBERRY CHARLES , FERRARA ASSIAMIRA 
Published: June 2023

Background: Healthy lifestyle behaviors are critical to maternal cardiometabolic health. Yet little research examines whether motivations for these behaviors shift from pregnancy—considered a time of strong motivation for self-care—to postpartum, often a vulnerable period marked by weight retention and barriers to self-care.
Methods: We prospectively examined intrinsic motivation from early pregnancy to 1-year postpartum for 3 key behaviors: self-monitoring of weight (i.e., self-weighing, a standard weight management technique); healthy eating; and physical activity (PA) in the Pregnancy, Lifestyle and Environment Study-2 (PETALS-2). Diverse participants (N=167; 20% Asian, 7% Black, 27% Hispanic, 17% multiracial, 30% White) completed validated surveys at 10-13 weeks’ gestation and 1-year postpartum; higher scores on 5-point scales indicated greater motivation.
Results: Overall, motivation for self-weighing was similarly low in pregnancy as postpartum (mean [SD] = 2.53 [0.84] vs. 2.42 [0.84]; p=.16). Motivation for healthy eating was descriptively higher, but with a non-significant trend toward decline over time (3.93 [0.66] vs. 3.83 [0.83]; p=.06). Motivation for PA was moderate and stable (3.32 [1.08] vs. 3.35 [1.03]; p=0.66). In regression analyses adjusted for education, race/ethnicity, pre-pregnancy BMI, and parity, motivation for PA declined significantly more over time among older vs. younger participants (40-44 vs. 18-24 years of age; score difference [95% CI]: -1.16 [-1.99, -0.32], p=.007).
Conclusions: Intrinsic motivation for key lifestyle behaviors was generally stable from early pregnancy to 1-year postpartum, although older age was linked to decline in motivation for PA over time. Interventions to improve cardiometabolic health could capitalize on comparatively high motivation for healthy eating, while mitigating consistently low motivation for self-weighing and declining motivation for PA among older individuals in the perinatal period.

Disclosure
S.D.Brown: None. M.M.Hedderson: None. A.Millman: None. S.Daredia: None. H.Serrato bandera: None. C.Quesenberry: None. A.Ferrara: None.

Funding
National Institutes of Health (R01HL142996)
709-P: A Multistakeholder, Longitudinal Perspective on the Perceived Impact of a Diabetes Intervention for South Asians in New York
Authors: ALI SHAHMIR H. , ONAKOMAIYA DEBORAH , MOHSIN FARHAN M. , MOHAIMIN SADIA , SAIF NABEEL I. , RAHMAN FARDIN , ZANOWIAK JENNIFER , MAMMEN SHINU , LIM SAHNAH , ISLAM NADIA 
Published: June 2023

Multi-stakeholder community-clinical linkage models hold the potential to address the significant diabetes burden faced by South Asians in the US. This study longitudinally evaluates stakeholders’ perspectives on the implementation of a diabetes management and prevention intervention among South Asians in NYC. Participating intervention stakeholders were interviewed annually (2019-2022) on their experience of the intervention's implementation (79 interviews). Stakeholders included 5 research personnel, 8 CHWs, 8 CBO partners, and 18 primary care providers/staff. Qualitative coding was informed by the Consolidated Framework for Implementation Research (CFIR); our analysis focuses on the types of perceived benefits for participants/stakeholders. Along with observing changes related to interventional targets (weight/A1C reduction), CHWs expressed that the intervention structure helped facilitate referrals to social services (e.g., health insurance, financial assistance) and address secondary health concerns (e.g., mental health). Participant occupation, family structure, and technological capacity were reported as mediators in the intervention's perceived impact. Providers/staff (particularly from smaller, less-resourced clinics) emphasized improvements in patients’ health literacy and self-efficacy as important gaps addressed by the intervention. CBO partners highlighted that intervention participation helped develop strong collaborations with academic partners (which helped them secure additional resources) and other CBOs. Research personnel reported that stakeholder perceptions of the intervention's importance increased as greater participant health impact was observed. Findings suggest that community-clinical linkage models can provide multi-faceted benefits to both participants and stakeholders by holistically supporting participant health needs and facilitating strong partnerships.

Disclosure
S.H.Ali: None. N.Islam: None. D.Onakomaiya: None. F.M.Mohsin: None. S.Mohaimin: None. N.I.Saif: None. F.Rahman: None. J.Zanowiak: None. S.Mammen: None. S.Lim: None.

Funding
National Institute on Minority Health and Health Disparities (U54MD000538, R01DK11004801A1)
71-LB: Tirzepatide Reduces the Predicted Risk of Developing Type 2 Diabetes—SURMOUNT-1 Post Hoc Analysis by Prediabetes Status
Authors: HANKOSKY EMILY R. , WANG HUI , NEFF LISA M. , KAN HONGJUN , WANG FANGYU , AHMAD NADIA , STEFANSKI ADAM , TIMOTHY GARVEY W. 
Published: June 2023

Background: This study assessed the effect of tirzepatide (TZP) on the 10-year risk of developing type 2 diabetes (T2D) in people with overweight or obesity with and without prediabetes.
Methods: The Cardiometabolic Disease Staging model was applied to the SURMOUNT-1 trial to derive T2D risk scores at baseline, 24, and 72 weeks. Mean change from baseline to week 72 was derived for participants with and without prediabetes at baseline.
Results: Age, sex, BMI, and other cardiometabolic factors were significantly different between participants with (n=987) and without prediabetes (n=1552). Mean baseline 10-year diabetes risk scores of participants with and without prediabetes were 29-32% and 19-20%, respectively, and did not differ by treatment group. Mean absolute reductions from baseline in the risk score at week 72 for TZP 5/10/15 mg were greater in participants with prediabetes (16-20%) vs those without prediabetes (10-11%), and both were greater than PBO. Mean change in 10-year risk vs PBO in the TZP 5/10/15 mg groups was -13%, -17%, and -18% respectively in those with prediabetes and -11%, -12%, and -12% in those without; the reduction was greater in participants with prediabetes (interaction p&lt;0.001). Conclusion: TZP significantly reduced the predicted risk of developing T2D compared to PBO regardless of prediabetes status. Risk reduction was greater in participants with prediabetes.

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

Funding
Eli Lilly and Company
711-P: Measuring Social Determinants of Health (SDOH) Using Ecological Momentary Assessment (EMA) in Underserved Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: FINNAN MOLLY , SCHECHTER CLYDE , CRESPO-RAMOS GLADYS , HOOGENDOORN CLAIRE J. , GONZALEZ JEFFREY S. , AGARWAL SHIVANI 
Published: June 2023

Background: While it is recognized that underserved YA with T1D experience SDOH that contribute to adverse outcomes, it is unknown how often and what SDOH are most frequently experienced, or whether they interfere with self-management, which limits potential for intervention. Using EMA methods, we explored relationships between daily experience of SDOH and diabetes self-management.
Methods: We recruited 61 underserved YA (18-30 yo) with T1D from the Bronx, New York. We prompted EMA surveys via smartphone 3 times daily over a 14-day period. We asked YA how SDOH interfered with self-management twice daily: “Since the last survey, which of the following life factors got in the way of your diabetes care today?”. Answer choices included money, food, housing, transportation, personal safety, mental health, and racial/ethnic or socioeconomic discrimination. Descriptive statistics were used to quantify and report frequency and variation of SDOH related care burden over the 14-day period.
Results: Overall, 51 YA completed 778 EMA surveys over the 14-day period (23±4 yo, 65% F, 36% Black, 54% Hispanic, 73% Medicaid-insured, mean HbA1c 8.6%). Thirty-seven YA (73%) endorsed at least one daily SDOH related diabetes care burden, on an average of 22% of days. Mental health problems were reported most frequently (n=23 [62%], 11% of days), followed by transportation problems (n=17 [46%], 6% of days), and financial problems (n=15 (41%), 5% of days). The other SDOH choices accounted for less than 5% of responses.
Conclusion: Using EMA to study SDOH in a short timeframe identified significant daily SDOH related diabetes care burdens in underserved YA with T1D. Mental health, transportation, and financial barriers prominently and frequently interfered, while others were described more sporadically albeit still present. SDOH need to be measured in new ways to better understand how and when to intervene to improve outcomes in underserved populations.

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

Funding
NY-Regional Center for Diabetes Translational Research (5P30DK111022-08); National Institute for Diabetes and Digestive and Kidney Diseases (K23DK115896-05)
713-P: The Concomitant Health Needs and Health Care Utilization Patterns of U.S. Women with Lifetime Criminal Legal Involvement and Diabetes, 2015–2019
Authors: HAWKS LAURA , WALKER REBEKAH J. , EGEDE LEONARD E. 
Published: June 2023

Background: Over 100 million Americans have a history of criminal legal involvement (CLI), which is increasingly recognized as a risk for poor disease outcomes. Women with diabetes and CLI may have unique needs and utilization patterns, but this population has not been studied.
Methods: Using nationally representative data, we examined a sample of respondents with lifetime CLI and self-reported diabetes. We compared rates by gender of physical conditions, mental health conditions, and substance use disorders using multivariate logistic regression considering relevant sociodemographic confounders. We then estimated the adjusted odds of outpatient, emergency department and inpatient hospitalization using similar models. Stata 16.1 was used.
Results: In our sample of US adults with diabetes and CLI (N=2,742), 28% were women. Women were generally of lower socioeconomic status but more likely to have insurance. Compared to men, women reported higher rates of comorbid physical conditions, including having ≥2 conditions (aOR 1.5, 95% CI 1.2-1.9); higher rates of serious mental illness (aOR 2.5, 95% CI 1.8-3.6), any mental illness (aOR 2.1, 95% CI 1.6-2.6), and past year major depression (aOR 2.1, 95% CI 1.6-2.8). They were less likely to have a substance use disorder (aOR 0.7, 95% CI 0.5-0.9). Compared to men, women were more likely to use the emergency department (aOR 1.2, 95% CI 1.1-1.3) with a trend towards increased hospitalizations (aOR 1.2, 95% CI 0.9-1.5). They were also more likely to use outpatient care (aOR 2.1, 95% CI 1.3-3.5).
Conclusions: Women with diabetes and CLI have higher rates of chronic disease and mental illness, but lower rates of substance use disorders, a pattern which is distinct. Additional research should consider if addressing the unique needs of this marginalized population could improve diabetes outcomes and decrease unnecessary acute care utilization.

Disclosure
L.Hawks: None. R.J.Walker: None. L.E.Egede: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK132505-01A1)