bluuebunny/crossref_metadata_2025_split huggingface dataset:
651-P: Sensitivity and Specificity of the PHQ-8 to Identify Depressive Disorder (DD) in Teens with Type 1 Diabetes (T1D)
Authors: PATTON SUSANA R. , MARKER ARWEN , MCDONOUGH RYAN , CLEMENTS MARK A. 
Published: June 2023

Objective: A recent study identified that a cut-off score &gt;5 on the Patient Health Questionnaire (PHQ-9) had greater sensitivity and specificity to detect DD in teens with T1D than the normative cut-off score. Still, limited provider training or capacity to intervene on a suicide screening item (item 9) leads some clinics to omit item 9. We examined the ideal cut-off score to detect DD in teens with T1D using the modified PHQ-8 screener, and if removing item 9 impacts sensitivity.
Methods: Teens (N=100; Mean age = 15.0 ± 1.7; 60% Male; 87% White; Mean HbA1c = 8.88 ± 1.8%) completed the PHQ-8 electronically. We used the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS DSM-5) depression module to determine if the teen met criteria for DD. We compared teens’ PHQ-8 cut-off scores (PHQ-8 ≥ 10) to KSADS results.
Results: Per KSADS, 15% of teens met criteria for current DD. The PHQ-8 demonstrated low sensitivity (.20) to detect DD using a normative cut-off score, but an adjusted cut-off score &gt;5 increased sensitivity (.87) while maintaining good specificity (.80) (Table 1).
Conclusions: Using a lower cut-off score of &gt;5 on the PHQ-8 can more reliably identify DD in teens with T1D and matches previous PHQ-9 sensitivity and specificity metrics. This suggests removing item 9 does not negatively impact DD screening accuracy, although clinics should consider alternative methods to screen for suicide risk.

Disclosure
S.R.Patton: None. A.Marker: None. R.Mcdonough: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes.
657-P: Diabetes Stigma and Use of Diabetes Technologies among U.S. Adults Living with Type 2 Diabetes
Authors: GARZA MATTHEW , SHOGER ERIK , HOLMES-TRUSCOTT ELIZABETH , JOINER KEVIN , ADDALA ANANTA , NARANJO DIANA , BEVERLY ELIZABETH A. , SPEIGHT JANE 
Published: June 2023

Nearly 80% of adults with diabetes report experiences of diabetes stigma, varying by the use of insulin therapy. We aimed to examine associations between diabetes stigma and the use of diabetes technologies among adults with insulin and non-insulin-treated type 2 diabetes (T2D). In August 2022, 947 adults with T2D (mean age: 64±11 years; duration T2D: 19±9 years; 62% women; 61% insulin-treated) from the dQ&A US Patient Panel completed an online survey. Questions included the Type 2 Diabetes Stigma Assessment Scale (DSAS-2) and diabetes and demographic characteristics. DSAS-2 total and subscale (Treated Differently, Blame and Judgment, Self Stigma) scores were compared by device use (independent samples t-test), and separately by treatment (insulin vs. non-insulin). Individuals with non-insulin-treated T2D using (vs. not using) CGM reported more stigma (Total; Treated Differently; Blame & Judgment) but did not differ on Self Stigma (Table). Stigma did not differ by device use among participants on insulin treatment, but was higher overall than those on non-insulin treatment. Further research is needed to understand how the experience of diabetes stigma may be affected by the visibility of T2D, specifically via diabetes technologies.

Disclosure
M.Garza: Other Relationship; Sanofi. E.Shoger: Other Relationship; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Beta Bionics, Inc., Xeris Pharmaceuticals, Inc., MannKind Corporation. E.Holmes-truscott: Research Support; Sanofi, AstraZeneca. K.Joiner: None. A.Addala: None. D.Naranjo: None. E.A.Beverly: None. J.Speight: Research Support; Sanofi, Medtronic, Abbott Diabetes, Lilly, Novo Nordisk A/S, Speaker's Bureau; Sanofi.
663-P: Dynamic Real-Time Relationships among Glucose and Cognitive Performance in Diverse Adults with T1D
Authors: HOOGENDOORN CLAIRE J. , HERNANDEZ RAYMOND , SCHNEIDER STEFAN , PETERS ANNE L. , CRANDALL JILL P. , CRESPO-RAMOS GLADYS , JIN HAOMIAO , PHAM LOREE T. , AGARWAL SHIVANI , SPRUIJT-METZ DONNA , PYATAK ELIZABETH , GONZALEZ JEFFREY S. 
Published: June 2023

Introduction: Blood glucose (BG) regulation is linked to cognitive performance among people with diabetes. Most studies are cross-sectional and limited to adults with T2D. Pairing continuous glucose monitoring (CGM) with ambulatory cognitive tests, we examined real-time bidirectional associations between BG and cognition in everyday life among adults with T1D.
Methods: Participants wore a blinded CGM for 10-14 days and completed ambulatory cognitive tests 5-6 times daily. Using dynamic structural equation modeling, we evaluated within-person bidirectional relationships between BG and cognition over sequential 3-hr periods. BG metrics included mean BG, time in range (TIR; 70-180 mg/dL), % time in low (50-69 mg/dL), high (181-250 mg/dL) and very high BG (&gt;250 mg/dL), and coefficient of variation (CV). Cognitive variables included processing speed and sustained attention.
Results: Among 182 adults with T1D (40±14 yrs, 46% male, 41% Latino, 29% White, 15% Black), greater mean BG (beta=0.03), lower TIR (beta=-0.03), and more time in high (beta=0.03) and very high BG (beta=0.03) predicted slower processing speed 3 hrs later (ps&lt;.05); no BG metric predicted sustained attention ability. Surprisingly, slower processing speed predicted lower mean BG (beta=-0.05), more TIR (beta=0.04) and less time in high (beta=-0.01) and very high BG (beta=-0.04) over the next 3 hrs. Reduced sustained attention predicted more time in very high BG (beta=-0.01) and lower CV (beta=0.03) (ps&lt;0.05).
Conclusion: Our findings suggest that poorer BG regulation negatively influences processing speed over short time frames. Slower processing speed predicted subsequent improvements in CGM metrics, suggesting that individuals may take steps to correct BG when experiencing cognitive effects of poor BG regulation. These short-term relationships illuminate opportunities for in-the-moment interventions.

Disclosure
C.J.Hoogendoorn: None. D.Spruijt-metz: None. E.Pyatak: Research Support; Abbott Diabetes. J.S.Gonzalez: Consultant; Virta Health Corp. R.Hernandez: None. S.Schneider: None. A.L.Peters: Advisory Panel; Abbott Diabetes, Medscape, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Stock/Shareholder; Omada Health, Inc., Livongo. J.P.Crandall: Research Support; Abbott. G.Crespo-ramos: None. H.Jin: None. L.T.Pham: None. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc.

Funding
National Institutes of Health (R01DK121298, P30DK020541, P30DK111022)
67-LB: Factor Structure and Effects of Illness Perception on Depression and Anxiety in Patients with Diabetes
Authors: TAJIMA EMI , HATA KOTONE , SUZUKI SHIN-ICHI 
Published: June 2023

Objective: Illness perception represents how a patient perceives his or her health and illness. The Brief Illness Perception Scale (BIPQ; Broadbent et al. 2006) is often used to assess illness perception. However, the factor structure of the BIPQ is inconsistent across studies. The present study aimed to confirm the factor structure of the BIPQ in diabetic patients and to examine its impact on depression and anxiety.
Methods: Patients with diabetes (N = 340, type 1: 39. type 2; 296, others: 5) provided demographic and clinical information and completed the Japanese version of the BIPQ, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder -7. This research was conducted with the approval of Waseda University's Ethics Review Committee on Human Studies (Accreditation Number: 2021-351).
Results: We eliminated one item on the timeline because of the ceiling effect. Then, we conducted an exploratory factor analysis and adopted a two-factor structure. Moreover, a confirmatory factor analysis with the same two-factor structure indicated the sufficient model fit (GFI = .93, AGFI = .86, CFI = .87) Furthermore, from multiple regression analyses, assessed the effects of "Impact on daily life" and "Sense of control", the two factors we named, on depression and anxiety indicated a significant coefficient of determination (R 2 = .31, p &lt; .001, R 2 = .30, p &lt; .001). Additionally, the Impact on daily life (β = .36, p &lt; .01, β = .29, p &lt; .01) and the Sense of control (β = - .29, p &lt; .001, β = -.23, p &lt; .001) had significant effects on depression and anxiety.
Conclusion: The results supported the two-factor structure of the BIPQ, similar to that for cancer survivors (Hata et al., 2020), even though we eliminated one item. Illness perception in patients with diabetes consists of the impact of the disease on their daily lives and their sense of control over diabetes and its symptoms. Improving these perceptions would reduce depression and anxiety.

Disclosure
E. Tajima: None. K. Hata: None. S. Suzuki: None.

Funding
Japan Society for the Promotion of Science (19J22933)
672-P: Supporting Gestational Diabetes (GDM) Risk Reduction among Young Indigenous Females Who Experience Food Insecurity—A Qualitative Exploration
Authors: STOTZ SARAH A. , HEBERT LUCIANA E. , SCARTON LISA , BEGAY KELLI R. , GONZALES KELLY L. , GARROW HEATHER , ASPAAS MELANIE L. , CHARLEY MELANIE , CHARRON-PROCHOWNIK DENISE 
Published: June 2023

The purpose of this study was to re-engage participants of a GDM risk reduction study along with additional key informants to explore GDM risk reduction opportunities among young Indigenous females who experience food insecurity. Participants were adult American Indian (AI) women who had GDM or who have female relatives (e.g., daughters) between 12-24 yo (n= 41), AI females between 12-24 yo (n=18), and key informants with expertise in food/nutrition and health within Indigenous communities (n=32) across the US. Data were collected using a semi-structured, conversation-based moderator guide. Zoom interviews were recorded, transcribed, and coded using thematic content analysis methods. Three themes emerged, which emphasize supporting wellness among young Indigenous females through culturally centered approaches and describe how colonization has interrupted healthful dietary practices. Themes include: 1) Guidance on how to support young female's holistic wellness (e.g., strong cultural identity, physical activity, and support from multigenerational family and community); 2) Generations of colonial violence including forced removal, forced poverty, and the imposition of a western based food system of high fat and sugary foods causes deeper, systemic fracturing of traditional cultural food knowledge and practice; 3) Opportunities for support may include investment in place-based, community-driven Indigenous food sovereignty efforts with economy and relationship building including traditional food teachings (e.g., gardening, gathering, farming, seed and land stewardship, hunting, fishing, and food/meal planning and preparation). These themes suggest alternative understanding about the relationships between food insecurity and GDM risk drawing from Indigenous values, strengths, and knowledge, within the context of colonialism, and can guide next steps of decreasing GDM disparities in Indigenous communities.

Disclosure
S.A.Stotz: None. L.E.Hebert: None. L.Scarton: None. K.R.Begay: None. K.L.Gonzales: None. H.Garrow: None. M.L.Aspaas: None. M.Charley: None. D.Charron-prochownik: None.

Funding
National Institute on Minority Health and Health Disparities (R21MD016126 to S.A.S.)
680-P: Improvement in Anxiety and Depression in Patients with Type 2 Diabetes through Customized Lifestyle Intervention
Authors: TRIPATHI PRAMOD , KADAM NIDHI S. , SHARMA BABY , VYAWAHARE ANAGHA R. , DAS BISWAS MAYURIKA , GANLA MALHAR H. , SABOO BANSHI D. 
Published: June 2023

Background: Type 2 diabetes (T2D) is a chronic metabolic disorder that has a significant impact on the mental health of an individual, which in turn results in increased morbidity and mortality.
Objective: To evaluate the effect of holistic lifestyle intervention in improving mental health outcomes in patients with T2D. Materials and
Methods: In this quasi-experimental study, baseline data (anthropometry and medical history) on 428 T2D patients enrolled in a one-year online holistic lifestyle intervention program at the Freedom from Diabetes Clinic (Pune, India) between May 2021 and Feb 2022 were collected. The validated Patient Health Questionnaire (PHQ-9) (scoring 0-27) and Generalized Anxiety Disorder Assessment (GAD-7) scale (scoring 0-21) were used to assess depression and anxiety, respectively. The intervention included a customized vegan diet and exercise protocol along with stress-relieving group sessions for diabetes management and one-on-one psychological counselling sessions (aimed specifically at people with anxiety and/or depression). After 6 months of intervention, the questionnaires were re-administered to assess the reduction in anxiety and depression.
Results: The prevalence of depression, anxiety, and both was 7.9%, 7.2%, and 8.9% at baseline, respectively. Post-intervention, it reduced to 3.5%, 3.7%, and 4.9%, respectively. The absolute change (calculated as final score-initial score/initial score*100) was significantly higher for both depression and anxiety scores in those who received the intervention (group therapy or individual counselling) vs those who chose not to receive the intervention (p&lt;0.05). Of the 72 and 69 patients who showed depression and anxiety at baseline, 43 and 40 shifted to the minimal to mild categories, respectively, indicating improvement.
Conclusion: Our findings suggest that incorporating a psychological component into lifestyle interventions may help improve mental health in patients with T2D.

Disclosure
P.Tripathi: Board Member; Freedom from Diabetes Clinic. N.S.Kadam: Research Support; Freedom from Diabetes Clinic. B.Sharma: Research Support; Freedom From Diabetes clinic. A.R.Vyawahare: Research Support; Freedom From Diabetes. M.Das biswas: Employee; Freedom from Diabetes Clinic. M.H.Ganla: Employee; Freedom from Diabetes Clinic. B.D.Saboo: None.
690-P: Variation in Physical Activity and Weight Loss by Demographic Characteristics among Participants in the National Diabetes Prevention Program
Authors: CANNON MICHAEL , PENG NG BOON , ELY ELIZABETH 
Published: June 2023

The National Diabetes Prevention Program lifestyle change program aims to prevent type 2 diabetes by promoting behavioral changes such as increased physical activity and improved nutrition, with a goal of losing ≥5% of body weight. We analyzed data from 2012-2019 from participants who reported weekly physical activity (PA) minutes and weight and who participated either in-person (N=127,092) or online (self-paced, asynchronous interactions with coach) (N=196,670). Among those retained through the core phase (16 sessions), average weekly PA minutes were higher among men than women (228 vs. 182 in-person and 277 vs. 204 online), higher for older than younger participants (210 vs. 187 vs. 164 in-person and 248 vs. 233 vs. 191 online for ≥65, 45-64, and 18-44 years), higher for those with lower BMI (213 vs. 184 in-person and 244 vs. 215 online for 23-29 BMI and ≥30 BMI) and varied by race/ethnicity (187 in-person and 183 online for non-Hispanic Black participants, 183 in-person and 207 online for Hispanic participants, and 198 in-person and 227 online for non-Hispanic White participants). Percent weight loss by session 16 was greater for men than women (6.0 vs. 5.2 in-person and 5.5 vs. 4.2 online), greater for older than younger participants (5.8 vs. 5.3 vs. 4.6 in-person and 5.5 vs. 4.7 vs. 4.0 online for ≥65, 45-64, and 18-44 years), greater for those with higher BMI (5.2 vs. 5.4 in-person and 4.4 vs. 4.6 online for 23-29 BMI and ≥30 BMI) and varied by race/ethnicity (3.8 in-person and 3.7 online for non-Hispanic Black participants, 4.4 in-person and 4.0 online for Hispanic participants, and 5.9 in-person and 4.8 online for non-Hispanic White participants). We found that participants with different demographic characteristics experience program successes differently despite similar time in the program, suggesting a need to understand the reasons for these differences and customize program delivery strategies to address them.

Disclosure
M.Cannon: None. B.Ng: None. E.Ely: None.
692-P: Characteristics of Young Adults with Type 1 Diabetes (T1D) Attending a Virtual Young Adult Diabetes Clinic (YADC) as a Component of Transition from Pediatric to Adult Diabetes Care
Authors: JOARDER FARAHNAZ , PANDHARPURKAR TEJAL H. , TWEET RYAN D. , HEYERMAN TESS , O'NEIL KELLY , PARK JULIE J. , GUTTMANN-BAUMAN INES 
Published: June 2023

Objectives: Young adults (18-25) living with T1D are at high risk of acute and chronic complications and poor glycemic control in part because of difficulties seen in transitioning from pediatric to adult care. In 2017 an in-person YADC was created to help engage and support new patients transitioning from pediatric to adult care. In 2021, in response to the COVID-19 pandemic, the YADC was adapted to a virtual model. This study characterizes the participants of the virtual YADC.
Methods: The YADC is a comprehensive virtual clinic that includes a group welcome, orientation to adult diabetes care, peer-to-peer interaction, group discussion about pediatric-to-adult transition of care (facilitated by a behavioral health clinician), a diabetes education visit and a medical provider visit. Young adult attendees were self-select; those who were referred to an adult endocrinologist were given the option to join the YADC. Descriptive statistics were utilized to summarize the characteristics of patients attending the virtual YADC.
Results: Of 89 patients scheduled, 61 patients attended the virtual YADC between January 2021 and December 2022. Attendees ranged in age from 18 to 25, with a mean age of 21. Forty-one attendees (67%) had private insurance and 20 had state insurance. The mean HbA1c of virtual YADC participants was 8.61%. In comparison, the mean HbA1c of those who did not attend was 9.84%. Among young adult patients who did not attend, 19 (67%) attendees had state insurance, whereas 9 attendees had private insurance.
Conclusions: Characterization of virtual YADC attendees reveals a higher proportion with private insurance vs state insurance. This finding implies potential differences in access to care. Future studies will focus on understanding the differences between those who do and do not attend virtual YADC and how to increase patient engagement.

Disclosure
F.Joarder: None. T.H.Pandharpurkar: None. R.D.Tweet: None. T.Heyerman: None. K.O'neil: None. J.J.Park: None. I.Guttmann-bauman: None.
717-P: Unmet Needs and Communication Preferences for mHealth Self-Management Solutions in People with Type 1 Diabetes and Insulin Resistance
Authors: WILSON ANDREW R. , FARRAR MATTHEW , CAMPBELL MATTHEW D. 
Published: June 2023

Insulin resistance (IR) is prevalent within type 1 diabetes (T1D) and associated with increased morbidity and mortality. Mobile health (mHealth) applications are useful platforms for delivering health behaviour interventions, but technologies focusing on addressing IR in T1D are absent. The aim of this formative study was to identity salient unmet patient needs, communication preferences, and barriers for mHealth self-management solutions in people with T1D and IR. 70 adults with type 1 diabetes (male=57%; HbA1c 8.1±3.4%; 28±5years) completed an online survey evaluating skills gaps in self-management and priorities for diabetes mHealth apps. Survey responses were ranked using a 9-point scale and analysed using descriptive and inferential statistics. Qualitative write-in responses were subsequently coded and analysed using inductive thematic analysis. IR was assessed using estimated glucose disposal rate (eGDR). Among all respondents, 49% (n=34) identified glycemic control/variability as the principle unmet self-management need. Fewer than 5% (n=3) reported having no self-perceived skills gaps. 89% (n=62) identified paternalistic communication and weight stigmatization as barriers to mHealth use. Real-life/situational feedback for glucose control/variability was reported as the single largest facilitator of mHealth use (65%, n=46). Preferred communication strategies were empathy, concern, and compassion (81%, n=57), and informal, open, and direct (77%, n=54). Our results highlight that glucose control/variability is the principle unmet self-management need in T1D adults with IR. Several communication barriers negatively impact mHealth acceptability and efficacy in this group, particularly paternalistic and weight-stigmatizing language. mHealth solutions that target glycemic control/variability and are non-weight stigmatizing are urgently needed for people with T1D and IR.

Disclosure
A.R.Wilson: None. M.Farrar: None. M.D.Campbell: None.
718-P: Digital Health for Self-Management and Psychoeducational Support of Caregivers of Children with Type 1 Diabetes—A Feasibility Study
Authors: FERNANDEZ-LUQUE LUIS , DE ARRIBA ANTONIO , CIVITANI ELISA , PILAR FERRER MARIA , GARCÍA CASTELLANOS TERESA , LÓPEZ-GUIMET JÚLIA , QUER PALOMAS SILVIA 
Published: June 2023

Becoming a caregiver of child with Type 1 Diabetes (T1D) involves understanding, accepting, and managing the new medical condition that may cause sleep deprivation, depression, anxiety, self-neglection, and poorer quality of life. Related to family caregiver fatigue, parental mental well-being has been associated with less effective parenting and poorer disease management of those kids. Digital Health programs can offer psychoeducational support to caregivers during family daily life, complementing medical care. The present study aims to better understand the barriers/facilitators to the adoption of a digital health solution for adaptive self-management. The digital solution provides a personalized digital program that includes motivational messages, educational units, mental well-being activities, and coaching services. A cohort of 20 caregivers of children with type 1 diabetes was recruited at a large pediatric hospital in Spain. Demographic and health data were recorded at baseline. After joining the program for 1 month, a SUS (System Usability Scale) questionnaire and a semi-structured interview were administrated. Preliminary results showed that the digital solution is widely useful in obtaining a SUS score of 95’38 out of 100 (SD 7’95) and achieved positive engagement outcomes. In the interviews, caregivers expressed that the educational units reinforced disease self-management. Mental health data at baseline exposed a high percentage of caregivers with symptoms of depression (25%), anxiety (35%), and stress (30%). These results highlight the importance of caregivers’ emotional wellness and the digital health solution's potential to empower them to self-manage during the disease. A subsequent study clinical study will evaluate the clinical impact of the digital intervention on a larger cohort during 2023.

Disclosure
L.Fernandez-luque: Other Relationship; Adhera Health Inc. A.De arriba: Board Member; Merck KGaA, Speaker's Bureau; Novo Nordisk. E.Civitani: None. M.Pilar ferrer: None. T.García castellanos: None. J.López-guimet: None. S.Quer palomas: Employee; AdheraHealth Inc.

Funding
Novo Nordisk Pharma S.A. (Spain)