bluuebunny/crossref_metadata_2025_split huggingface dataset:
516-P: A One-Year Curriculum for Diabetes Self-Management Education to Promote Lasting Lifestyle Changes
Authors: SALLAM HANAA , PAN WENTONG , FERGUSON MONIQUE L. , LEE WEI-CHEN , MCKINNEY KEVIN H. , SERAG HANI 
Published: May 2022

The use of telehealth for Diabetes Self-Management Education and Support (DSMES) is expanding. There is a need among people with diabetes (PWD) to manage their diabetes, as they represent 20% of ICU admissions, 30% of hospitalized cases and have an increased risk of COVID-related mortality. While people at risk for diabetes or prediabetes may join a 1-year CDC accredited diabetes prevention program to make lifestyle changes to reduce their diabetes risk, PWD are often offered short-term DSMES programs that do not necessarily incorporate long-term goals. We developed a year-long intensive Diabetes Self-Management Education and Support (iDSMES) program combining Virtual Diabetes Conversation Map® and selected modified modules from the PreventT2® curriculum to suit PWD. The curriculum included 18 maps/modules. Our team of certified lifestyle coaches/diabetes educators/Conversation Map® Trainers used shared decision-making and problem-solving approaches to improve glycemic control and diabetes self-management. We hypothesized that iDSMES would improve diabetes outcomes in PWD. Fourteen PWD (12F/2M) with a BMI of 25 or above underwent the iDSMES in a group with their lifestyle coaches using the Zoom® platform. We collected their fasting blood glucose, weight, blood pressure, and physical activity minutes at each session (every three weeks) and assessed their Hemoglobin A1c quarterly. Nine PWD completed the iDSMES and lost an average of 8.8% of their initial body weight (a total of 203lbs) . We observed a 1% decrease in their A1c, 10mg/dL decrease in fasting blood glucose, and mm Hg decrease in systolic and diastolic blood pressure, respectively. There was also a 110-minute increase in their physical activity. A year-long iDSMES distance learning program effectively enhances lasting lifestyle changes to improve diabetes self-management in PWD. A 5-year follow-up is warranted to assess factors affecting the maintenance of accomplished lifestyle changes.

Disclosure
H.Sallam: None. W.Pan: None. M.L.Ferguson: None. W.Lee: None. K.H.Mckinney: None. H.Serag: None.

Funding
Texas Department of State Health Services (#HHS000740800001)
517-P: The Prevalence and Predictors of Improper Sharps Disposal among People with Diabetes in Saudi Arabia
Authors: ALSUWAILEM GHADAH , BARAKEH MAEE , ALMARSHOUD GHAIDA A. , ZAWAWI ALIA , BAKADER RAWAN A. , AL-SOFIANI MOHAMMED 
Published: May 2022

Background: Diabetes often requires the use of sharp objects (e.g. needles, lancets, etc) to maintain optimal glycemic control. Improper disposal of sharps poses substantial threats to the environment and public health.
Objectives: To estimate the prevalence, and identify predictors, of improper sharps disposal among people with diabetes (PWD) in Saudi Arabia.
Method: We surveyed PWD, visiting a diabetes center in Riyadh, Saudi Arabia in Sep- Oct, 2021. We asked questions about sociodemographics, type and duration of diabetes, methods of sharps disposal, and whether the study participants had received instructions on proper sharps disposal. We defined “proper sharps disposal” as: dispensing sharps into a designated sharps disposal container or home-made sealed container.
Results: Of the 293 PWD surveyed, 60% were women, 54% were ≥35 years old, and 53% had type 1 diabetes. Majority (80% and 72%) reported improper disposal of needles and lancets, respectively. Approximately, 56% of needle users and 61% of lancet users reported that they had never received instructions on safe sharps disposal. Receiving education on safe sharps disposal was associated with a 66% reduction in the risk of improper sharps disposal practice[OR (95% CI) : 0.34 (0.16-0.68) ] after adjusting for age, gender, type and duration of diabetes, income, education, and nationality of the study participants. Among those who improperly dispose their needles, 67% thought their way of sharps disposal was appropriate and 47% did not know what type of infections can be transmitted via needlestick injuries.
Conclusion: Our findings highlight the high prevalence of unsafe sharps disposal practices among PWD, and how providing education on safe sharps disposal can help address this environmental and public health threat. Policies to reduce diabetes-related waste, unify the approach to proper sharps disposal, and educate PWD on how to safely dispose sharps are needed to achieve a sustainable and safe waste management system.

Disclosure
G.Alsuwailem: None. M.Barakeh: None. G.A.Almarshoud: None. A.Zawawi: None. R.A.Bakader: None. M.Al-sofiani: None.
52-LB: Adult’s Lived Experience Using the Insulin-Only Bionic Pancreas
Authors: GARZA KIMBERLY P. , HOWARD KELSEY R. , WEISSBERG-BENCHELL JILL , FELDMAN MARISSA ,   BIONIC PANCREAS GROUP
Published: May 2022

The Insulin-only Bionic Pancreas (BP) Pivotal Trial compared the BP initialized only with body weight vs. standard-of-care (SC) . The BP autonomously determines all insulin doses. Meals are announced without carbohydrate counting. For adults aged 19-75 the mean adjusted difference of HbA1c at 13 weeks between BP and SC was -0.5% (95% CI: -0.6, -0.3, P&lt;0.001) ; percent of time &lt;54 mg/dl was not different between groups. Focus groups were conducted among BP users at the trial’s end.
Adults reported improved time in range and A1c. Many reported it corrected highs well; others felt it took too long. Some experienced fewer lows; others reported more, stating the algorithm was too aggressive in correcting highs. Concerns were raised about the inability to prevent lows even when predicted. Many experienced improved glycemia at night, improved sleep and waking up in target range; some found night-time lows negatively impacted sleep. Many reported difficulties suspending insulin to prevent lows, leading to less exercise during the trial. Meal announcements were appreciated, with increased freedom to eat without guilt, but most wished for snack announcements. Some found challenges managing high-fat foods and not having an extended bolus.
Many reported decreased emotional, cognitive and management burden with less worry, guilt, and burnout due to increased TIR and no need to carbohydrate count. Some found increased burden due to increased lows, and increased time filling cartridges and changing infusion sites. Some trusted the BP immediately, felt it learned their body quickly, and appreciated the automation. Others found waiting for corrections intolerable, engaging in either over-treating lows or administering external insulin for highs. Not knowing insulin-on-board was difficult for some.
System-specific concerns included: cartridge capacity, short tubing, no clip, poor back-lighting, the screen timing out quickly, and not being waterproof. Gathering patient perspectives offers insights into learning and using the BP as well as the psychosocial impact of the BP which can be used to guide future innovations.

Disclosure
K. P. Garza: None. K. R. Howard: None. J. Weissberg-benchell: None. M. Feldman: None. Bionic pancreas group: n/a.

Funding
National Institute of Diabetes Digestive and Kidney Disease (#1UC4DK108612-01)
521-P: Care Partner in Virtual Diabetes Self-Management Education and Support
Authors: ZUPA MARGARET , JOHNSON PATRICIA A. , KRALL JODI S. , NG JASON , REYNOLDS SHARI L. , ROSLAND ANN-MARIE , SIMINERIO LINDA M. 
Published: May 2022

Background: Support from care partners (CPs) , family or friends who are involved in diabetes management, is associated with improved self-management and clinical outcomes for adults with type 2 diabetes (T2D) . Therefore, guidelines recommend active CP involvement in diabetes self-management education and support (DSMES) . Telemedicine is increasingly being used to deliver DSMES and may facilitate CP involvement.
Objective: To examine the frequency and type of CP involvement in virtual DSMES sessions delivered to patients in their homes over 12 months as part of the Telemedicine for Reach, Education, Access, Treatment, and Ongoing Support study, designed to evaluate the impact of longitudinal DSMES conducted via videoconferencing.
Methods: 43 patients with T2D and an HbA1c&gt;9% were enrolled from rural federally qualified health centers. A diabetes care and education specialist (DCES) performed an initial in-person needs assessment, followed by individualized virtual DSMES sessions via videoconferencing over 12 months. Participants were surveyed on the presence and roles of CPs at baseline, and DCES recorded CP involvement at each DSMES session. Twenty participants identified a diabetes CP at baseline; 75% lived with their CP and 60% of CPs were the patient’s significant other. Patients reported that CPs regularly helped with self-management by encouraging healthy eating (80%) , medication adherence (70%) , and discussing home blood glucose results (70%) . Nine participants had a CP involved in at least one virtual DSMES session; CPs performed diverse functions, including assisting with technology, setting up continuous glucose monitors, reviewing nutrition recommendations, and facilitating information sharing between participants and DCES.
Conclusions and Future Direction: For adults with T2D, virtual visits offer opportunities for CPs to support and enhance DSMES. Efforts to more actively engage existing CPs could better leverage this resource to support ongoing diabetes self-management.

Disclosure
M.Zupa: None. P.A.Johnson: None. J.S.Krall: Research Support; Becton, Dickinson and Company, Sanofi. J.Ng: Research Support; Sanofi. S.L.Reynolds: None. A.Rosland: None. L.M.Siminerio: Advisory Panel; Abbott, Bayer AG, Research Support; Becton, Dickinson and Company, Sanofi.

Funding
NIDDK (R34DK123370) NCATS (TR001856)
528-P: Provider Perspectives: Digital Apps in Delivering Diabetes Self-Management Education and Support (DSMES)
Authors: MEHROTRA NEHA , KRALL JODI S. , NG JASON , SIMINERIO LINDA M. 
Published: May 2022

Introduction: DSMES is a critical component of diabetes (DM) care. Providers are expected to perform this service, but time for it is limited, especially for ongoing support. Digital tools, like mobile applications (apps) , show promise in extending efforts and supporting self-management, but have yet to be fully utilized. The purpose of this study was to examine provider insights on the role of mobile apps in DSMES delivery.
Methods: DM providers representing inpatient, outpatient, and community settings were invited to complete a validated survey about experiences with and perspectives on app use for DSMES. Survey results were recorded and summarized to capture dominant themes.
Results: Sixty providers (33% diabetes care and education specialists, DCESs, 21% endocrine clinicians) completed the survey. Of those, 17% (10/59) reported being very familiar with apps; 33% (20/59) had used an app to provide DM education while 25% (15/59) used an app for support. Respondents (77%, 46/60) primarily viewed apps as adjunct to DCES education, particularly for reinforcement. In terms of recommending apps, 90% of providers (54/60) rated patient app interest and access as most important factors to consider. In addition, 70% (42/60) agreed apps may be particularly useful to patients who use telehealth or live far from clinics. Specific to insulin, 70% agreed apps could serve as a helpful tool to prepare those new to insulin and aid with injection skills, dosing decisions and titration. Features they viewed as useful include clear set-up instructions, goal setting and digital coaching. Interestingly, outpatient DCESs reported willingness to use 15 or more minutes of visit on setting up/teaching app use, while hospital-based providers were willing to spend 5 minutes.
Conclusion: National standards recommend digital coaching as an effective method to deliver DSMES. These findings offer important feedback for introducing digital tools into clinical practice.

Disclosure
N.Mehrotra: None. J.S.Krall: Research Support; Becton, Dickinson and Company, Sanofi. J.Ng: Research Support; Sanofi. L.M.Siminerio: Advisory Panel; Abbott, Bayer AG, Research Support; Becton, Dickinson and Company, Sanofi.

Funding
Becton, Dickinson and Company
532-P: Voluntary Exercise during Food Restriction Promotes a Sustained Increase in Hepatic Oxidative Metabolism
Authors: DEJA STANISLAW , KUCEJOVA BLANKA , MAURER ADRIANNA , MIZERSKA MONIKA N. , FU XIAORONG , THYFAULT JOHN P. , BURGESS SHAWN C. 
Published: May 2022

Exercise is an important lifestyle intervention for the prevention and treatment of NAFLD. Importantly, exercise can reduce hepatic steatosis independent of changes in body mass, which may stem from increased oxidative demand in liver during exercise. Increased hepatic gluconeogenesis (GNG) and tricarboxylic acid (TCA) cycle flux have been observed during exercise in rodents, but it is unclear whether this adaptation is chronically maintained outside of the exercise window. Liver metabolism is also altered by nutritional status. Fasting promotes hepatic fat oxidation, ketogenesis and GNG, while feeding promotes glycogen storage and fat synthesis. Hence, fasting and exercise may have a positive interaction, whereas exogenous nutrient intake or glucose infusion is known to reduce the induction of GNG during exercise. Here, we tested whether nutritional status impacts exercise induced hepatic metabolic adaptations. Sprague-Dawley rats were kept sedentary or provided voluntary wheel running (VWR) for 4 weeks in the presence or absence of food restriction during the dark phase when rats spontaneously run. Experiments were conducted one day following the last exercise bout. Hepatic metabolic flux was examined by in vivo stable isotope infusions of [U-13C3]propionate, [3,4-13C2]glucose and 2H2O in rats using mass spectrometry and computational analysis. Chronic VWR in the fed state had no effect on basal hepatic fluxes outside of the exercise window. However, exercise during food restriction chronically induced a 2-fold induction of TCA cycle turnover, increase in GNG from glycerol and lowered ketogenesis outside of the exercise window. Thus, VWR during food restriction triggered an increase in hepatic energy demand that was sustained for at least 24 hours, while the effects of exercise in the fed state dissipated by 24 hours. These data suggest that acute nutritional state may be an important factor in the long-term programming of liver metabolism by exercise.

Disclosure
S.Deja: None. B.Kucejova: None. A.Maurer: None. M.N.Mizerska: None. X.Fu: None. J.P.Thyfault: None. S.C.Burgess: n/a.

Funding
National Institutes of Health (R01DK121497, R01DK078184, P41EB015908)
54-OR: Psychosocial Factors and Medication Adherence in Young Adults with Youth-Onset Type 2 Diabetes: Longitudinal Results from the iCount Study
Authors: TRIEF PAULA M. , KALICHMAN SETH , USCHNER DIANE , FETTE LIDA M. , WEN HUI , DREWS KIMBERLY , ANDERSON BARBARA , BULGER JANE D. , WEINSTOCK RUTH S. 
Published: May 2022

Aim: To identify psychosocial factors in young adults (mean age 26 yrs) that predict medication adherence 1 year later in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) observational study.
Methods: Validated psychosocial measures (attitudes, beliefs, self-efficacy, distress, depression, anxiety, self-management support, needs insecurities) were completed at baseline (T1) . Medication adherence was assessed at T1 and 1 year later (T2) . Adherence to oral hypoglycemia agents (OHA) was assessed with 3 monthly unannounced phone pill counts. Insulin adherence was self-report. Adherence was defined categorically (≥ 80% pills/insulin=high adherent; &lt; 80% = low adherent) and continuously (% adherence) . Logistic and linear regressions assessed psychosocial measures as predictors of adherence group (high vs. low) and % adherence, controlling for potential confounders.
Results: OHA adherence: Mean scores declined from T1 to T2 (57.9% vs. 51.4%, p=0.004; N=171) . In adjusted multivariable analyses, more concerns about diabetes medications (e.g. long-term effects) (p=0.035) and lack of healthcare coverage (p=0.043) predicted higher odds of being low adherent. Beliefs that medications are harmful (p=0.004) or overused (p=0.002) , lack of healthcare coverage (p&lt;0.0001) , reporting ≥1 (p=0.004) and ≥2 (p=0.017) need insecurities predicted lower % adherence.Insulin adherence: Mean scores were stable from T1 to T2 (70.8% vs. 69.3%, p=0.622; N=157) . Beliefs that medications are harmful (p=0.022) or overused (p=0.002) and lower self-management support (p=0.006) predicted being low adherent and lower % adherence. High diabetes distress predicted lower % adherence (p=0.044) .
Conclusions: Negative beliefs about medicines and unmet material needs predicted poorer OHA adherence. Negative beliefs, low support and distress predicted lower insulin adherence. These factors may be targets for future interventions.

Disclosure
P.M.Trief: None. S.Kalichman: None. D.Uschner: None. L.M.Fette: None. H.Wen: None. K.Drews: None. B.Anderson: None. J.D.Bulger: None. R.S.Weinstock: Research Support; Boehringer Ingelheim International GmbH, Dexcom, Inc., Diasome, Eli Lilly and Company, Insulet Corporation, Kowa Pharmaceuticals America, Inc., Medtronic, Novo Nordisk, Tandem Diabetes Care, Inc., Tolerion, Inc.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (RO1DK110456, U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254)
540-P: Meta-analysis of Blood Glucose Response to High Intensity Exercise in Adults with Type 1 Diabetes
Authors: MCCLURE REID , WESEEN EMMA , ALCÁNTARA CORDERO FRANCISCO JAVIER , MALDANER MIRANDA , HART SARAH , BOULÉ NORMAND G. , YARDLEY JANE E. 
Published: May 2022

Background: High intensity exercise-induced hyperglycemia is recognized in T1D clinical guidelines, but its occurrence after high intensity intermittent exercise (HIIE) in acute studies is inconsistent. This meta-analysis aimed to examine the available evidence of BG responses to HIIE in adults with T1D. The secondary aim was to assess the role of prandial status (fasted/fed) , sex (by percentage of female participants ≤ 50, or &gt; 50) , mean age, fitness (VO2peak) , interval duration, and total exercise duration on BG outcomes. We hypothesized that there would be no consistent effect on BG from HIIE, unless examined in the context of participant prandial status.
Methods: We conducted a literature search using keywords related to T1D and HIIE. Studies were required to have a minimum of 6 participants with T1D aged ≥17 years, involving a HIIE intervention, and a pre- and post-exercise measure of BG to be included. Analyses were performed using a general inverse variance statistical method with a random effects model on RevMan5® statistical software and a weighted multiple regression on STATA17® statistical software.
Results: Seventeen interventions from 13 studies were included in the final analysis. A mean overall BG change of -1.4 mmol/L (-3.0, 0.2) was found during exercise albeit with high heterogeneity (I2= 92%) . Fasted exercise increased BG by +1.7 mmol/L (-0.2, 3.6) , while fed exercise decreased BG by -2.6 mmol/L (3.7, -1.5) , with a statistically significant difference between groups (p&lt;0.001) . There were no significant effects from sex (p=0.74) , fitness (p=0.46) , age (p=0.89) , interval duration (p=0.25) or exercise duration (p=0.38) .
Conclusions: The effect of HIIE on BG is inconsistent, but partially explained by prandial status.

Disclosure
R.Mcclure: None. E.Weseen: None. F.Alcántara cordero: None. M.Maldaner: None. S.Hart: None. N.G.Boulé: None. J.E.Yardley: Research Support; Abbott, Dexcom, Inc., LifeScan, Speaker's Bureau; Abbott Diabetes.
552-P: Changes in Food and Nutrient Intake and Diet Quality on a Low-Fat Vegan Diet Are Associated with Changes in Body Weight and Body Composition in Overweight Adults: A Randomized Clinical Trial
Authors: KAHLEOVA HANA 
Published: May 2022

Objective: The aim was to identify changes in food, nutrient intake, and diet quality on a low-fat vegan diet and associations with changes in body weight and body composition.
Methods: Overweight adults (n=244) were randomly assigned to follow a low-fat vegan diet (n=122) or make no diet changes (n=122) . Main outcome measures were changes in food intake, macro- and micronutrient intake, and dietary quality as measured by AHEI-2010, analyzed from 3-day diet records, and associations with changes in body weight and body composition. A repeated measure analysis of variance (ANOVA) model, Spearman correlations, and linear regression were used for statistical analysis.
Results: The intervention group’s AHEI-20increased by 6.0 points on average in contrast to no significant change in the control group (treatment effect +7.2 [95% CI +3.7 to +10.7]; p&lt;0.001) . Increase in AHEI-20correlated with reduction in body weight (r=0.14; p=0.04) , fat mass (r=-0.14; p=0.03) , and HOMA-IR (r=-0.17; p=0.02) , after adjustment for changes in energy intake. Fruit, vegetable, legume, meat alternative, and whole grain intake significantly increased in the intervention group. Intake of meat, fish and poultry; dairy products; eggs; nuts and seeds; and added fats decreased. Decreased weight was most strongly associated with increased intake of legumes (r=‑0.38; p&lt;.0001) and decreased intake of total meat, fish, and poultry (r=+0.43;p&lt;.0001) . Reduced fat intake was associated with reduced body weight (r=+0.15; p=0.02) and, after adjustment for changes in BMI and energy intake, with reduced fat mass (r=+0.14; p=0.04) .
Conclusions: Diet quality as measured by AHEI-20improved on the low-fat vegan diet, which was associated with improvements in weight and metabolic outcomes. Increased legume intake was the strongest single food group predictor of weight loss.

Disclosure
H.Kahleova: None.