bluuebunny/crossref_metadata_2025_split huggingface dataset:
63-LB: Correlates of CGM Uptake among Adults with Type 2 Diabetes in Primary Care
Authors: MAYBERRY LINDSAY S. , RODDY MCKENZIE K. , JASER SARAH S. , ELASY TOM A. 
Published: May 2022

Clinical trials indicate continuous glucose monitor (CGM) use in type 2 diabetes (T2D) can be beneficial across medication regimens and outpatient settings. CGM use in care for T2D is increasing rapidly, but little is known about predictors of CGM use in T2D. Adults (age 18-75) with T2D receiving primary care at an academic medical center enrolled in a RCT evaluating a self-management support intervention. The intervention did not address CGM use. At enrollment, patients completed an A1c test, self-reported demographic, clinical characteristics and individual (diabetes distress, diabetes self-efficacy, health literacy) , social (family/friend involvement, shared illness perception) , and behavioral (self-care behaviors) factors. The 15-month assessment queried CGM use in prior 12 months (current use/used and quit vs. no use) . We explored potential correlates of CGM use with unadjusted non-parametric tests of difference. Patients (N=109) completed 15-month assessments from July 2021 to March 2022. Mean age was 58±10 years; 57% female; 54% non-Hispanic white, 31% non-Hispanic black, 7% Hispanic; mean baseline A1c was 8.8%±1.8%. One-third (n=36) used CGM during the prior 15 months (including n=3 who quit) . CGM users were younger (median [IQR]: age 55 [47, 62] vs. 60 [53, 68], p=.031) , had higher baseline A1c (9.1% [8.1, 10.4] vs. 8.3% [7.5, 9.5], p=.048) and more were using insulin (69% vs. 36%, p=.002) as compared to non-users. CGM users also had higher baseline diabetes distress (45 [25, 55] vs. 30 [15, 50], p=.09) . CGM use was not related to gender, diabetes duration, race, ethnicity, health literacy, diabetes self-efficacy, family/friend involvement, perceiving diabetes as a shared illness, nor self-care behaviors. In a prospective study of adults with T2D from primary care clinics, younger age, insulin use, higher A1c and higher diabetes distress were associated with starting CGM. Two-thirds of CGM users were taking insulin. We did not find gender, race, ethnicity nor health literacy disparities in CGM use in our diverse sample.

Disclosure
L. S. Mayberry: Consultant; Abbott Diabetes, Cecelia Health. M. K. Roddy: None. S. S. Jaser: None. T. A. Elasy: None.

Funding
National Institutes of Health (R01DK119282)
634-P: Transition Readiness Variables Predict Transfer to Adult Care among Youth with Type 1 Diabetes
Authors: SHAPIRO JENNA , WEISSBERG-BENCHELL JILL 
Published: May 2022

The transfer from pediatric to adult care for adolescents and young adults (AYA) with T1D is a challenging process during which AYAs are vulnerable to worsening metabolic outcomes, missed clinic visits, and increased ED and hospital admissions. This study investigated which modifiable individual and family-specific transition readiness variables may lead to improved transfer of care outcomes. Two-hundred fifty-four individuals with T1D ages 16 to 25 years (Mage=20.9+2.7) completed an online survey. Multiple regression in SPSS assessed relations between (a) individual (diabetes-specific resilience, diabetes distress, self-care behaviors, problem solving) and (b) family (diabetes-related conflict, communication, miscarried helping, support) transition readiness variables and transfer of care outcomes. Variables were entered simultaneously, above and beyond covariates, and significant predictors were indicated by p &lt; .05. With respect to individual factors, greater problem solving was associated with seeing an adult (versus pediatric) provider, less hospital admissions, less severe low blood sugars, and more clinic visits one-year post-transfer. Resilience was associated with increased readiness to transfer. Self-care behaviors were associated with fewer severe low blood sugars. Diabetes distress was associated with lower likelihood of seeing an adult provider and more ED and clinic visits. With respect to family factors, higher conflict was associated with a higher rate of ED visits, fewer clinic visits, and fewer episodes of severe low blood sugars post-transfer. Miscarried helping was associated with a greater likelihood of seeing an adult provider. Modifiable individual and family-specific transition readiness variables are uniquely associated with key transfer of care outcomes. Interventions that reduce family conflict and diabetes distress, and improve diabetes resilience and problem solving, are likely to improve these outcomes.

Disclosure
J.Shapiro: None. J.Weissberg-benchell: None.

Funding
Dixon Family Foundation
638-P: Differences in Perceived Stress between Genders among People with Diabetes during COVID Lockdown in Argentina
Authors: POMARES MARIA L. , MARTIN CAROLINA GOMEZ , APOLONI SUSANA , MURATORE CAROLINA M. , AVILA PABLO J. , FORLINO MARIANO A. , RIVERA FRANCISCO , CASTAGNINO LUISINA , PIEDIMONTE BARBARA ,   COVID-GRAD STUDY GROUP,   SOCIETY ARGENTINE DIABETES
Published: May 2022

Many studies suggest that there is a difference in perceived stress (PS) among genders in general population. Gender differences in patients with diabetes are uncertain. Descriptions of gender differences in PS during Covid lockdown in people with diabetes are lacking.
Objectives: To assess the differences regarding perceived stress and anxiety between genders among persons with diabetes during COVID-pandemic lockdown. Secondary: To describe the association between PS with metabolic control and other co-variables.
Methods: Multicenter, cross-sectional observational study of data collection through an online survey. Adults with T1D and T2D in 37 Argentine Diabetes Centers were included, from April to May, 2020. Degree of stress was evaluated by the Perceived Stress Scale (PSS) , and anxiety by the Beck Anxiety Inventory (BAI) .
Results: 2273 patients were included. 1194 (52.5%) were female. Age in woman 48.6 years and 52.1 in men. The proportion of patients with T2D was higher in male (58.6% vs. 48.9%) . Diabetes duration was around 14 years, similar in both genders. A1c levels were higher in female patients (7.7% vs. 7.5%, p &lt; 0.05) . BAI and PPS scales resulted significantly correlated (r=0.58; p &lt;0.001) . In the univariate analysis BAI and PPS scores were significantly higher in women with both T1D and T2D vs. men (BAI 8.9 vs. 6.6, p&lt;0.001, PSS 14.3 vs. 11.8, p&lt;0.001) . Using a logistic model as a discriminant function, female gender was significantly associated with BAI and PPS scores after adjustment for type of diabetes, age, A1c, educational level, living alone condition and the presence of comorbidities or complications (p&lt;0.001) . Using multiple linear regression, BAI and PSS scores were significantly associated with female gender, after adjustment by the same covariates (BAI p&lt;0.00 and PSS p&lt;0.0013) .
Conclusion: In the study sample, female gender was associated with higher scores of anxiety and PS, in a context of isolation due to COVID pandemic in Argentina.

Disclosure
M.L.Pomares: None. Study group covid-grad, argentine diabetes society: n/a. C.Gomez martin: None. S.Apoloni: None. C.M.Muratore: None. P.J.Avila: None. M.A.Forlino: Speaker's Bureau; Novo Nordisk. F.Rivera: None. L.Castagnino: None. B.Piedimonte: None.
642-P: Physicians' Knowledge and Attitudes of Disordered Eating Behaviors among Patients with Diabetes
Authors: KHATCHADOURIAN NAYIRI , SCHMELTZ LOWELL , UHLEY VIRGINIA , BRENNAN MICHAEL R. 
Published: May 2022

Patients diagnosed with type 1 and type 2 Diabetes Mellitus (DM) are at increased risk for developing clinical disordered eating behaviors (DEBs) . Although research supports this higher incidence and the impact on health outcomes, few studies have assessed physicians’ knowledg,attitudes and training to identify and treat DEB. The American Diabetes Associations’ 2021 Standards of Care included a new section aboutDEB, further highlighting the importance of addressing this issue. Our goal was to assess physicians’ level of training, comfort and attitudes towards providing clinical care to patients diagnosed with DM and their experience in assessing, identifying, and treating DEBs in this patient population.
The cross-sectional study, a 17-question online survey through Qualtrics, was developed by modifying questionnaires from the Michigan Diabetes Research Center and was emailed to participants. The response size was 34 physicians or medical residents that provide care for patients diagnosed with DM.
97% of the physicians were endocrinologists with years of experience ranging from 6-35 years. 58.8% reported not having received any education about identifying or assessing for DEB among patients diagnosed with DM during or after their professional training. 67.6% identified that they did not believe they have the resources available to assist a patient with DEB; requested suggestions included an online learning course, screening questionnaires and specialty training.
These research results highlight possible gaps in medical education programs regarding training around DEB. Our future plans are to address this by creating continuing medical education training modules for endocrinologists and endocrinology residents focused on the evaluation, diagnosis, and treatment of DEB in patients diagnosed with DM. We anticipate that this will help to enhance the knowledge and skills of physicians and residents in the clinical care and support of patients diagnosed with DM.

Disclosure
L. Schmeltz: Research Support; Abbott Diabetes. Speaker's Bureau; Abbott Diabetes, Dexcom, Inc., Lilly, Novo Nordisk, Xeris Pharmaceuticals, Inc. V. Uhley: None. M.R. Brennan: Advisory Panel; Insulet Corporation. Speaker's Bureau; Novo Nordisk. Other Relationship; Bayer AG.
647-P: Improved Glycemic Control and Continuous Glucose Monitoring (CGM) Utilization: A Comparison of Real-Time CGM and Intermittent Scanning CGM
Authors: HANNAH KATIA , NEMLEKAR POORVA , PRICE DAVID A. , NORMAN GREGORY J. 
Published: May 2022

Evolution of CGM technology has equipped the market with different systems. This study compared two types of CGM devices, real-time (rt) CGM and intermittently scanned (is) CGM on clinical outcomes among persons with diabetes using intensive insulin therapy. A retrospective analysis was performed using Optum Clinformatics® Database comprised of administrative claims data. CGM naïve patients with type 1 or type 2 diabetes initiated rtCGM (Dexcom G6®) or isCGM (FreeStyle Libre®) between 8/1/2018 through 3/31/2020 (index date = earliest observed pharmacy claim) . Patients with continuous health plan enrollment 12-months pre and post index date, age ≥18 years, with ≥1 sensor pharmacy claim, with A1C lab values during baseline and follow up were included in the study. Outcomes were the proportion reaching a target A1C of &lt; 7% and the change in number of severe hypoglycemia (SH) inpatient/ER visits. A total of 272 rtCGM (average age = 47.3 (sd = 13.1) years, 46.7% female) and 467 isCGM (average age = 50.9 (sd = 12.7) years, 37.5% female) patients on intensive insulin therapy met inclusion criteria. After adjusting for baseline, rtCGM users were nearly twice as likely, compared to isCGM users, to reach an A1C of &lt; 7% (OR = 1.97, 95% CI, 1.32 to 2.95, p&lt;0.01) . A significant reduction was found in SH events from 40 to 13 after rtCGM initiation (baseline mean = 0.15, sd=0.49; and follow up mean = 0.05, sd=0.23, p&lt;0.01) . For isCGM users SH events reduced from 42 to 32 (mean = 0.09, sd=0.44; and follow up mean 0.07, sd=0.35, p=0.239) . Findings suggest CGM naïve patients benefit from rtCGM compared to isCGM through significantly greater numbers achieving A1C &lt; 7%. Improved access to rtCGM should help more patients achieve optimal glycemic control and reduce health care encounters due to SH.

Disclosure
K.Hannah: Employee; Dexcom, Inc. P.Nemlekar: None. D.A.Price: Employee; Dexcom, Inc. G.J.Norman: Employee; Dexcom, Inc.
648-P: Lag Times in a Seventh-Generation Continuous Glucose Monitoring System
Authors: ZHANG XIAOHE , REID JENNIFER L. , WALKER TOMAS C. , WELSH JOHN , BALO ANDREW 
Published: May 2022

Background: Glucose transport from blood to interstitial fluid impacts performance of interstitially-placed continuous glucose monitoring (CGM) sensors. We examined time series offsets (“lag times”) of the G7 CGM system (Dexcom) .
Methods: In a pivotal accuracy study conducted in the US, 316 adults with diabetes wearing 6sensors participated in clinic sessions that included glucose manipulations and frequent venous plasma glucose (YSI) determinations. G7 values were obtained every 5 min and interpolated to provide values at 1-min intervals. Each YSI value was associated with 21 G7 values obtained from min before to min after. The absolute relative difference (ARD) was calculated for each YSI:G7 pair and each sensor’s lag was estimated as the time with the lowest mean ARD.
Results: A lag time of 2 minutes provided the lowest mean ARD of 8.6% and the highest %20/20 agreement rate of 94.4%. The Figure shows summary statistics for the distribution of sensor-specific lag times. Lag times of ≤0 min (where interstitial glucose leads blood glucose) were observed for 2 (33.0%) of the sensors.
Conclusions: The distribution of G7 time series offsets suggests that CGM values may most accurately reflect previous or upcoming blood glucose values. This finding is likely due to technological innovations in G7’s hardware and algorithm. The minimal lag time observed should provide users with confidence in using CGM to manage their diabetes.

Disclosure
X.Zhang: Employee; Dexcom, Inc. J.L.Reid: Employee; Dexcom, Inc., GenMark Diagnostics. T.C.Walker: Employee; Dexcom, Inc., Stock/Shareholder; Dexcom, Inc. J.Welsh: Employee; Dexcom, Inc. A.Balo: Employee; Dexcom, Inc.

Funding
Dexcom, Inc.
650-P: Artificial Intelligence and Individualized Optimal Glycemic Target in ICU Patients
Authors: YUN JAE-SEUNG , LEE GARAM , KIM JAESIK , KO SEUNG-HYUN , AHN YU-BAE , KIM DOKYOON , SONG KI-HO 
Published: May 2022

Introduction: Deep learning methods, commonly called artificial intelligence (AI) , have been widely adopted in medical research. Reinforcement learning is a particularly promising AI tool that can generate optimal strategies based on non-optimized training data. The aim of the currentstudy was to develop and validate a reinforcement learning algorithm for determining optimal glycemic targets for sepsis patients in the ICU.
Methods: We developed and validated a clinical decision support model that provided an individualized daily glycemic target for each critically ill patient based on the retrospective analysis of two independent ICU databases, Medical Information for Mart for Intensive Care III (MIMIC-III) and the eICU Collaborative Research Database (eICU-CRD) . We used a Markov decision process (MDP) to formulate sequential decision-making. The discrete state was generated by quantizing all patients’ longitudinal health records using a k-means clustering algorithm. To evaluate clinician policy, we used the temporal-difference (TD) learning method. To learn AI policy, we generated a random action policy, updated the value function, and used the value function to update the policy.
Results: Average return per patient was significantly higher in survivors than non-survivors, and a significant inverse relationship was observed between AI performance return and estimated 90-day mortality. Contrary to the current guidelines that recommend maintaining a glycemic range of 140-180 mg during ICU admission, AI most often recommended a glycemic range of 120-139 mg/dL for ICU patients. Analysis of mortality rate according to mean glucose level during ICU admission revealed that the greater the difference between AI recommendation and real glycemic control range, the higher the mortality rate.
Conclusion: These results suggest that tighter glycemic control, guided by a similar AI policy for daily individualized optimal glycemic target, may help improve ICU patient survival.

Disclosure
J.Yun: None. G.Lee: None. J.Kim: None. S.Ko: None. Y.Ahn: None. D.Kim: n/a. K.Song: n/a.
658-P: Gaps Remain for Achieving Guideline-Recommended and Individualized HbA1c Targets for People with Type 1 and Type 2 Diabetes Using Mealtime Insulin or Basal-Only Insulin
Authors: HANKOSKY EMILY R. , SCHAPIRO DAVID , GUNN KARLI B. , LUBELCZYK ELIZABETH , MITROI JESSICA , NELSON DAVID R. 
Published: May 2022

Background: HbA1c is a primary measure of glycemic control and managing HbA1c may help reduce the risk of complications. This study aimed to describe trends in HbA1c by insulin regimen.
Methods: This was a retrospective analysis of cross-sectional surveys collected from the National Health and Nutrition Examination Survey between 2009-2018. Mean HbA1c and proportion achieving guideline- and HCP-recommended (i.e. personalized) HbA1c targets were evaluated in aggregate and over time in adults (18-64 years) with type 1 (T1DM) or type 2 (T2DM) diabetes using mealtime insulin (MTI) or basal insulin only. Trends over time between 2009-2018 were evaluated after adjusting for age, gender, race/ethnicity. The analysis included the strata, clusters, and weighting of the complex survey design.
Results: From 2009-2018, 26.1% of people with T1DM (weighted n=891,194; mean HbA1c [SE] 7.9% [0.2]) , 24.8% with T2DM MTI (weighted n=1,591,183; mean HbA1c [SE] 8.6% [0.2]) , and 11.2% with T2DM basal only (weighted n=1,087,895; mean HbA1c [SE] 8.6% [0.2]) achieved the ADA recommended HbA1c goal of &lt;7%. Among those who reported personalized HbA1c goals, 28.7% (T1DM) , 9.5% (T2DM MTI) , and 17.1% (T2DM basal only) achieved their goals. After adjustment, the proportion of people achieving HbA1c &lt;7% in the basal only group increased significantly over time (2009-2018; p=0.04) , driven by an increase in 2017-2018. Adjusted mean HbA1c for T2DM MTI significantly decreased during the 2009-2018 timeframe (p=0.003) , whereas no significant differences were seen in the other subgroups.
Conclusions: Across all insulin regimens based off the most recent NHANES data, ∼75-90% of individuals are not achieving ADA-recommended or personalized HbA1c goals. Emerging treatment tools (e.g. new technologies, advanced insulins, and time in range metrics) may facilitate improved diabetes outcomes.

Disclosure
E.R.Hankosky: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. D.Schapiro: Employee; Eli Lilly and Company. K.B.Gunn: Employee; Eli Lilly and Company. E.Lubelczyk: Employee; Eli Lilly and Company. J.Mitroi: None. D.R.Nelson: Employee; Eli Lilly and Company.

Funding
Eli Lilly and Company
661-P: Use of a Sequential Continuous Glucose Monitoring with or without Exercise Tracker on Glycaemic Control in Middle-Aged Patients with Diabetes Mellitus
Authors: KHOO CHIN MENG , HTIKE KYU , DAN YOCK YOUNG 
Published: May 2022

This study examined if a sequential continuous glucose monitoring (CGM) program using a Freestyle Libre would improve glycaemic control with or without an exercise tracker among middle-aged (50 to 65 years) patients with type 2 diabetes. We randomized 94 subjects (mean 57±4 years and HbA1c 10.1±1.6%) into a group wearing CGM alone (CGM-alone, n=52) and another group wearing CGM and an exercise tracker (CGM-Fit, n=42) . We measured HbA1c at pre-randomization, at 4 months and 6 months from randomization. All subjects wore the CGM every 2 weekly sequentially for the first 6 weeks and received diabetes counselling and professional dietary advice based on the CGM profile. Diabetes treatment was adjusted by the diabetes educator as appropriately. Those in the CGM-Fit group received a Fitbit watch with app-based guidance on an exercise regime. At baseline (pre-randomization) , there was no between-group difference in the HbA1c levels. At 4-month post-randomization, the HbA1c improved by 1.6±1.5% in CGM-alone (p&lt;0.05) and 1.9±1.7% in CGM-Fit group (p&lt;0.05) . Compared to baseline, at 6-month post-randomization, the HbA1c improved by 0.8±1.7% in CGM-alone (p&lt;0.05) and 1.6±1.6% in CGM-Fit group (p&lt;0.05) group) . Between the 4-month and 6-month post-randomization, the HbA1c had increased by 0.8±1.1% in CGM-alone (P &lt;0.05) but only 0.2±0.8% in CGM-fit group (P &gt;0.05) . Overall, 42.4% of subjects had an increase and 39.4% a decrease in diabetes medication when reviewed by the diabetes nurse educator.
In summary, the use of sequential CGM (for 6 weeks) with DM counselling and dietary advice improved HbA1c significantly by a mean of 1.7%. However, this does not appear sustainable at 6 months of follow up. The use of an exercise tracker might be helpful to sustain the improvement in glycaemic control. The use of CGM can guide management in titrating diabetes medication to improve glycaemia.

Disclosure
C.Khoo: None. K.Htike: None. Y.Dan: None.

Funding
NUHS AHS Mission Fund
663-P: Improving Knowledge, Competence, and Confidence of Diabetologists and Endocrinologists and Primary Care Providers Related to CGM Use with Curriculum-Based Online Education
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE 
Published: May 2022

Purpose: We sought to determine if a curriculum of online continuing medical education (CME) activities could improve the clinical knowledge, competence, and confidence of diabetologists and endocrinologists (D/Es) and primary care providers (PCPs) related to rtCGM.
Methods: The curriculum consisted of 5 online activities, all of which used repeated pairs pre-/post-assessment study design and McNemar’s test (P &lt;.is considered significant) to assess educational effect. The activities launched from April 30, 20through March 16, 2020 and data were collected for up to 12 weeks for each activity.
Results: The education reached over 15,500 physicians, including 4,187 D/Es and 3,196 PCPs. Overall, knowledge improved by 15% among D/Es (N=598, P&lt;.01) and 22% among PCPs (N=829, P&lt;.01) and competence improved by 40% among D/Es (N=228, P&lt;.01) and 21% among PCPs (N=307, P&lt;.01) . 29% relative increase in knowledge among D/Es (P=.059) and 36% relative increase in knowledge among PCPs (P&lt;.01) related to the role of CGM in type 2 diabetes (T2D) . 7% relative increase in knowledge among D/Es (P&lt;.01) and 14% relative increase in knowledge among PCPs (P&lt;.01) related to fundamentals of rtCGM. 40% relative increase in competence among D/Es (P&lt;.01) and 21% relative increase in competence among PCPs (P&lt;.01) related to optimal use of CGM in pregnancy. 37% of D/Es and 42% of PCPs had a measurable increase in confidence (both P&lt;.01) , and among those the average level of confidence increased 52% for D/Es and 73% for PCPs.
Conclusion: While this curriculum demonstrated success in educating on this topic, some gaps still remain after education. 37% (D/Es) and 40% (PCPs) of the questions assessing knowledge on the role of CGM in T2D and 21% (D/Es) and 37% (PCPs) of questions on fundamentals of CGM were still incorrectly answered after education, demonstrating a need for more education.

Disclosure
A.Larkin: None. J.Schrand: None. A.Le: None.

Funding
Developed through an independent educational grant from Dexcom