bluuebunny/crossref_metadata_2025_split huggingface dataset:
594-P: Telehealth Results in Increased Visit Frequency and Lower Diabetes Distress in Young Adults (YA) with Type 1 Diabetes (T1D)
Authors: RAYMOND JENNIFER , FOGEL JENNIFER L. , REID MARK W. , SALCEDO-RODRIGUEZ ELIZABETH , FOX D STEVEN , PYATAK ELIZABETH 
Published: May 2022

Background: Managing T1D as a YA is challenging due to changing physiology, psychosocial demands, and increasing independence. Fewer than one-third of YA with T1D meet the ADA guidelines of quarterly diabetes visits and only one in seven attain the recommended hemoglobin A1c level of &lt;7%. YA from disadvantaged ethnic, racial, and socioeconomic backgrounds face even greater T1D management obstacles.
Methods: The CoYoT1 Care model was adapted for diverse, predominantly publicly insured, YA with T1D at a large urban hospital. A 15-month 4-arm randomized controlled trial collected data on 68 YA, ages 16-25. Participants received either CoYoT1 Care or Standard Care via in-person or Telehealth (TH) , prior to COVID-19; all in-person visits transitioned to TH in March 2020. CoYoT1 Care consists of patient-centered provider visits with bimonthly virtual T1D peer group sessions.
Results: YA who attended &gt;50% of study visits by TH attended more visits during the study period (3.4) than those who primarily attended in-person (2.6, p&lt;0.0001) . Those who were seen more by TH also had stable levels of diabetes distress versus increased distress in those attending in-person visits (p=0.02) . A conjoint analysis conducted with YA found that not having to travel to clinic for visits was TH’s greatest benefit; technical problems and not always having private space were its biggest challenges. Participants also rated access to a clinic coordinator and TH visits as extremely valuable.
Conclusions: TH was successfully adapted for diverse YA with T1D, resulting in increased attendance and stable diabetes distress compared to in-person care. Participants overwhelmingly indicated that the benefits associated with TH, such as saving time and money traveling and parking, outweighed any technical challenges. Larger studies with longer term follow-up, not occurring during a global pandemic, are needed to refine TH’s role in patient-centered care of YA with T1D.

Disclosure
J.Raymond: None. J.L.Fogel: None. M.W.Reid: None. E.Salcedo-rodriguez: None. D.Fox: None. E.Pyatak: Research Support; Abbott Diabetes.

Funding
Donaghue Foundation
599-P: Disparities in the Impact of COVID-on Adolescents Living with Type 1 Diabetes at a Pediatric Diabetes Center in NYC
Authors: GOLDBERG MADELEINE , ILKOWITZ JENIECE , GONZALEZ JUANA E. , STEIN CHERYL R. , GALLAGHER MARY PAT 
Published: May 2022

Background: There are significant racial and socioeconomic disparities in health outcomes for patients with type 1 diabetes (T1D) . COVID-also disproportionately affected racial/ethnic minority groups.
Objective: We examined whether the pandemic differentially impacted patients with T1D who identified as minority (Hispanic, non-Hispanic Black, Asian) versus non-minority (non-Hispanic white) .
Methods: We administered the COVID-Exposure and Family Impact Survey to adolescents with T1D seen at the NYU Pediatric Diabetes Center from May 2020 - May 2021 (n=165) . Patient characteristics were compared using chi-square tests and linear regression models.
Results: Respondents (n=41) had a median age of 17 years (range 15-23, SD 2.2) . Most respondents identified as non-minority (58.5%) , female (53.7%) , and were privately insured (65.9%) . Those identifying as minority had higher distress scores (5.4 versus 3.9; p=.07) , less continuous glucose monitor use, and higher HbA1c levels compared to non-minority patients (p&lt;0.05) . Higher distress scores were associated with lower family income and worse family dynamics (p&lt;0.05) . Distress was also related to worse health behaviors, including reduced exercise, poor eating habits, and impaired sleep. Notably, impaired sleep was also associated with higher HbA1c levels (p&lt;0.05) .
Conclusion: Adolescents with T1D who identified as minority race reported a greater impact of the COVID-pandemic on their physical and psychosocial functioning compared to their non-minority peers. Further study may identify how to mitigate these worse outcomes.

Disclosure
M.Goldberg: None. J.Ilkowitz: None. J.E.Gonzalez: None. C.R.Stein: None. M.Gallagher: None.
60-LB: Real-World Evidence of Improved Glycemic Control in People Using the OneTouch Verio Flex Blood Glucose Meter with the OneTouch Reveal Mobile Application
Authors: GRADY MIKE , CAMERON HILARY , HOLT ELIZABETH H. 
Published: May 2022

Background: The OneTouch Verio Flex® (OTVF) meter with a 3-Color Range Indicator instantly sends readings by Bluetooth® to the OneTouch Reveal® (OTR) app. We sought to provide evidence that these products support improved glycemic control.
Methods: Anonymous glucose and app analytics were extracted from the LifeScan server for 100650 people with type 2 diabetes (T2D) and 20324 people with type 1 diabetes (T1D) . Data from their first 14 days was compared to 14 days prior to a 90 day timepoint using paired within-subject differences.
Results: Percentage glucose readings in-range (70-180mg/dl) improved by 8.7% (from 69.9 to 78.5%) in T2Ds and by 4.0% (from 56.1 to 60.1%) in T1Ds. Hyperglycemic readings (&gt;180mg/dl) reduced by -8.8% (from 28.4 to 19.7%) in T2Ds and by -4.3% (from 38.4 to 34.0%) in T1Ds. Mean glucose reduced on average by -14.1mg/dl (from 160.6 to 146.5mg/dl) in T2Ds and by -6.7mg/dl (from 176.7 to 170.1mg/dl) in T1Ds. Just 4 to 10 sessions per week or 20 to 60 minutes per week on the OTR app improved readings in-range in T2Ds by 9% or 10%, respectively (see graphs below) . Similar trends were observed in people with T1D.
Conclusion: Real world data from over 120000 people with diabetes demonstrates significantly improved data in-range and lower mean glucose in those using the OneTouch Verio Flex® meter and OneTouch Reveal® app.

Disclosure
M. Grady: Employee; LifeScan. H. Cameron: None. E. H. Holt: Employee; Intarcia Therapeutics, Inc., LifeScan.
602-P: Prenatal Exposure to Gestational Diabetes Mellitus and Autistic Traits among Typically Developing Children
Authors: ALVES JASMIN M. , ANGELO BRENDAN C. , NEGRIFF SONYA , LUO SHAN H. , CHOW TING , CABEEN RYAN , CARTER SARAH A. , XIANG ANNY , PAGE KATHLEEN A. 
Published: May 2022

Children exposed to GDM in utero are at increased risk of developing autism spectrum disorder, a neurodevelopmental disorder characterized by social deficits. Limited studies have tested if GDM exposure is associated with higher autistic traits in typically developing children or what the neural substrates are. We used the social responsiveness scale (SRS) to measure differences in autistic traits between GDM-exposed and unexposed children and examined if white matter pathways involved in the social brain network (SBN) were related to autistic traits in children. Children were recruited from Kaiser Permanente Southern California to participate in BrainChild, a study assessing neural programming of disease risk (N=136; 9 ±1.5 years; 63% female; 52% GDM-exposed) . During visits, children completed a brain magnetic resonance imaging scan, demographics were collected, and parents completed the SRS. Maternal GDM diagnosis, glucose levels from a 1-hr 50g glucose challenge completed during pregnancy, and pre-pregnancy BMI were obtained from electronic medical records. Fractional anisotropy (FA) was used to assess white matter microstructure. Linear regression was used to test associations between SRS raw scores with GDM exposure, maternal glucose levels, and SBN white matter pathways, controlling for child age, sex, socioeconomic status, and maternal pre-pregnancy BMI. SRS scores were higher for GDM-exposed children than unexposed (GDM: 35.7±2.1; Unexposed: 29.5±2.3, p=0.03) . Maternal glucose levels were associated with higher child SRS scores (β=0.002, p=0.06) . Higher SRS scores were associated with reduced FA in multiple SBN white matter tracts (p&lt;0.01) . GDM exposure and higher maternal glucose levels were associated with more autistic traits, suggesting that intrauterine exposure to a GDM hyperglycemic environment may affect autistic traits even among typically developing children. Further, SBN white matter tracts may be related to social deficits.

Disclosure
J.M.Alves: None. B.C.Angelo: None. S.Negriff: None. S.H.Luo: None. T.Chow: None. R.Cabeen: None. S.A.Carter: None. A.Xiang: None. K.A.Page: None.

Funding
pAmerican Diabetes Association (#1-14-ACE-36) ; R01DK116858
605-P: Self-Management Behaviors Mediate the Relationship between Diabetes Burden in Caregivers and A1C
Authors: O'DONNELL HOLLY K. , HIMELHOCH ALEXANDRA C. , VIGERS TIMOTHY B. , ALONSO GUY T. , MAJIDI SHIDEH , PYLE LAURA , SNELL-BERGEON JANET K. , WADWA R. PAUL , DRISCOLL KIMBERLY A. 
Published: May 2022

Type 1 Diabetes (T1D) treatment involves engaging in multiple complex and burdensome self-management behaviors daily. The purpose of this study was to examine the relationship between diabetes burden, self-management behaviors, and A1C.
Caregivers of 77 adolescents with T1D (age=14.9±1.9 years, A1C=9.8±1.6%, T1D duration=6.8±3.5 years, 45.5% male) participating in a RCT that provided integrated behavioral intervention to improve A1C completed a short version of Problem Areas in Diabetes-Parent Revised (PAID-PR) at the baseline visit prior to beginning intervention. The Immediate Burden subscale of PAID-PR was used to assess diabetes burden. Objective self-management behaviors were calculated using data downloaded from adolescents’ T1D devices.
As caregiver burden increased, so did the frequency of self-management behaviors of carbohydrate entries per day (r=0.365, p&lt;0.01) and insulin boluses per day (r=0.273, p&lt;0.05) , but not blood glucose readings. Caregiver burden increased as A1C decreased (r=-0.224, p&lt;0.05) . There was a significant indirect effect of diabetes burden on A1C through the self-management behaviors for carbohydrate entries per day (b=-0.023, 95% bias-corrected and accelerated bootstrap (BCa) CI [-0.056, -0.002] and insulin boluses per day (b=-0.016, 95% BCa CI [-0.041, 0.001]) .
Higher T1D self-management is associated with lower A1C, but this may come with a cost- greater feelings of burden due to T1D management. Family interventions to promote teamwork and assist caregivers and adolescents to appropriately distribute responsibility for T1D management may allow for continued high engagement while reducing burden.

Disclosure
H.K.O'donnell: None. A.C.Himelhoch: None. T.B.Vigers: None. G.T.Alonso: None. S.Majidi: None. L.Pyle: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. R.Wadwa: Advisory Panel; Dompé, Consultant; Beta Bionics, Inc., Other Relationship; Tandem Diabetes Care, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. K.A.Driscoll: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)
608-P: Intersectional Identities, Social Risk Factors, and Quality of Life in Men and Women with Diabetes
Authors: WILLIAMS JONI S. , THORGERSON ABIGAIL , OZIEH MUKOSO N. , EGEDE LEONARD E. 
Published: May 2022

Background: More than 34 million adults ≥18 years have diabetes in the U.S. Adverse social conditions associated with poor health, or social risk factors, contribute to poorer access to care, quality of care, and clinical outcomes for adults with diabetes. Intersectionality, defined as having multiple marginalized/disadvantaged social identities that reflect larger-scale inequalities and systems of oppression, may contribute to diabetes disparities. The study objective was to assess differences in the relationship between intersectionality and social risk factors between men and women with diabetes.
Methods: Data of 2,476 adults (weighted sample = 1,144,573) from the Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. The outcomes were physical and mental health quality of life, and the predictor was intersectionality summed as Non-Hispanic White, age ≥65 years, unemployment, less than high school education, and income &lt;$25K. Covariates included comorbidities, insurance, region, and metropolitan statistical area. Logistic regression models were found for each of the outcomes to assess their independent association with intersectionality.
Results: In the fully adjusted model, women with 3+ intersecting social identities were 4x more likely to have poorer physical health (OR=4.13 (95% CI 0.54, 7.73)) compared to women reporting no intersectionality. Men with food insecurity were 5x more likely to have poorer mental health (OR=4.93, 95% CI 1.02, 8.84) than men without food insecurity, whereas women with food insecurity were 3x more likely to have poorer mental health (OR=2.56, 95% CI 0.61, 4.51) compared to women without food insecurity. There were no significant associations between intersectionality and housing instability in this sample.
Conclusions: These findings suggest the need for understanding the influence of intersectionality among women with diabetes and social risk factors, especially food insecurity, among men and women with diabetes.

Disclosure
J.S.Williams: None. A.Thorgerson: None. M.N.Ozieh: None. L.E.Egede: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases (K24DK093699, R01DK118038, R01DK120861 and R21DK123720)
61-LB: Real-World Evidence of Improved Glycemic Control in People Using the OneTouch Verio Reflect Glucose Meter with the OneTouch Reveal Mobile Application
Authors: GRADY MIKE , CAMERON HILARY , HOLT ELIZABETH H. 
Published: May 2022

Background: The OneTouch Verio Reflect® (OTVR) meter provides advanced Color Range and Blood Sugar Mentor™ features that are complemented by the OneTouch Reveal® (OTR) app. We sought to provide evidence that these products support improved glycemic control.
Methods: Anonymous glucose and app analytics were extracted from our server for 1627 people with type 1 diabetes (T1D) and 5353 people with type 2 diabetes (T2D) . Data from their first 14 days was compared to 14 days prior to a 180 day timepoint using paired within-subject differences.
Results: Percentage glucose readings in-range (70-180mg/dl) improved by 6.0% (from 58.9 to 64.8%) in T1Ds and by 10.7% (from 73.2 to 83.9%) in T2Ds. Hyperglycemic readings (&gt;180mg/dl) reduced by -6.5% (from 36.4 to 29.9%) in T1Ds and by -10.8% (from 25.7 to 14.9%) in T2Ds. Mean glucose reduced on average by -11.4mg/dl (from 173.9 to 162.5mg/dl) in T1Ds and by -17.3mg/dl (from 156.8 to 139.5) in T2Ds. 2 to 3 sessions per week or 11 to 20 minutes per week on the OTR app improved readings in-range in T1Ds by 5% or 6%, respectively (see graphs below) . Similar trends were observed in people with T2D.
Conclusion: Real world data from nearly 7000 people with diabetes demonstrates significantly improved readings in-range and lower mean glucose in those using the OneTouch Verio Reflect® meter and OneTouch Reveal® app.

Disclosure
M. Grady: Employee; LifeScan. H. Cameron: None. E. H. Holt: Employee; Intarcia Therapeutics, Inc., LifeScan.
610-P: Negative Affect and Symptom Experience in Type 2 Diabetes (T2D) : A Bidirectional Evaluation Using Ecological Momentary Assessment (EMA)
Authors: FISHMAN SARAH R. , HOOGENDOORN CLAIRE J. , WANG CUILING , MULVANEY SHELAGH A. , JONAS VICTORIA H. , MENDEZ-RODRIGUEZ HEIDY , FANG RAN , SOLON CARLY A. , CRANDALL JILL P. , GONZALEZ JEFFREY S. 
Published: May 2022

Objectives: Physical symptoms (SXS) are commonly reported among adults with T2D and have a significant impact on functioning and self-management. Although there is evidence that symptom reporting is closely linked to the experience of negative affect (NA) , the directionality of this relationship remains unclear. This study used EMA to evaluate bidirectional temporal associations between SXS and NA in adults with sub-optimally controlled T2D.
Methods: Adults with T2D (N = 61; Age = 55 (10) yrs; Women = 64.5%; Black = 61%; Latino = 36%; A1C = 8.5 (2.3) completed smartphone EMA of SXS and NA 3 x daily over a 14-day period. Linear mixed effect models were used to assess associations of total number of SXS reported (0-13) and subsequent levels of NA (0-5) , and vice-versa.
Results: There were significant within- and between-person bidirectional associations between SXS and NA. Within-persons, a 1-point increase in SXS from one’s personal mean was associated with a 0.03-point increase in subsequent NA (95%CI: 0.01-0.04, p = .008) and a 1-point increase in NA from one’s personal mean was associated with a 0.39-point increase in subsequent SXS (95%CI: 0.27-0.50, p &lt; .0001) . Between-persons, a 1-point increase in SXS personal mean was associated with a 0.18-point increase in subsequent NA (95%CI: 0.12-0.26, p &lt; .0001) and a 1-point increase in one’s NA personal mean was associated with a 1.8-point increase in SXS (95%CI: 1.15-2.46, p &lt; .0001) .
Conclusion: Results showed bidirectional relations between SXS and NA, observed both within- and between-persons over the course of a day, among predominantly ethnic minority adults with T2D. If these patterns reflect causal associations, they suggest that interventions that reduce negative affect would also reduce the experience of physical symptoms, and vice versa. Given prior evidence linking these factors to self-management, functioning, and health outcomes in T2D, such interventions could have substantial impact.

Disclosure
S.R.Fishman: None. J.S.Gonzalez: Consultant; Virta Health Corp. C.J.Hoogendoorn: None. C.Wang: None. S.A.Mulvaney: None. V.H.Jonas: None. H.Mendez-rodriguez: None. R.Fang: None. C.A.Solon: None. J.P.Crandall: Research Support; Abbott Diabetes.

Funding
NIH P30 DK111022
612-P: Predicting Behavioral Intervention Choices in Women with Previous GDM
Authors: HUME MATTHEW , HANNON TAMARA S. , SANDY ROBERT , CONNOR ULLA M. 
Published: May 2022

Women with previous gestational diabetes mellitus (WPGDM) have high risk for T2D but low rates of engagement in diabetes prevention interventions. We used an informed decision-making strategy with WPGDM to promote participation in behavioral interventions. These included group (National Diabetes Prevention Program (DPP) , web-based DPP, modified DPP for families, WW) ; individual (health coaching, digital WW) ; and dietician consult (passive) . We evaluated 1) intervention preferences, and 2) determinants of intervention choices. We used the CoMac Descriptor™ (CoMac) to assess person-centered determinants of intervention choice. CoMac’s 12-question survey categorizes patients into three engagement categories based on locus of control, emotional state, and agency.
Of 116 WPGDM (age 34±7) who participated, 95 chose an intervention. CoMac predicted high (H) , moderate (M) or low (L) engagement with behavioral intervention (63% H; 29% M; 8% L) . Group interventions were chosen by a majority (58%) of participants (53% H, 79% M, 74% L) . Individual interventions were chosen by 34% (33% H, 21% M, 26% L) . Passive interventions were chosen by 8% (13.7% H, 0% M/L) . Participants categorized as H (mean A1C 5.2±.1) chose group interventions just more than half of the time. Participants categorized as M (mean A1C 5.3±.1) and L (mean A1C 5.4±.1) chose group interventions over individual at a higher rate than Hs, nearly three-quarters of the time. Our results show that the majority of WPGDM prefer active over passive behavior interventions. This runs counter to the passive behavioral interventions typically offered in healthcare settings. Results further show that person-centered trait clusters are associated with intervention preference, and CoMac’s patient categorization may help providers to better align interventions with patient preference.

Disclosure
M.Hume: None. T.S.Hannon: Advisory Panel; Eli Lilly and Company. R.Sandy: None. U.M.Connor: Other Relationship; CoMac Analytics, Inc.

Funding
Indiana University Grand Challenge Precision Health Initiative
616-P: Self-Care Scores Predicting Cognition Status in Patients with Type 2 Diabetes
Authors: CHOI SARAH E. , FREEBY MATTHEW , ROY BHASWATI , WOO MARY A. , KUMAR RAJESH , BRECHT MARY-LYNN 
Published: May 2022

Cognitive impairment is common in patients with type 2 diabetes mellitus (T2DM) and negatively impacts effective diabetes self-care. However, it is unclear whether self-care level can predict cognition status in T2DM patients. We aimed to identify self-care scores that would provide information on the patients’ cognition status.
Methods: We collected diabetes self-care and cognition data from 50 T2DM patients (age 55.9±7.6 years, diabetes duration 10.1±8.2 years, A1C 7.1±1.4%, 54% female) using the Scale for Summary of Diabetes Self-Care Activities Assessment (SDSCA) and the Montreal Cognitive Assessment (MoCA) . A mixed effects logistic regression model for repeated measures used both baseline and 6 months follow-up observations with adjustment for within-subject correlation (SAS GLMMIX) . First, from nine potential covariates, an iterative backward elimination process selected a parsimonious subset of covariates for predicting MoCA level (normal vs. impairment) , optimizing area under the curve (AUC) . Four covariates were identified (education, income, ethnicity, sleep quality; AUC=.75) . Then an iterative process calculated AUC for MoCA level predicted from self-care level, using each possible self-care score cut point from .to 6.95 in .increments, controlling for the four identified covariates. An optimal cut point was selected that produced the highest AUC value.
Results: The optimal self-care cut point was 2.95 (AUC=.76) , producing good discrimination of MoCA level. As a sensitivity analysis, the second best cut point of 3.95 produced AUC=.75.
Conclusion: Self-care cut points, accounting for education, income, ethnicity, and sleep quality, could be used to gain information on T2DM patients’ cognition status, which may prompt clinicians and researchers to further evaluation with formal cognitive tests.

Disclosure
S.E.Choi: None. M.Freeby: Research Support; Abbott Diabetes, Novo Nordisk. B.Roy: None. M.A.Woo: None. R.Kumar: None. M.Brecht: None.

Funding
National Institutes of Health (RNR017190)