bluuebunny/crossref_metadata_2025_split huggingface dataset:
640-P: The Association of Happiness and Resilience with Glycemic Control in Pediatric Type 1 Diabetes Mellitus
Authors: RAMESH RESHMIKA , BYEON GA YOUNG , SANFILIPPO ANDREW , MARLEN NATALIE , HANKINS ANDREA , GUILLEN MICHELE , ALFORD JENNIFER , NADGIR ULHAS , PRAKASAM GNANAGURUDASAN , PARISE CAROL , VYAS ARPITA 
Published: May 2022

Background: Depression and anxiety are examples of states of emotion that are associated with poor adherence to treatment in pediatric type 1 diabetes mellitus (T1DM) . The relationship between perceived happiness and glycemic control is unknown. Resilience also influences perceived happiness and is positively correlated with improved compliance in T1DM. The purpose of this study is to determine if perceived happiness and resilience are positively correlated with better diabetes control.
Methods: Participants were patients between 12-18 years of age with T1DM for 2 or more years without a mental health condition, learning disability, history of substance abuse, or recent significant adverse life events. The Oxford Happiness Score and the Diabetes Strengths and Resilience (DSTAR) Questionnaires were completed by patients. Demographics, hemoglobin A1c (HbA1c) , mode of treatment, and duration of TIDM were documented. Pearson Correlations were used to assess the relationship of Happiness with HBA1c, DSTAR, and duration of diabetes. Analysis of Variance was used to determine if mean happiness and DSTAR varied by mode of treatment.
Results: Data were obtained from 34 patients with a mean age of 14.7±2.16 years, had a mean HbA1c of 8.5±2.03, and had T1DM for 6.8±3.79 yrs. Happiness did not correlate with HbA1c (r =-0.229, p=0.201) . Higher resilience was correlated with lower HbA1c (r=-0.562, p=0.002) and a higher resilience correlated with increased happiness (r= 0.597, p=0.001) . Patients using pump therapy had both higher DSTAR (F1,25 =15.39, p = 0.001) and happiness scores (F1,31=12.44, p=0.001) when compared with patients on insulin injections.
Conclusion: Our preliminary data suggests that increased happiness is associated with higher resilience in patients with T1DM. Furthermore, patients with higher resilience have lower HBA1c. Our ongoing study aims to recruit more patients and identify targeted interventions to improve states of emotion in T1DM.

Disclosure
R.Ramesh: None. C.Parise: None. A.Vyas: None. G.Byeon: None. A.Sanfilippo: None. N.Marlen: None. A.Hankins: None. M.Guillen: None. J.Alford: None. U.Nadgir: None. G.Prakasam: None.
641-P: Behavioral Health Needs of a Commercially Insured Adult Population with Type 2 Diabetes
Authors: COOK DAVID J. , DEFAIL ANTHONY , LIVESEY CECILIA , PEDERSON DEREK 
Published: May 2022

Background: There is an increasing appreciation of the interconnection between chronic illnesses such as type-2 diabetes and behavioral health conditions such as depression and anxiety, as well as more serious behavioral health conditions. The separation of practice and payment for medical and behavioral conditions is ripe for disruption. This is of particular importance for risk-bearing entities.
Methods: Level2 is a virtual accountable care organization taking total cost-of-care risk for a commercially insured population. Using a de-identified administrative claims research database, we estimated the behavioral health profile of our enrolled population by examining the prescribing of common behavioral health medications.
Results: In our enrolled population of 7,361 members, the average age was 54.4 years, and the M:F ratio was 53:47. Prescriptions for behavioral health medications were demonstrated in 26.2% of the population. Medications for depression and anxiety were most common (20.0% and 8.0% respectively) , while antipsychotics were prescribed in 0.1% of attributed members. Twenty-four months of enrollment (November 2019- November 2021) showed stable prescribing patterns.
Conclusion: The movement towards provider risk bearing, and a more sophisticated understanding of the relationship between physical and behavioral health, necessitate a more comprehensive and integrated approach to care for patients. While this intersection may be evident to providers in their daily activities, the analysis of a population of nearly 7,400 members gives a broader insight into this challenge and calls for clinical service redesign, the application of new methodologies and measurements, and over time, new payment models. Of note, the prescribing data spans the COVID and pre-COVID periods and was stable over time, so the high use of behavioral health medications is not COVID-attributable.

Disclosure
D.J.Cook: None. A.Defail: Employee; Level2. C.Livesey: Advisory Panel; Compass Pathways, Employee; UnitedHealth Group. D.Pederson: Employee; Level2.
643-P: Perceived Usefulness of Mindfulness-Based Stress Reduction in Persons with Type 2 Diabetes
Authors: FERRARA LUCILLE , KAUFMAN SOPHIE R. 
Published: May 2022

Diabetes management can be burdensome and stressful. Mindfulness-based Stress Reduction (MBSR) is a method that has shown to help mitigate stress. This qualitative study, as part of a larger study, examined the effects of MBSR on stress in persons with DM2 participating in an 8-week MBSR course and explored how participants: Gained insight regarding their stress Identified aspects of MBSR perceived as useful for stress management Continued to incorporate mindfulness practice in their daily lives as a method of stress management (6 months and 1 year post-intervention) Study Population: 13 adults &gt; 18 years with DM2 having a recent A1C &gt;7% who committed to participate in an 8-week MBSR course. Study Design: Qualitative study exploring the effects of MBSR on stress in persons with DM2. Participants enrolled in an 8-week MBSR course completed open-ended questionnaires at orientation, mid-way, and upon completion of the course to assess learning and attitude towards stress. Video recordings of the classes were transcribed and analyzed. Participants completed the Mindfulness Attention Awareness Scale (MAAS) at the start and end of the course. Participants received follow-up at 6 and 12 months post intervention, including completing the MAAS and were surveyed about the incorporation of mindfulness into their daily lives. Results: Participants shared their realization of the effect of stress on their body and mind, and reported noticing patterns of reactivity, and learning to let go and respond rather than react to stressors. Participants’ reflections and observed behaviors illustrated increased self-awareness, curiosity, patience, less self-judgment, and compassion and kindness toward their experience. Participants reported incorporating mindfulness in their daily routine at 6 month and 12 month post intervention, including meditation, yoga, mindful eating, different response to stressful situations, and better focus. MAAS: Results indicated an increase in MAAS scores over time.

Disclosure
L.Ferrara: None. S.R.Kaufman: None.

Funding
Josiah Macy Foundation (P19014)
645-P: Real-World Outcomes of Thai Patients with Impaired Glucose Tolerance: Patterns of Metformin Usage and Weight Change
Authors: CHATCHOMCHUAN WARALEE , THEWJITCHAROEN YOTSAPON , PRASARTKAEW HUSSAMON , SRICHOMCHEY PANITA , BUTADEJ SIRIWAN , NAKASATIEN SOONTAREE , WANOTHAYAROJ EKGALUCK , KRITTIYAWONG SIRINATE , HIMATHONGKAM THEP 
Published: May 2022

Background: Even though lifestyle modifications and pharmacological interventions have been shown to be effective in patients who have impaired glucose tolerance (IGT) , the patients’ responses to lifestyle changes after receiving the diagnosis of IGT in Thai patients are lacking. Therefore, this study aims to determine the weight changes following the diagnosis of IGT and elucidate the patterns of metformin use among Thai patients with IGT.
Methods: A 5-year retrospective study of newly diagnosed Thai patients with IGT in Theptarin Hospital, Bangkok during 2016-2020 was analyzed. Their weight at the last clinical visit was compared with that at the initial visit. The prevalence and characteristics of metformin prescription were also collected.
Results: Two hundred and sixty-six IGT patients (63.9% female, mean age of 51.8 ± 12.5 years, mean body weight 69.8 ± 15.0 kg, and mean body mass index (BMI) of 26.5 ± 4.7 kg/m2) were diagnosed during 2016-2020. The prevalence of metformin usage among these patients was 21.1%. During the median follow-up of months, the mean weight change was -1.0 ± 3.7 kg. A significant weight reduction was found in metformin group compared with control group, (mean weight change of -2.2 ± 4.7 kg vs. -0.7 ± 3.4 kg; p-value =0.006) . Furthermore, up to 26.8% of patients who was prescribed metformin achieved &gt; 5% weight reduction. Metformin was more frequently prescribed in patients who had age ≥ 60 years, BMI ≥ 35 kg/m2, concomitant statin usage, combined impaired fasting glucose (IFG) and IGT, and patients who had A1C ≥ 6.0%.
Conclusions: Weight reduction is minimal among Thai patients who had IGT. More intensive efforts with structured lifestyle programs should be implemented to prevent diabetes. Metformin should be considered if patients are unable or unwilling to lose weight with lifestyle changes.

Disclosure
W. Chatchomchuan: None. Y. Thewjitcharoen: None. H. Prasartkaew: None. E. Wanothayaroj: None. T. Himathongkam: None.
65-LB: Time in Range as a Clinical Outcome—Results of a Longitudinal Analysis of the Literature and Clinical Trials
Authors: PATEL PRANAV M. , ABANIEL RICHARD , DOGRA NATASHA , FRAZZITTA MARIE , VIRDI NAUNIHAL 
Published: May 2022

Background: HbA1c has traditionally been the gold standard of glycemic control. Continuous glucose monitoring (CGM) has enabled capture of newer glycemic measures such as time in range (TIR) which has been associated with diabetes outcomes, captures glucose variability, and has been endorsed by professional societies. This preliminary analysis describes trends in publications and clinical trials that capture TIR as a clinical outcome.
Methods: Systematic review of Embase, MEDLINE, and clinical trial registries was conducted. For each article, year of publication, country of research, role of technology, and funding source were captured. Clinical trials also captured study start dates and anticipated completion dates.
Results: TIR was reported in 1561 publications and 401 clinical trials. The number of publications with TIR mentioned grew 12-fold between 2017-2021 (Figure 1) . Among clinical trials capturing TIR, 138 trials were completed between 2010-2020; another 240 have been finished or are estimated to conclude between 2021-2025.
Conclusion: TIR as an important clinical outcome continues to proliferate suggesting increasing acceptance of TIR as an emerging standard of care in diabetes management. Further analysis will differentiate studies where CGM was part of the intervention from those where CGM was used to measure outcomes with other interventions.

Disclosure
P. M. Patel: Employee; Abbott Diabetes. R. Abaniel: None. N. Dogra: Employee; Abbott Diabetes. M. Frazzitta: Employee; Abbott Diabetes, Abbott Diabetes. N. Virdi: Employee; Abbott Diabetes.

Funding
Abbott Diabetes Care
659-P: Long-Term Health Benefit and Economic Return of Time in Range (TIR) Improvement in Individuals with Type 2 Diabetes
Authors: ALKHUZAM KHALID , SHI LIZHENG , FONSECA VIVIAN , ZHANG YONGKANG , GUO JINGCHUAN , SHAO HUI 
Published: May 2022

Time in range (TIR) referres to the percentage of time that blood glucose levels stay within a pre-determined range for patients with diabetes. This study used simulation methods to quantify the long-term health benefit and economic return associated with the improvement of TIR in individuals with T2D. Individuals with self-reported T2D were identified from the 2017-2018 National Health and Nutrition Examination Survey as the target population for the simulation. A Markov model with three states (i.e., diabetes, diabetes with a history of cardiovascular disease (CVD) , death) was developed to calculate the 20-year cost, quality-adjusted life-years (QALY) gained, and cardiovascular disease (CVD) risk reduction under four scenarios: TIR &gt;85%, 71-85%, 51-70%, and ≤50%. The risk of CVD and mortality were extracted from literature. CVD and mortality risk reduction associated with TIR improvement, as well as cost and QALY associated with each health state were all extracted from the literature. Costs were standardized to the 2021 US Dollar, and a 3.0% annual discount rate was used. A willingness-to-pay threshold of $50,000/QALY was used to determine cost-effectiveness. Compared with having a TIR &lt;50%, improving the TIR to 51-70% was associated with an increase of 1.14 QALY and 1.20 life years, and a 5.86% relative risk reduction in CVD; improving the TIR to 71-85% was associated with an increase of 1.69 QALY and 1.46 life-years, and a 8.05% relative risk reduction in CVD; improving the TIR to &gt;85% was associated with an increase of 3.QALY and 1.97 life-years, and a 14.89% relative risk reduction in CVD. The annual spending on treatment to improve the TIR from &lt;50% to 51-70%, 71-85%, and &gt;85% should be lower than $2,592, $3,082, and $4,120 respectively to make the treatment cost-effective. Improving TIR can potentially lead to a substantial health benefit. Our study qualified the maximum medical expenses allocated to improve the TIR while keeping the treatment cost-effective.

Disclosure
K.Alkhuzam: None. L.Shi: None. V.Fonseca: Consultant; Abbott, Asahi Kasei Corporation, Bayer AG, Novo Nordisk, Sanofi, Research Support; Fractyl Health, Inc., Jaguar Gene Therapy, Stock/Shareholder; Abbott, Amgen Inc., BRAVO4Health, Mellitus Health. Y.Zhang: None. J.Guo: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.
66-LB: System Performance of an Integrated Blood Glucose Monitoring Device Developed to Reduce Common Barriers to Checking Glucose
Authors: TOMASCO MICHAEL , DAVIS JUDITH M. , REYNOLDS PAUL D. , ESCUTIA RAUL , PERRY JOHN N. , O’DONNELL TIM , HESLEY ROBB P. 
Published: May 2022

The POGO Automatic® Blood Glucose Monitoring System miniaturizes individual items required to perform a blood glucose test (lancet, lancing device, test strip, etc.) and integrates those components into a multi-test cartridge that pairs to a handheld device, addressing many perceived checking barriers. This device allows the user to place and hold a finger on the device while the blood sample is acquired and moved to the reagent pad automatically for quantitation. Performance testing was conducted on the device to assess accuracy, precision, and tolerance to hematocrit and interfering substances.
Fingerstick capillary blood was collected from 285 untrained subjects with either type 1 or type 2 diabetes at two sites (age 21-95, mean 58.1; 50.2% female, 84.9% Caucasian) and run on a YSI 2300 analyzer while the subject used the system as designed to obtain a glucose result. When compared against the YSI reference result, 264/277 (95.3%) results were within ± 15 mg/dL or 15% of the reference reading, and 275/277 (99.3%) results were within ± 15 mg/dL or 20% of the reference reading. Precision testing was conducted by running 300 tests using venous blood at each of five glucose levels across the dynamic range, achieving CVs ranging from 2.3%-3.4%. Hematocrit tolerance was evaluated using venous whole blood manipulated into a matrix of seven hematocrit levels (20%-60%) ; each hematocrit was tested across the dynamic range. No mean bias versus YSI at any test condition exceeded 7.5%, and at least 95% of all tests at each condition were within 15% of the YSI reference value. Twenty-three substances, including acetaminophen, ascorbic acid, and maltose, were tested at both therapeutic and toxic concentrations to determine potential interference with measurement accuracy. For all substances tested, the entire 95% confidence interval for interferent bias was within ± 15%, and the average bias was within ± 10% of results from the control sample.

Disclosure
M. Tomasco: Employee; Intuity Medical, Inc. J. M. Davis: None. P. D. Reynolds: Employee; Intuity Medical, Inc. R. Escutia: Employee; Intuity Medical, Inc. J. N. Perry: Employee; Intuity Medical, Inc. T. O’donnell: Employee; Intuity Medical, Inc. R. P. Hesley: Employee; Intuity Medical, Inc.
662-P: Glycemic Variability Patterns Strongly Correlate with Partial Remission Status in Children with Newly Diagnosed Type 1 Diabetes
Authors: POLLE OLIVIER G. , DELFOSSE ANTOINE A. , MARTIN MANON , GIES INGE , IEBRETHON MARIE-CHRISTINE , MOURAUX THIERRY H. , LOUIS JACQUES , SERET NICOLE , GATTO LAURENT , LYSY PHILIPPE A. 
Published: May 2022

Residual β-cell secretion is commonly used as primary endpoint of β-cell mass prevention trials. Recently, peak C-peptide was challenged as a clinically relevant marker of β-cell function considering its poor integration of insulin sensitivity and β-cell glucose responsiveness. In our DIATAG study, we evaluated the correlations between metrics of glycemic variability (GV) and markers of diabetes control (i.e. A1C, insulin daily dose, insulin dose-adjusted A1C [IDAA1C]) to identify whether GV indexes may overcome residual β-cell secretion estimates (BSE) in the evaluation of glucose homeostasis during the first year of type 1 diabetes (e.g. remission period) . Data from 78 new-onset type 1 diabetes pediatric patients were collected from diabetes onset (Δ) and cross-sectionally compared using adjusted mixed-effects models at Δ+3, +12 months for BSE (n=119) and Δ+3, +6, +9, +12 months for glucose control and CGM metrics (n=169) . BSE demonstrated weak-to-moderate correlations with clinical parameters and CGM metrics (r2= 0.05-0.25; p&lt;0.05) . CGM metrics strongly correlated with clinical parameters (r2 &gt;0.52; p&lt;0.05) and were sufficient to distinguish remitters from non-remitters (i.e. IDAA1C respectively &lt;9 or ≥9) . Moreover, CGM metrics from remitters exhibited specific nycthemeral patterns characterized by increased glycemic stability (in 63-160 mg/dL range) across days in the early morning period and decreased grade II hypoglycemia during the day (p&lt;0.01) . Using hierarchical clustering on 46 CGM metrics and clinical parameters (n=169) , we identified four unique glucotypes (p&lt;0.001) during the first year of diabetes that allowed better segregation of intermediate values of IDAA1C from Δ+3 months (38% in Group 1, 26% in Group 2, 29% in Group 3, 7% in Group 4) . We conclude that a combination of CGM metrics and clinical parameters unraveled key clinical milestones of glucose homeostasis and remission status during the first year of type 1 diabetes.

Disclosure
O.G. Polle: None. A.A. Delfosse: None. M. Martin: None. I. Gies: None. M. Iebrethon: None. J. Louis: None. N. Seret: None. L. Gatto: None.

Funding
Fond National de la Recherche Scientifique (FRIA grant, FSR starting grant) Belgian Society for Pediatric Endocrinology and Diabetology (BESPEED) Société Francophone du Diabète (SFD)
665-P: Awareness of Time in Range Varies by Type of Health Care Provider
Authors: KENNEY JULIA , BRISKIN ANDREW , TAIT JACQUELINE , SHOGER ERIK , WOOD RICHARD , PETERS ANNE L. 
Published: May 2022

Background and Aims: Previous studies have shown an association between Time in Range (TIR) and risk of microvascular complications, but TIR is not used widely in diabetes care. This study aimed to assess differences in awareness and use of TIR among healthcare providers (HCPs) .
Methods: In an online survey in September 2021, 303 HCPs, each working with a minimum of 30 patients with diabetes each month, were asked a series of questions related to challenges, evaluation, and goal-setting when discussing diabetes management with patients. Respondents were classified as either Endocrinologists (Endo) , Diabetes Educators (DE) , or primary care providers (PCP) . Statistical significance was tested at the 95% confidence level (p&lt;0.05) .
Results: DEs were more likely to be aware of (96%, n=106) and use (94%, n=106) TIR in clinical practice than Endos (92%, 88%, n=98) and PCPs (56%, 46%, n=99) . Among respondents who were aware of TIR (n=247) , Endos were more likely to use TIR when making treatment decisions (87%, n=90) than PCPs (69%, n=55) . Among those who reported using TIR in clinical practice (n=234) , PCPs were least familiar (67%, n=46) with CGM metrics compared to Endos (91%, n=88) and DEs (79%, n=100) .
Conclusions: This data highlights differences in TIR use between Endos, DEs, and PCPs, and the lower levels of TIR awareness among PCPs. This study emphasizes opportunities for increased awareness of TIR through education and training of PCPs on CGM and TIR.

Disclosure
J.Kenney: None. A.Briskin: None. J.Tait: Employee; dQ&A. E.Shoger: Other Relationship; Diabetes industry. R.Wood: Other Relationship; Multiple companies and patient organizations (&gt;10) . A.L.Peters: Advisory Panel; Abbott Diabetes, AstraZeneca, Eli Lilly and Company, Novo Nordisk, Shouti, Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Other Relationship; Omada Health, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Leona M. and Harry B. Helmsley Charitable Trust, Stock/Shareholder; Teladoc Health.
666-P: CGM Access Is the Main Barrier to TIR Use among Providers
Authors: KENNEY JULIA , TAIT JACQUELINE , BRISKIN ANDREW , SHOGER ERIK , WOOD RICHARD , PETERS ANNE L. 
Published: May 2022

Background and Aims: Previous studies have shown a correlation between Time in Range (TIR) and risk for microvascular complications, but the metric is not used widely in diabetes care. This study aimed to assess the barriers to TIR use among healthcare providers.
Methods: In an online survey in September 2021, 303 HCPs, each working with a minimum of 30 patients with diabetes each month, were asked a series of questions related to challenges, evaluation, and goal-setting when discussing diabetes management with their patients. Respondents were classified as either Endocrinologists (Endo) , Diabetes Educators (DE) , or primary care providers (PCP) . Statistical significance was tested at the 95% confidence level (p&lt;0.05) .
Results: 80% of HCPs who use TIR (n=234) identify access to CGM as a main drawback of TIR and 72% (n=289) identified cost as a downside of CGM use. When TIR non-users (n=64) were asked what would convince them to use TIR with patients, 41% cited increased access to CGM and 30% cited training and resources about how to use TIR data. 83% of non-users (n=64) believe TIR would be useful in their diabetes care. When asked what would improve their diabetes care, 39% of HCPs said having more patients on CGM and 28% said the ability to use TIR data with more patients (n=246) .
Conclusions: This data highlights the barriers to TIR adoption and use among HCPs. Increased access to CGM and education on TIR use in clinical practice can help advance TIR in diabetes care.

Disclosure
J.Kenney: None. J.Tait: Employee; dQ&A. A.Briskin: None. E.Shoger: Other Relationship; Diabetes industry. R.Wood: Other Relationship; Multiple companies and patient organizations (&gt;10) . A.L.Peters: Advisory Panel; Abbott Diabetes, AstraZeneca, Eli Lilly and Company, Novo Nordisk, Shouti, Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Other Relationship; Omada Health, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Leona M. and Harry B. Helmsley Charitable Trust, Stock/Shareholder; Teladoc Health.