bluuebunny/crossref_metadata_2025_split huggingface dataset:
493-P: Medical Assistant Health Coaching for Type 2 Diabetes in Primary Care: A Pragmatic, Cluster-Randomized Controlled Trial
Authors: FORTMANN ADDIE L. , PHILIS-TSIMIKAS ATHENA , CLARK TAYLOR , BAGSIC SAMANTHA R. SPIERLING , SANDOVAL HALEY , SAVIN KIMBERLY L. , ROESCH SCOTT , GALLO LINDA 
Published: May 2022

While good cardiometabolic control can reduce complications in type 2 diabetes (T2D) , many individuals do not achieve clinical targets. This real-world trial compared medical assistant health coaching (MAC) to usual care (UC) in improving outcomes among adults with T2D and ≥ 1 of the following in the past 90 days: HbA1c ≥ 8%, LDL ≥ 100 mg/dL, SBP ≥ 140 mm/Hg. This N=600 study was conducted from 2016-2021 at four cluster-randomized clinics within two diverse health systems in Southern CA: a large, private insurance-based system [n = 298, majority non-Hispanic White, English-speaking, mid/upper socioeconomic status (SES) ]; M age = 70.2 ± 12.6] and a Federally-Qualified Health Center (n = 302, majority Hispanic, Spanish-speaking, lower SES; M age = 56.9 ± 12.0) . MAC and UC received diabetes care as usual in primary care, with referral to diabetes education and/or specialists as indicated. MAC also received in-clinic and telephone-based health coaching for up to one year (1-14 sessions; M = 5.2 ± 2.8) . Baseline mean HbA1c = 8.8 ± 2.2%, LDL = 101.8 ± 44.8 mg/dL, and SBP = 137.9 ± 19.4 mm/Hg. From baseline to 12-months, the percentage of individuals meeting quality metrics increased in both groups: HbA1c &lt; 8% (MAC: 74.8 to 79.9%; UC: 64.0 to 80.4%) , LDL &lt; 100 mg/dL (MAC: 75.7 to 84.9%; UC: 72.6 to 82.4%) , SBP &lt; 140 mm/Hg (MAC: 75.0 to 86.9%; UC: 80.2 to 86.4%) . When outcomes were analyzed continuously using multi-level modeling, both MAC and UC demonstrated statistically significant improvements on all clinical outcomes; however, the rate of improvement was largely equivalent across groups (time-by-group ps &gt; .05) . Due to the pragmatic nature of this trial, there was marked variation (by design) in intervention duration and intensity across participants, and in clinical and sociodemographic characteristics of participants across health systems. Additional analyses examining under what conditions and/or for whom the MAC intervention may prove more/less effective will be presented.

Disclosure
A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. T.Clark: None. S.R.Spierling bagsic: None. H.Sandoval: None. K.L.Savin: None. S.Roesch: None. L.Gallo: None.

Funding
NIH/NIDDK 1R18DK104250
5-LB: Dulaglutide in Youth with Type 2 Diabetes (T2D) —Results of the AWARD-PEDS Randomized, Placebo-Controlled Trial
Authors: ARSLANIAN SILVA A. , CHO JANG IK , HANNON TAMARA S. , ZEITLER PHILIP , CHAO LILY , BARRIENTOS MARGARITA , BOUCHER-BERRY CLAUDIA C. , BISMUTH ELISE , DIB SERGIO A. , COX DAVID 
Published: May 2022

AWARD-PEDS was a Phase 3 trial to assess the efficacy and safety of dulaglutide (DU) , a once-weekly GLP-1 receptor agonist, in youth (10 to &lt;18 years old) with T2D treated with lifestyle alone or on stable metformin with or without basal insulin. Participants (mean age, 14.5 yrs; mean BMI, 34.1 kg/m2) were randomized to placebo (N=51) , DU 0.75 mg (N=51) , or DU 1.5 mg (N=52) . The primary aim was to demonstrate superiority of DU (pooled doses) vs. placebo for change in HbA1c at 26 weeks. Analyses included all patients with ≥1 dose of study drug, excluding data after initiation of rescue therapy. DU was superior to placebo (figure) in improving glycemic control measured by change in HbA1c, percent of patients with HbA1c &lt;7%, and change in fasting glucose at Week 26. No effect of DU was observed on BMI change (p=0.776) . Fewer patients assigned to DU compared to placebo required rescue therapy (2.9% vs. 17.6% respectively, p=0.003) . Incidence of common GI adverse events was higher in DU group vs. placebo [nausea (14.6% vs. 7.8%) , vomiting (15.5% vs. 3.9%) , diarrhea (18.4% vs. 13.7%) ] but comparable to that observed in adults.
In conclusion, in youth with inadequately controlled T2D treated with or without metformin and/or basal insulin, once weekly DU 0.75 mg or 1.5 mg was superior to placebo in improving glycemic control without an effect on BMI through 26 weeks, with a safety profile consistent with that established in adults.

Disclosure
S. A. Arslanian: Advisory Panel; Eli Lilly and Company, Novo Nordisk. Research Support; Eli Lilly and Company, Novo Nordisk. Other Relationship; AstraZeneca. J. Cho: None. T. S. Hannon: Advisory Panel; Eli Lilly and Company. P. Zeitler: Consultant; Boehringer Ingelheim International GmbH, Daiichi Sankyo, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Takeda Pharmaceutical Company Limited. L. Chao: None. M. Barrientos: Research Support; Boehringer Ingelheim International GmbH, Eli Lilly and Company, Janssen Research & Development, LLC, Novo Nordisk. C. C. Boucher-Berry: None. E. Bismuth: None. S. A. Dib: None. D. Cox: Employee; Eli Lilly and Company.

Funding
Eli Lilly and Company
5-OR: Tcf21 Functions as a Rate-Limiting Factor during Visceral Adipose Tissue Development
Authors: LIU QIANGLIN , LI CHAOYANG , GAO PEIDONG , WANG LESHAN , LI YUXIA , SHIRI MOHAMMAD , ALKAIFI FOZI N. , SUN JIANGWEN , FU XING 
Published: May 2022

Using an inducible lineage-tracing mouse line, we identified that Tcf21, a bHLH transcription factor gene, is expressed in visceral adipose tissue (VAT) but not in subcutaneous adipose tissue. In VAT, Tcf21 is expressed in mesenchymal progenitor cells but not in adipocytes. Tcf21 lineage progenitor cells actively proliferate followed by differentiation into adipocytes during neonatal development but have limited adipogenic capacity in adult mice even when fed with a high-fat diet (HFD) . Bulk RNAseq and ATACseq analyses of Tcf21 lineage progenitor cells isolated from mice of different ages or adiposities revealed the dynamic gene expression and chromatin accessibility in Tcf21 lineage progenitor cells. In particular, higher expression of pro-mitotic genes was observed in neonatal mice followed by an elevation of pro-adipogenic gene expression. Increased expression of inflammatory genes and fibrotic genes was observed in Tcf21 lineage progenitor cells from obese mice. Using transcriptomic and motif enrichment data, we constructed a gene regulatory network mediating the gene expression changes in Tcf21 lineage progenitor cells. Single-cell RNAseq and immunostaining identified multiple subpopulations of Tcf21 lineage cells including 2 major subpopulations including a mesothelial subpopulation and an interstitial subpopulation. Using an inducible cell-type-specific Tcf21 KO mouse line, we identified that neonatal deletion of Tcf21 in Tcf21 lineage progenitor cells led to their increased adipogenic differentiation during postnatal development and improved metabolism after HFD treatment. In vitro loss-of-function and gain-of-function studies showed that Tcf21 inhibits the adipogenic differentiation of VAT progenitor cells. Mechanistic studies identified that Tcf21 inhibits adipogenesis and developmental progress of VAT progenitor cells through promoting the expression of Dlk1, a negative regulator of adipogenesis, mainly in the interstitial subpopulation.

Disclosure
Q.Liu: None. C.Li: None. P.Gao: None. L.Wang: None. Y.Li: None. M.Shiri: None. F.N.Alkaifi: None. J.Sun: None. X.Fu: None.

Funding
Louisiana Board of Regents (BOR.Fu.LEQSF (2019-22) -RD-A-01) ; NIH/NIDDK (1R15DK122383) ; NIH/NIGMS (P20GM130555) ; NIH/NHLBI (1R01HL157519) .
511-P: Perspective on Technology Training in Individuals with Type 1 Diabetes
Authors: ANDRE CAMILLE C. , LIAO XIYUE 
Published: May 2022

The importance of training on diabetes technology has significantly changed with rapidly increasing use of technology in diabetes care, including use of insulin pumps, continuous glucose monitors, and automated insulin delivery (AID) systems. This study aimed to assess patient perspectives on technology training, and how nutrition, exercise and other aspects of health are discussed during healthcare appointments.
We conducted an IRB approved 42 question online survey for people living with type 1 diabetes (T1D) . Participants were recruited from the T1D Exchange Online Community by email over a 3 week period. Survey questions covered education on diabetes technology, nutrition, mental health and other medical conditions.
Of the 666 adult respondents, 581 reported receiving care from an endocrinologist and 533 used an insulin pump. With regard to advanced pump features, 55% reported their provider educated them on use of temporary basal rates for exercise, while 38% learned about temporary rates from a T1D online community, and 6.2% learned from a friend. Less than 50% of participants using an AID system talked with their provider about settings adjustments around exercise. Provider education around nutrition focused mainly on carb counting vs. other topics (low carb diet, food choices, effect on blood sugar; p=0.03) . Only 30% reported receiving education from their provider on use of advanced pump features around meals, and only 13% reported their provider discussed healthy eating often or always at clinic visits. Participants expressed a strong desire to receive education on low carb diets and different food choices as their primary need.
People with T1D continue to seek and receive advice for important topics related to diabetes management from online communities. They also seek information regarding nutrition and technology that is not discussed frequently at visits with their provider. Further development of educational materials for providers and people with T1D should address these needs.

Disclosure
C.C.Andre: None. X.Liao: None.
513-P: Diabetes Mobile Apps: A Resource for Inpatient Education and Support?
Authors: KRALL JODI S. , NG JASON , SIMINERIO LINDA M. 
Published: May 2022

Diabetes mellitus (DM) -related hospitalizations are recognized as important opportunities for self-management intervention. Yet, there remains a need for practical delivery strategies.
Objective: To assess provider perspectives on DM mobile apps as a tool for self-management education and support in the inpatient setting.
Methods: Healthcare professionals (n=33) who oversee or provide DM care and education to hospitalized patients completed a validated survey about DM mobile apps.
Results: Only 21% of respondents had previously used an app for DM education. Of those who had never used a DM app, 100% indicated that they would consider recommending one to their patients. For 82% of respondents, patient access to and interest in app use were rated as the most important factors in their decision to recommend apps. Patient acuity and time were also noted as key considerations. In fact, 54% of respondents were only willing to spend 5 minutes to download and teach app use. Hospitalized patients considered best candidates for apps are those newly diagnosed with DM, new to insulin, admitted with a DM-related complication, or requiring additional education/support (change in treatment plan) . Perceived benefits of apps in relation to self-management were to reinforce education (71%) , support education with trustworthy information (62%) , and serve as a resource after discharge (56%) . Some respondents also foresaw a role for apps in teaching patients during hospitalization, especially younger patients generally viewed as more interested in apps. Most respondents agreed the following features are important for apps in education and support: Content is developed by DM experts (91%) , provide answer to basic DM self-management questions (96%) , user experience can be customized (91%) , and include features for logging/tracking glucose results (91%) .
Conclusions: Hospital-based providers offer valuable insights into DM app use. Exposing them to apps to support patient self-management warrants strong consideration.

Disclosure
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
523-P: The Results of Virtual Diabetic “Boot Camp”
Authors: CHEN YI-JU , UDEH UBA C. , RAJAK KRIPA , AMIRIAN ASLAN , ATRASH ANAS , YARI KOLSOUM , JOSHI RENU 
Published: May 2022

Introduction: The use of telemedicine exponentially increased during the COVID-pandemic as it provided easier access as well as the provision of safety via social distancing. A 12-week intense telemedicine diabetic Bootcamp was therefore launched for patients with uncontrolled DM intended for high-quality outpatient diabetic care.
Methods: Patients with DM seen at ambulatory clinics with HbA1c &gt; 8.0%, were voluntarily enrolled from September 2020 to November 2021. The dietitians and diabetic educators conducted biweekly visits via telehealth. Patient demographics, HbA1c, BMI, BP were compared before and after the intervention.
Results: A total of 134 patients were included for analysis and 94 patients (70.2%) completed the visits. Mean HbA1c change was -2.09% ± 2.4%, and HbA1c reduction was similarly observed across different age groups, gender, ethnicity, BMI, referred clinic types [Table 1]. A greater HbA1c reduction in patients who completed the visits was noted although it was not statistically significant. We found a negative correlation between the initial HbA1c and the change of HbA1c (coefficient -0.7709, p&lt;0.0001, r2= 0.3899) . No significant BMI or MAP change was observed.
Conclusions: This quality improvement project demonstrated an improvement in HbA1c for all poorly controlled diabetic patients, regardless of patient characteristics. Moreover, higher initial HbA1c was associated with a greater HbA1c reduction.

Disclosure
Y.Chen: None. U.C.Udeh: None. K.Rajak: None. A.Amirian: None. A.Atrash: None. K.Yari: None. R.Joshi: n/a.
525-P: The Influence of Age of on the Weight Loss Outcome of Women in the National Diabetes Prevention Program
Authors: OTTUR MEGHANA , COOKE GREGG , RAJAN SINDHU 
Published: May 2022

In the National Diabetes Prevention Program (DPP) developed by the CDC, participants receive health-coach facilitated education on lifestyle modification to develop better eating and exercise habits with the goal of losing 5-7% weight over the course of a year. Incorrect assumptions about weight loss can lead to reduced participation and low outcomes in DPP. This study aims to determine the truth of common assumptions about weight loss and the impact that such assumptions have on the effectiveness of DPP. A common assumption observed is that women of menopausal age (45-60) find it more difficult to lose weight and we hypothesized that women at the menopausal age will achieve the weight loss goal at a slower rate compared to younger women of pre-menopausal age (18-44) .
Weight loss is defined as the difference between initial and final weight as a percentage of initial weight; a positive value indicates weight loss. Effectiveness is defined as the percentage of participants who achieve a specific weight loss threshold. The data used was the number of days until each participant achieved the weight loss goal of 5%. This was divided into two groups: 641 women aged 45-60) , and 278 women aged 18-44. A Students t-test was then performed on the data sets to measure the effect of assumptions about menopause and weight loss.
Contrary to the hypothesis, we found that menopausal women to be just as likely to achieve the 5% weight loss goal as pre-menopausal women in the same amount of time. This indicates that the assumption is untrue, however it is a useful assumption in the sense that it can encourage menopausal women to lose weight.

Disclosure
M.Ottur: None. G.Cooke: None. S.Rajan: None.
534-P: Sustained Improvement of Whole-Body Oxidative Capacity but Not Insulin Sensitivity after Detraining of People with Type 2 Diabetes
Authors: MASTROTOTARO LUCIA , APOSTOLOPOULOU MARIA , SAATMANN NINA , GRANATA CESARE , HARTWIG SONJA , KARUSHEVA YANISLAVA , GANCHEVA SOFIYA , LEHR STEFAN , AL-HASANI HADI , SZENDROEDI JULIA , RODEN MICHAEL 
Published: May 2022

High-intensity interval training (HIIT) improves skeletal muscle mitochondrial oxidative capacity in humans with different degrees of insulin sensitivity, whereas it increases insulin sensitivity along with number of circulating small extracellular vesicle (SEV) mainly in insulin resistant individuals with or without T2D (T2D, IR) . In order to examine the sustainability of metabolic effects induced by HIIT, this study tested whether the observed effects on insulin sensitivity, oxidative capacity and SEV number remain and/or differ between insulin sensitive (IS) , IR and T2D humans.
Twenty T2D and age- and BMI-matched IR and 12 IS individuals (HbA1c in %: 7.2±0.2, 5.4±0.1, 5.4±0.1; M-value in mg*kg-1*min-1: 3.0±0.4, 4.2±0.4, 7.4±0.4) performed a 12-week HIIT cycling protocol for 3 d/week. Whole-body insulin sensitivity was assessed by hyperinsulinemic-euglycemic clamps, physical fitness (VO2max) by spiroergometry and myocellular pathways of insulin sensitivity by immunoblotting of muscle biopsies at baseline, 72 h after the last HIIT bout and 4 weeks (detraining) later. SEV were isolated from serum by size exclusion chromatography.
Compared to HIIT, insulin sensitivity decreased in T2D after detraining (p&lt;0.01) , instead VO2max decreased in T2D and IR (p&lt;0. and p&lt;0.05) , although it remained higher than baseline (p&lt;0.0 and p=0.05) . Of note, HIIT-induced reduction of the nuclear factor-κB protein (p&lt;0.vs. baseline) disappeared in IR after detraining, whereas decreased protein kinase Cε activity was sustained in T2D (p&lt;0.vs. HIIT and p&lt;0.vs. baseline) , who also showed higher circulating SEV number (p&lt;0.vs. baseline) .
In conclusion, HIIT-induced increases in physical fitness and SEV number, but not insulin sensitivity are maintained at least after short-term detraining in T2D. Characterization of SEV cargo might help to better understand the differences in metabolic responses to detraining in individuals with and without T2D

Disclosure
L.Mastrototaro: None. J.Szendroedi: Advisory Panel; Boehringer Ingelheim International GmbH. M.Roden: Advisory Panel; Eli Lilly and Company, Research Support; Boehringer Ingelheim International GmbH, Nutricia, Speaker's Bureau; Novo Nordisk. M.Apostolopoulou: n/a. N.Saatmann: None. C.Granata: None. S.Hartwig: None. Y.Karusheva: None. S.Gancheva: None. S.Lehr: None. H.Al-hasani: Consultant; Bayer AG.
535-P: The Effect of Starting Blood Glucose Levels on Electrolyte Balance During and After Exercise in Type 1 Diabetes
Authors: MOMENI ZEINAB , BOULÉ NORMAND G. , PRADO CARLA , YARDLEY JANE E. 
Published: May 2022

ADA guidelines recommend that people with type 1 diabetes (PWT1D) start exercise with blood glucose (BG) levels of 7-mmol/L. Those fearing hypoglycemia often start higher, which may affect kidney function and electrolyte balance. We examined serum and urine electrolyte concentration during aerobic exercise (cycling 45 min at 60%VO2peak) in PWT1D (10F/2M, mean±SD: age 29±7 years, VO2peak 37.8±7.6 mL/kg/min, A1C 7.6±0.8%) and age, sex, and fitness-matched controls. Control participants (CON) completed a single exercise session with BG in normal physiological range, while PWT1D completed two sessions with different starting BG levels: 8-mmol/l (MOD) , and 12-14 mmol/l (HI) .
Urine specific gravity, glucose and potassium were higher during exercise and recovery in MOD when compared to CON (effect of treatment p&lt;0.05) , with only urine glucose being higher in HI when compared to MOD (effect of treatment p&lt;0.05) . Serum sodium, potassium, magnesium, and calcium increased from pre to post exercise in all sessions, with sodium being higher, and magnesium and calcium being lower in MOD versus CON (effect of treatment p&lt;0.05) . There was no difference in these electrolytes between MOD and HI sessions (effect of treatment p&gt;0.05) in PWT1D. Serum glucose decreased during exercise in MOD and HI sessions (effect of time p&lt;0.05) , with serum glucose being higher during the HI session (effect of treatment p&lt;0.05) . The lack of significant differences in electrolytes between MOD and HI sessions suggests that exercise with higher BG levels does not pose immediate risk during exercise of moderate intensity and duration. Further studies should examine the impact of hyperglycemia on electrolyte balance during longer or more intense exercise sessions.

Disclosure
Z.Momeni: None. N.G.Boulé: None. C.Prado: Consultant; Pfizer Inc., Other Relationship; Abbott, Fresenius Kabi, Nestle Health Science, Nutricia. J.E.Yardley: Research Support; Abbott, Dexcom, Inc., LifeScan, Speaker's Bureau; Abbott Diabetes.

Funding
Alberta Diabetes Institute
537-P: Timing of Moderate-to-Vigorous Physical Activity Is Associated with Improvements in Glycemic Control in Type 2 Diabetes in the Look AHEAD Study
Authors: QIAN JINGYI , XIAO QIAN , WALKUP MICHAEL P. , CODAY MACE , ERICKSON MELISSA , UNICK JESSICA L. , JAKICIC JOHN M. , HU KUN , SCHEER FRANK A. , MIDDELBEEK ROELAND 
Published: May 2022

Background: We examined the association of time-of-day bout-related moderate-to-vigorous physical activity (bMVPA) with changes in glycemic measures and use of antidiabetic medications in adults with type 2 diabetes.
Methods: Look AHEAD participants were randomly assigned to a lifestyle intervention or a control group, in which the most intensive intervention occurred in Year 1. Among 1755 participants (age, mean ± SD 60 ± 7 years; 57% women) with 7-day waist-worn accelerometry data at Year 1, we grouped them by the timing of bMVPA (≥3 METs in ≥min bouts) : ≥50% of bMVPA during the same time period (Morning, Midday, Afternoon, or Evening; N=191-258) , &lt;50% of bMVPA in any time period (Mixed; N=379) , and ≤1 day with bMVPA per week (Inactive; N=485) . Analyses were adjusted for covariates including socio-demographic factors, randomization arm, and clinics; then further adjusted for weekly bMVPA volume and intensity.
Findings: Timing of bMVPA was associated with changes in HbA1c across Year 1 (P=0.01) , independent of weekly bMVPA volume and intensity. Participants in the afternoon group as compared to the inactive group had a greater HbA1c reduction (mean: -0.16%; 95%CI: -0.33% to 0%) . Among non-insulin users the odds of discontinuation vs. maintaining or initiating antidiabetic medications across Year 1 trended to differ between the bMVPA timing groups (P=0.09) , with the afternoon group having the highest odds of discontinuation (OR vs. inactive group: 1.86; 1.14 to 3.02) .
Interpretation: Timing of bMVPA may be linked with improvements in glycemic control in adults with type 2 diabetes. While regular physical activity remains to be the cornerstone for blood glucose management in diabetes, our findings suggested that exercise interventions aimed to increase glycemic control in patients with diabetes can be enhanced by engaging in physical activity at specific times of the day. Experimental protocols are needed to test the causality.

Disclosure
J.Qian: None. R.Middelbeek: Research Support; Novo Nordisk. Q.Xiao: None. M.P.Walkup: None. M.Coday: None. M.Erickson: None. J.L.Unick: None. J.M.Jakicic: Advisory Panel; Spark360, Wondr Health, WW International, Inc. K.Hu: None. F.A.Scheer: None.

Funding
National Institutes of Health (K99HL148500, DK57136, DK57149, DK56990, DK57177, DK57171, DK57151, DK57182, DK57131, DK57002, DK57078, DK57154, DK57178, DK57219, DK57008, DK57135, DK56992, R01HL140574, RF1AG059867, RF1AG064312)