bluuebunny/crossref_metadata_2025_split huggingface dataset:
94-OR: CGM Metrics, HbA1c, and Retinopathy Are Differentially Associated by Disease Duration in Long-Duration Type 1 Diabetes
Authors: YU MARC GREGORY , BOUMENNA TAHANI , GAUTHIER JOHN , THAM REGINA , FICKWEILER WARD , SUN JENNIFER , SHAH HETAL , KING GEORGE L. 
Published: May 2022

Continuous glucose monitor (CGM) -derived metrics provide measures of glycemic variability that are not captured with the use of HbA1c alone. However, they have not been evaluated in long-duration type 1 diabetes (T1D) subjects, in whom the greater risk of glycemic excursions and comorbidities highlight the need for other glycemic markers apart from HbA1c. Among the Joslin “Medalists” with T1D≥50 years, a single consecutive 14-day block of CGM data was remotely obtained from a subset of CGM users (n=64) after a period of routine activities. Using linear regression, mean historical HbA1c associated with mean glucose (β= 17.54, p&lt;0.0001) , glucose management indicator (GMI; β= 0.42, p&lt;0.0001) , and time above range (TAR) &gt;250 mg/dL (β= 3.31, p=0.0003) ; and inversely with time in range (TIR) 70-180 mg/dL (β= -8.08, p=0.0003) and time below range (TBR) &lt;70 mg/dL (β= -2.11, p=0.0006) . While no associations were found between CGM metrics and complications in the overall subset, tertile analysis by T1D duration (tertile 1, 51-61 years; tertile 2, 62-69 years; tertile 3, 70-85 years) revealed that T1D duration modified the effect of CGM metrics on proliferative retinopathy (PDR) even after adjusting for HbA1c (p for interaction &lt;0.05) . In subjects with the longest T1D duration (tertile 3) , PDR associated with mean glucose (β= 26.92, p=0.02) , GMI (β= 0.64, p=0.02) , and TAR (β= 6.81, p=0.03) ; and inversely with TIR (β= -12.57, p=0.04) . Tertile analysis of HbA1c and complications in the overall Medalist cohort (n=952) showed that HbA1c associated with PDR in tertile 1 (p=0.03) . Our results suggest that while HbA1c and CGM metrics are closely linked in long-duration T1D subjects, they may provide differential contributions to the temporal onset of microvascular complications, independent of each other. Additionally, as development to PDR has been demonstrated to stabilize in Medalists with the longest T1D duration, favorable values of CGM metrics may contribute to this protection.

Disclosure
M.Yu: None. T.Boumenna: None. J.Gauthier: None. R.Tham: None. W.Fickweiler: None. J.Sun: Consultant; American Diabetes Association, American Medical Association, Research Support; Adaptive Sensory Technology, Boehringer Ingelheim International GmbH, Genentech, Inc., Jaeb Center for Health Research, Janssen Pharmaceuticals, Inc., Novartis Pharmaceuticals Corporation, Novo Nordisk, Optovue, Incorporated, Physical Sciences, Inc, Roche Pharmaceuticals. H.Shah: None. G.L.King: Advisory Panel; Medtronic, Research Support; Janssen Pharmaceuticals, Inc.

Funding
American Diabetes Association (9-18-CVD1-005) ; Mary K. Iacocca Family Foundation, Thomas Beatson Jr. Foundation, National Eye Institute (R01EY026080-01)
941-P: Impact of Whatsapp-Based Monitoring on Glycemic Control and Exercise Habits in Patients with Diabetes in Indian Population
Authors: SABOO BHARAT , SHRIVASTAVA ABHISHEK , TEWARI AJOY , INAMDAR ANIKET V. , SABOO SHWETA , SABOO BANSHI D. 
Published: May 2022

Introduction: Diabetes treatment requires the involvement of people with diabetes in the form of regular exercise and lifestyle measures. Exercise is an important strategy in the management of diabetes. Regular exercise is necessary for good Glycaemic control and Metabolic health. Newer methods like WhatsApp-based communication are now finding their way into diabetes care. It can assist to maintain a regular exercise program and reduce blood sugar levels.
Materials and Methods: A total of 262 patients were selected by random sampling. They were of age 15-65 years with DM. Inclusion Criteria: 1. Known case of DM 2. Consent to share data. 3. Ability to use WhatsApp. Exclusion criteria: 1. Inability to use WhatsApp 2. Any condition which impairs movement. Randomly allocated to two groups of 131 persons. The first group participants were added to a WhatsApp group and asked to send their exercise and blood glucose data to the clinic over WhatsApp. The other group was treated as usual. Participants were monitored for HBA1C at 3 and 6 months and surveyed for exercise patterns by a questionnaire at 3 and 6 months. The results were analyzed using SPSS.
Result: After excluding, 2 dropped patients from both groups remaining 258 patient data shows: HBA1C reduction in the WhatsApp group of 1.9% as compared to 1% in the routine care group. The number of patients achieving the target goal of 7% HBA1C in the WhatsApp group (74%) as compared to the routine group (56%) . 77% of patients in the WhatsApp group did regular exercise as compared to 42% in the routine group.
Discussion: With newer modalities, the ways and means to communicate with patients have improved. This has paved way for newer messaging platforms like WhatsApp for better patient-centric communication. These tools if used correctly can reduce in-person follow-ups but increase the connection between caregiver and patients and can result in better patient outcomes and will lead to reduced complications and financial implications.

Disclosure
B.Saboo: None. A.Shrivastava: None. A.Tewari: None. A.V.Inamdar: None. S.Saboo: None. B.D.Saboo: None.
943-P: Impact of Culturally Appropriate Diabetes Care amongst Asian Americans with Type 2 Diabetes during the COVID Pandemic
Authors: ADAM ATIF , LAU KA HEI KAREN , SHAH HETAL , YU MARC GREGORY , KING GEORGE L. 
Published: May 2022

Even as patients with T2D have been shown to have increased COVID-related morbidity and mortality, little is known on the impact of COVID on appointment adherence. This report reviews the impact of culturally-relevant diabetes clinics on adherence to clinical appointments, (pre-and during COVID) . This is a retrospective observational study using EMR data of adult patients with T2D managed at Joslin Diabetes Center before the COVID pandemic (April 20to Dec. 2019) and during the COVID pandemic (April 2020 to Dec. 2020) . Demographic and clinical visit data were extracted from patients seen at least once in both time periods. Clinical appointment adherence and outcomes were compared to patients in the general adult diabetes clinic (GADC) versus the Asian American Diabetes Initiative clinic (AADI) . 297 adult patients with T2D were seen in the AADI clinic and 4,655 patients were seen in the GADC clinics. The AADI clinic catered to a significantly larger proportion of patients who were non-native English speaking (46.1% vs. 8.7%, p&lt;0.001) and on Medicaid (8.4% vs. 4.6%, p&lt;0.001) . Early in the pandemic, virtual appointments were the major source of kept visits, with in-person kept appointments adherence returning in late 2020 (Oct-Dec.) . While the AADI clinic saw no significant changes in kept appointment rates, the GADC clinic had significantly fewer kept appointments overall compared to a similar time frame pre-COVID (pre: 71.7% vs. during: 63.5%, p=0.03) . Both clinics had significantly higher no-show rates during the pandemic. Comparing clinical outcomes, while GADC clinic patients saw a decline in their eGFR during the pandemic (80 vs. 75; p-value=0.04) , the AADI clinic did not observe a significant change in their patient’s renal status (82 vs. 83; p-value=0.93) . Our study shows that culturally oriented clinics like the AADI can successfully allow lower-incomes and older adults to acclimatize to telehealth services while also ensuring ongoing clinical wellbeing

Disclosure
A.Adam: None. K.Lau: None. H.Shah: None. M.Yu: None. G.L.King: Advisory Panel; Medtronic, Research Support; Janssen Pharmaceuticals, Inc.
944-P: Medicaid Insured Persons with Diabetes Have Increased Proportion of Missed Appointments and Poor Diabetes Control
Authors: RADHAKRISHNAN RAMYA , CADE WILLIAM H. , BERNAL-MIZRACHI ERNESTO , GARG RAJESH 
Published: May 2022

Poor socioeconomic status and inadequate insurance coverage may affect an individual’s ability to utilize healthcare services. This study was conducted to evaluate whether the type of insurance coverage is associated with missed appointments for diabetes care. Data analysis included all patients with diabetes mellitus (DM) managed at a major academic center between Jan 2015 and Dec 2020. Association between insurance coverage and proportion of missed appointments was evaluated using analysis of covariance with adjustments for demographic variables and social determinants of health. The relationship between proportion of missed appointments and glycemic control was also evaluated in multivariate analyses. The final dataset included 30,633 patients, out of which 14,064 (46%) reported commercial insurance, 13,376 (44%) reported Medicare and 3,193 (10%) reported Medicaid coverage. Medicaid group was identified to have the highest proportion of Spanish-speakers, African Americans, women, current smokers and single individuals. Proportion of missed appointments was 18.1 ± 18.1% in Medicaid covered patients as compared to 12.1 ± 15.3% among commercially insured and 10.2 ± 14.1% among Medicare covered patients (p &lt;0.001) . Type of insurance was found to be a statistically significant predictor of the proportion of missed appointments after adjusting for age, race, preferred language, marital status, smoking, BMI, HbA1c and type of diabetes (p&lt;0.001) . Proportion of missed appointments was associated with HbA1c with partial correlation coefficient +0.1 (p &lt;0.001) after adjusting for age, race, gender, type of insurance, BMI and type of diabetes. We conclude that Medicaid covered patients with diabetes have higher proportion of missed clinic appointments and higher HbA1C. More research is needed to evaluate the root causes of inability to keep appointments in this population so that strategies for improved healthcare delivery can be designed.

Disclosure
R.Radhakrishnan: None. W.H.Cade: None. E.Bernal-mizrachi: None. R.Garg: None.
945-P: Predictors of Lack of Improvement in Glycemic Control in Persons with Type 2 Diabetes
Authors: GARG RAJESH , LOUIE JUDY Z. , SHIFFMAN DOV , ROWLAND CHARLES M. , MCPHAUL MICHAEL J. , BERNAL-MIZRACHI ERNESTO , KENYON NORMA SUE 
Published: May 2022

The ADA recommends an A1C &lt;7% for most people with diabetes and &lt;8.5% for those with relaxed glycemic goals. However, a large proportion of people with T2D fail to achieve the goal A1C. This study was performed to evaluate the factors associated with lack of improvement in A1C over a period of 3 years. This was a retrospective analysis including all patients with T2D treated at an academic center from 2015 to 2020. Patients with at least one A1C value available in each of 3 years prior to current A1C and ≥1 of those values &gt;8.5% (poor control) were included. Patients with improved glycemic control (current A1C ≤8.5%) were compared with those with lack of improvement (current A1C &gt;8.5%) . On multivariate logistic regression analysis including all variables in the model, independent predictors of lack of improvement were: younger age (OR 0.89 per 1-SD [12 years]; 95 % CI 0.79 - 1.00) , female gender (1.30, 1.- 1.56) , presence of hypertension (1.29, 1.- 1.55) , Black race (1.32, 1.- 1.68, White as reference) , low income area code (1.86,1.28 - 2.68, high as reference) and insurance coverage other than Medicare (1.32, 1.- 1.66) . Presence of current smoking was associated with a paradoxical improvement in A1C (0.69, 0.47 - 0.99) . We conclude that socioeconomic factors like income, insurance coverage and neighborhood are associated with lack of improvement in A1C. Further studies need to identify specific modifiable socioeconomic factors.

Disclosure
R. Garg: None. J.Z. Louie: None. D. Shiffman: Employee; Quest Diagnostics. Stock/Shareholder; Quest Diagnostics. C.M. Rowland: Employee; Quest Diagnostics. Stock/Shareholder; Quest Diagnostics. M.J. McPhaul: Employee; Quest Diagnostics. E. Bernal-Mizrachi: None. N. Kenyon: Research Support; Elodon Phamaceutical, Takeda Pharmaceutical Company Limited.
948-P: Patient Satisfaction with Virtual Diabetes Care during the COVID-Pandemic
Authors: CHANG CALVIN , DISSANAYAKE ASHINI , PAWLOWSKA MONIKA , SCHROEDER BENJAMIN , MACKENZIE-FEDER JESSICA , WHITE ADAM 
Published: May 2022

The COVID-pandemic has required changes to healthcare delivery and has been a stressful time for people with diabetes mellitus (DM) . Previous literature suggests that virtual health appointments for diabetes care can be effective and result in high patient satisfaction. However, it is unclear if patients with DM are satisfied with the widespread adoption of virtual care during the pandemic. The aim of this study was to evaluate the impact of virtual care during the pandemic on patient satisfaction in patients with type 1 and type 2 DM. The validated Patient Satisfaction Questionnaire (PSQ-III) was completed by 197 patients who had an in-person appointment in the six months before March 18, 2020 (pre-COVID) and a subsequent virtual appointment within six months after that date. For each form of healthcare delivery (i.e. in-person and virtual) , the satisfaction in six aspects of care was measured: general satisfaction, technical quality, interpersonal manner, communication, time spent with doctor, and accessibility of care. Both type 2 DM and age &gt;55 years were associated with decreased general satisfaction with virtual care compared to in-person care. Both type 2 DM and female sex were associated with decreased technical quality of care. Accessibility of care decreased significantly in the overall study group. No significant differences in patient satisfaction were observed in the type 1 DM group. Despite our findings, 74% of respondents answered they would consider virtual health appointments in the future. Our data suggests that many patients welcome virtual health as an addition to their medical care. However, virtual health does not seem to deliver the same level of patient satisfaction as in-person appointments over the longer term. Future research on how fatigue with pandemic restrictions has affected patient satisfaction is needed to evaluate whether virtual health appointments are a viable option for long term diabetes care.

Disclosure
C.Chang: None. A.Dissanayake: None. M.Pawlowska: Advisory Panel; Novo Nordisk, Other Relationship; Medtronic. B.Schroeder: Advisory Panel; Novartis Canada, Novartis Canada, Novartis Canada, Novo Nordisk Canada Inc., Novo Nordisk Canada Inc., Novo Nordisk Canada Inc. J.Mackenzie-feder: Advisory Panel; Recordati S.p.A. A.White: Advisory Panel; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, HLS Therapeutics Inc., Janssen Pharmaceuticals, Inc., Novo Nordisk Canada Inc.
95-LB: Interim Data from a Prospective Study Measuring User Satisfaction and Metabolic Outcome while Using a Novel Modular Patch Pump System
Authors: DAIN ALEJANDRO , MOCERI SANDRA , DAGENBACH NICOLE , REES CHRISTEN , VULCANO CRISTINA , VOGT GERHARD , ETTER TOBIAS J. 
Published: May 2022

Background and aims: Intensified insulin therapy for type 1 diabetes (T1D) can be administered by multiple daily injection therapy (MDI) or continuous subcutaneous insulin infusion therapy (CSII) . Despite the clinical benefits of CSII, its therapeutic implementation rate remains low. Thus, this study aims to evaluate the change in treatment satisfaction and metabolic changes of people with T1D switching from MDI to CSII therapy using a novel modular patch pump system.
Materials and Methods: A total of 50 adults from Argentina with T1D, naïve to CSII, were enrolled in a multi - center, prospective, single - armed study for the Accu-Chek® Solo micropump system (ACS) . Change in diabetes treatment satisfaction after 13 weeks (mean 106, min 83, max 176 days) was assessed by the “Impact and Satisfaction” section of the Diabetes Technology Questionnaire (DTQ) as the primary outcome. In addition, changes in the HbA1c were reported by the investigator as a secondary outcome.
Results: The mean DTQ “now” score improved from 92.96 ± 14.98 to 103.15 ± 19.47 (p = 0.0166) and the “change” score, as the primary outcome, was 113.24 ± 17.50 (p &lt; 0.0001) . Based on pre - defined sub - categories, the following mean DTQ scores were measured: 3.83 ± 0.62 for “diabetes distress and burden,” 3.98 ± 0.70 for “hypoglycemia fear, worry and behavior,” 3.59 ± 0.70 for “device acceptance and satisfaction,” 3.92 ± 0.61 for “other.” In addition, the mean HbA1c, as a secondary outcome, decreased from 8.19 % ± 1.36 to 7.83 % ± 1.23 (- 0.37 %pt, p = 0.0148) . Thereby, the HbA1c reduction was not associated with any reported incidents of hypoglycemia.
Conclusion: The switch from MDI to the Accu-Chek® Solo micropump system led to a significant improvement of subjects’ treatment satisfaction after 13 weeks, which was linked to a significant reduction of the outcome HbA1c without any reported incidents of hypoglycemia.

Disclosure
A. Dain: Advisory Panel; Boehringer Ingelheim International GmbH, Novo Nordisk, Roche Diabetes Care, Speaker’s Bureau; Abbott Diabetes, AstraZeneca, Lilly Diabetes, Novo Nordisk. S. Moceri: Employee; Roche Diabetes Care. N. Dagenbach: Employee; Roche Diabetes Care. C. Rees: Employee; Roche Diabetes Care. C. Vulcano: Employee; Roche Diabetes Care. G. Vogt: Employee; Roche Diabetes Care. T. J. Etter: Employee; Roche Diabetes Care.

Funding
Roche Diabetes Care Gmbh, Mannheim, Germany
956-P: Integrating an Evidence-Based Diabetes Digital Texting Program (Dulce Digital) via an EMR Patient Portal in a Large Health System
Authors: RUIZ MONICA , PHILIS-TSIMIKAS ATHENA , SANDOVAL HALEY , FORTMANN ADDIE L. , STECHSCHULTE MARIAH A. , BAGSIC SAMANTHA R. , PATEL KAREN , MENDEZ KRISTINE 
Published: May 2022

Dulce Digital (DD) , a simple low-cost text message program designed to enhance clinical diabetes care with educational, motivational and glucose reminder messages when delivered 2-3 times/day over 6 months has been shown to be highly acceptable in diverse racial/ethnic minorities and low SES communities and results in a mean 1% reduction in HbA1c compared to usual care. During the COVID pandemic, barriers to in-person care, including quarantines, stay-at-home work schedules, childcare, and transportation, make digital messaging a practical means of improving patient health. To maximize reach in the T2DM population, a large Southern California health care provider integrated DD into their DSME/S offering. This study aims to learn the reach, acceptability, and effectiveness of Dulce Digital in a real-world patient care setting to motivate patients with daily self-care behaviors. An existing diabetes registry identified N=1423 patients with T2DM and HbA1c&gt;7.5% in the last 6 months. There was enthusiastic adoption of the DD texting program byprimary care clinic sites with 78 providers across the County. Patient recruitment was conducted via a patient portal message (EPIC My Chart) sent from healthcare providers encouraging participation in the program. Within one week of portal outreach, 116 patients (8.2%) enrolled (mean age = 57.3 y/o +/- 14.4, range 24-92; 50% female; mean HbA1c= 9.9 % +/- 1.5, range 8.1-16.2) . Program workflows include using support staff to monitor blood glucose responses in the texting platform, assess possible reasons for hyper/hypoglycemia, and encourage follow up with a provider as needed. Adoption by patients and providers to date demonstrate a digital texting program is acceptable and desired equally by men and women across a wide range of ages in patients with T2D and elevated HbA1c. Outreach to enroll patients using a patient EMR portal can be successful and can serve as an enhanced approach to support DSME/S.

Disclosure
M.Ruiz: n/a. 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. H.Sandoval: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. M.A.Stechschulte: None. S.R.Bagsic: None. K.Patel: None. K.Mendez: None.
962-P: Interim Real-World Ten-Site Data from the National Danish PRO Diabetes Multisector Study (M-PRODIA) Engaging 460 Persons with Diabetes and 30 Health Care Professionals Shows High Acceptability and Benefits
Authors: EJSKJAER NIELS , KJAER PERNILLE H. , BERTHELSEN DORTHE B. , KAPLAN SHERRIE H. , JAKOBSEN POUL ERIK O. , GLÜMER CHARLOTTE , SKOVLUND SOREN E. 
Published: May 2022

Introduction: A national value-based health care project, VBHC-PRO-DIA, was initiated in 2017 to develop and evaluate a scalable solution for value based diabetes care in Denmark. Our project was undertaken in partnership and alignment with a national PRO diabetes program. We present the study design for this national project.
Materials and Methods: A participatory multi-stakeholder research design process 2017-2020 with systematic involvement of &gt; 70 PWD using interviews, workshops, clinical & qualitative research: 1) A minimal patient-important diabetes outcome domain set (VBHC structure) . 2) A unified PRO diabetes “logic model” for how to use PRO to drive health value. 3) A national psychometric PRO Diabetes Questionnaire & Decision-Algorithm. 4) A VBHC-PRO IT Tool for seamless use of outcome data in routine diabetes care. 5) A multi-center real-world PRO pilot study of public health potential (RE-AIM) . 6) Implementation planning, data-driven VBHC model design and effectiveness study.
Results: National PRO Model: PWD fills out PRO before visit. PRO is used in-visit for collaborative, focused, whole-person care. A multi-dimensional PRO questionnaire (36-70 items) covering: General health/wellbeing, daily life with diabetes, diabetes distress, self-care, BG regulation, symptoms, access to care, personal goals and priorities. Real-world 10-site PRO study : Interim data: &gt; 460 PWD/ 30 HCPs showed high acceptability and experience of benefits related to active engagement of PWD and person-centred diabetes care quality.

Disclosure
N.Ejskjaer: None. P.H.Kjaer: None. D.B.Berthelsen: None. S.H.Kaplan: n/a. P.O.Jakobsen: None. C.Glümer: n/a. S.E.Skovlund: Consultant; Roche Diabetes Care.
963-P: Preservation of Renal Function in Patients with Diabetes and Comorbid CKD 3 as Measured by eGFR in 1,877 Elderly Patients at CanoHealth. A Two-Year Retrospective EHR-Based Analysis.
Authors: AGUILAR RICHARD , KENNEY ROBERT E. , ANTUNEZ EFRAIN , OSORIO MERLIN , HERMAN MARY , CONGER MORGAN , AGUILAR MICHELLE 
Published: May 2022

This study sought to explore the effect of the CANO Model of Care (CMC) on renal function in elderly Medicare Advantage patients. A 2-Y retrospective review of laboratory data for patients new to CANO (≤3 mos) between Jan 1 and Dec 31, 2018 with diabetes and CKD 3 was conducted. We identified 1,877 patients and collected eGFR, A1C, BMI, SBP/DBP at baseline and at various time points for 24 months (Table 1) . Mean age was 76.5 +/- 9.2Y. Preservation of renal function as represented by eGFR was evident at all time points. Statistically significant improvements in eGFR values were observed during the first 15 months, with no significant changes from baseline for months 18 to 24. Renal function in patients with diabetes and CKD 3 decreases over time. In this cohort renal function, as measured by eGFR, was preserved for 24 months. Subgroup analysis of patients with CKD 3b (n=606) shows similar results. The preservation in renal function may be attributable in part to the Cano Model of Care. The CMC includes a propriety population health platform (CanoPanorama™) which informs care management decisions, imbedded structured data within the EHR, attainment of high PCP NCQA recognition for diabetes care (1) , monthly coordinated physician CMEs, pursuit of 5-star HEDIS® (2) quality metric ratings, and addressing clinical inertia (3) .

Disclosure
R.Aguilar: Speaker's Bureau; Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk A/S. R.E.Kenney: None. E.Antunez: None. M.Osorio: None. M.Herman: None. M.Conger: None. M.Aguilar: None.