bluuebunny/crossref_metadata_2025_split huggingface dataset:
619-P: Understanding Parental Influences on T1D Incorporation in Adolescents and Young Adults
Authors: COMMISSARIAT PERSIS V. , VOLKENING LISA K. , WEINZIMER STUART A. , DASSAU EYAL , LAFFEL LORI M. 
Published: May 2022

Aim: Positive incorporation of diabetes into one’s identity involves accepting and adjusting to the physical and emotional demands of T1D. Parents likely influence adolescent and young adult (AYA) illness identity. We evaluated alignment of AYA and parent experiences of diabetes distress (DD) and fear of hypoglycemia (FOH) , two potential barriers to T1D incorporation, and assessed associations of alignment with AYA incorporation.
Methods: AYA with T1D, ages 13-25 years with T1D duration ≥1 year, and their parents were recruited from 2 pediatric diabetes centers. AYA and parents completed validated measures of DD and FOH. AYA also completed a measure of T1D incorporation. Surveys were scored 0-100; higher score=more DD, FOH, incorporation. DD and FOH scores were categorized as Low (&lt;median) or High (≥median) for each AYA and parent. For DD and FOH, dyads were grouped based on AYA/parent survey score alignment: Low/Low (L/L) , Low/High (L/H) , High/Low (H/L) , High/High (H/H) . AYA incorporation scores were compared among DD and FOH groups.
Results: There were 88 AYA/parent dyads (AYA age 16.8±2.4 years, T1D duration 8.6±4.2 years, 48% male, 91% White, 75% pump users, 69% CGM users, HbA1c 8.4±1.3%) ; 82% of parents were mothers. Incorporation scores differed significantly between the 4 DD groups (L/L: 77.3, n=23; L/H: 69.0, n=19; H/L: 59.7, n=22; H/H: 44.3, n=22; p&lt;.001) . Incorporation scores of dyads with L/L FOH (72.0, n=24) were significantly higher than other FOH groups (L/H: 59.0, n=19; H/L: 59.9, n=25; H/H: 59.4, n=20; p=0.04) . AYA in dyads with H/H DD had significantly higher A1cs (9.2%) than other DD groups (8.2-8.7%) (p=0.004) ; there was no A1c difference among FOH groups.
Conclusion: Low DD in AYA is associated with the highest incorporation scores, suggesting identity is closely tied to personal experience of T1D. Low parent DD may protect AYA’s incorporation, while high FOH in either AYA or parents may hinder incorporation. Reducing AYAs’ DD and FOH may be valuable in integrating T1D into identity.

Disclosure
P.V.Commissariat: None. L.K.Volkening: None. S.A.Weinzimer: Consultant; Dompé, Research Support; Abbott Diabetes, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc. E.Dassau: Employee; Eli Lilly and Company, Research Support; Dexcom, Inc., JDRF, National Institute of Diabetes and Digestive and Kidney Diseases, Stock/Shareholder; Eli Lilly and Company. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.

Funding
National Institutes of Health (P30DK036836, DP3DK113511)
62-LB: Rapid CGM Uptake among Adults with Type 2 Diabetes
Authors: MAYBERRY LINDSAY S. , HENDRICKSON CHASE , MCCOY ALLISON B. , ELASY TOM A. 
Published: May 2022

Recently, continuous glucose monitors (CGM) have become increasingly available and affordable to support T2D management. Evidence to date supports CGM use in T2D to improve glycemic control and quality of life, across medication regimens and care settings. However, the rate and correlates of CGM uptake in T2D are unknown. We used electronic health record data to examine incidence of CGM use among adults (≥18 years old) receiving care for T2D at Vanderbilt University Medical Center. Eligible patients had T2D per a validated algorithm, and an A1c test and a primary care or endocrinology clinic visit from 10/1/2020 to 09/30/2021. We extracted historical data on CGM prescriptions and A1c values for these patients and compared CGM users and non-users on age, gender, race, ethnicity, insulin prescriptions, and A1c. Of the 26,841 adults seen for T2D, 12.3% (n=3,310) had been prescribed CGM. The earliest CGM prescriptions for the cohort appeared in Spring 2018. In 2021, each month an average of 110.2 patients (0.4% of cohort) were newly prescribed CGM (range 85-126 per month) . CGM use was associated with younger age, insulin use, and higher A1c, but not gender, race, or ethnicity (Table) . Since 2018, CGM use among adults with T2D has increased rapidly. Adults who are younger with higher A1c and using insulin are more likely to be prescribed CGM. There is potential to leverage the increase in CGM use among adults with T2D to improve outcomes and quality of life.

Disclosure
L. S. Mayberry: Consultant; Abbott Diabetes, Cecelia Health. C. Hendrickson: None. A. B. Mccoy: None. T. A. Elasy: None.
622-P: Comorbid ESRD and Diabetes Is Associated with Greater Odds for Depression
Authors: WOOLLEY RYAN , PARIS MELANIE , PIERCE ROBERT , DEWBERRY GWENDOLYN , SPIGLER MICHAEL 
Published: May 2022

People with comorbid end-stage renal disease (ESRD) and diabetes are more prone to poor clinical outcomes including increased mortality and hospitalization, poor treatment compliance and quality of life. Self-management of these coexisting conditions is challenging as the treatment regime is complex, burdensome, and nutrition guidelines may conflict. While it is known that each morbidity is known to be associated with an increased risk for depression, limited research has explored the potential compounding effect of comorbidity. To explore this, determinants of depression were compared between a cohort of ESRD patients with and without diabetes.
Data from the American Kidney Fund Health Insurance Premium Program of 63,254 low-income adults with ESRD were analyzed. All demographic and health condition data were collected through self-report. A logistic regression was performed to ascertain the effect of diabetes on the likelihood of depression in individuals with ESRD. Unadjusted and adjusted odds of having depression were calculated in those with and those without diabetes. Age, sex, race/ethnicity, income, marital status, employment status, and health conditions known to be associated with depression including anxiety, cardiovascular disease, insomnia, and sexual problems were included as covariates.
After adjusting for demographic and clinical variables, diabetes remained independently associated with higher odds of depression (1.9; 95% confidence interval: 1.8-2.1) .
Odds of depression significantly increased among adults with ESRD in the presence of diabetes. Screening for depression among people with ESRD is of particular importance to mitigate adverse outcomes and disease progression. Future studies should further examine the mechanisms of depression in both ESRD and diabetes, and test modifiable targets for interventions to prevent and treat depression in these populations.

Disclosure
R. Woolley: None. R. Pierce: None. M. Spigler: None.
625-P: Exploring Social Media as Potential Support for Young Adults (YA) with T1D
Authors: KAUSHAL TARA , BRANKA LILLIAN A. , WENTZELL KATHERINE , COMMISSARIAT PERSIS V. , LAFFEL LORI M. 
Published: May 2022

Objective: YA use social media (SM) frequently. Diabetes-focused SM posts may offer support for those with T1D. This qualitative study sought to explore perspectives of YA with T1D on diabetes-focused SM posts.
Methods: Semi-structured interviews were conducted through videoconferencing with YA with T1D (age 18-25 years, T1D duration 1 year) . Ten diabetes-focused Instagram posts were selected, encompassing major topic areas identified in previous SM literature (e.g., humor, venting) . Participants viewed posts with captions and provided their perspectives. Interview transcripts were coded and evaluated using thematic analysis.
Results: Fifteen YA participated (age 22±1.9 years, 86% white, 33% male, T1D duration 12±5.7 years, A1c 8.1±1.6%, 80% pump use, 100% CGM use) . All participants reported using SM at least once daily, but very few reported viewing or posting diabetes content. YA reactions to posts encompassed four major themes: 1. Perception of personal relevance: many participants noted whether posts applied to them. While many posts were described as “relatable,” others were suggested to be more useful soon after diagnosis or in contrast to participants’ own self-care behaviors. 2. Reduced isolation with T1D: many participants reported the posts made them feel “not alone;” some noted their lack of friends with T1D and mentioned benefits of community. 3. Frustration about living with T1D: some participants expressed anger or annoyance with diabetes, especially about hyperglycemia and cost of insulin. 4. Appreciation of public displays of T1D self-care: many participants valued openness with self-management in posts, although some expressed hesitancy in self-displays. After viewing and discussing all posts, some participants reported they may seek out diabetes-focused SM in the future when they had not previously.
Conclusions: SM may be a source of community, support, and reduced isolation for YA with T1D. Further research is needed to assess SM as a means to improve self-care in this group.

Disclosure
T.Kaushal: None. L.A.Branka: None. K.Wentzell: None. P.V.Commissariat: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.

Funding
NIH/NIDDK (K12DK094721,P30DK036836)
628-P: Factor Structure and Validity of a Dietary Screener among Diverse Adults with Suboptimally Controlled Type 2 Diabetes (T2D)
Authors: PAPPALARDO LINDSEY D. , SCHECHTER CLYDE , FANG RAN , HOOGENDOORN CLAIRE J. , GONZALEZ JEFFREY S. , WALKER ELIZABETH A. 
Published: May 2022

Objective: Although following a healthy diet is a key aspect of diabetes self-care, few brief, validated dietary measures exist. The 8-item Starting the Conversation (STC) questionnaire shows promise but has limited validation, particularly among Latinos, who are disproportionately impacted by T2D.
Methods: We assessed the STC’s factor structure in English and Spanish, convergent and divergent validity, and internal reliability at baseline using data from 812 predominantly Latino adults with T2D who participated in a trial of telephonic self-management support (Female = 56.9%; Latino = 85.8%; Mean (SD) Age and A1C = 59.2 (10.8) , 9.3 (1.8) , respectively) . We also examined the STC’s sensitivity to this intervention over 12 months.
Results: Exploratory factor analysis yielded 2 factors: Junk Food and Healthy Food. When 3 items were excluded due to low loadings, a single Junk Food factor was retained, explaining 40% of variance in STC scores. Cronbach’s alphas for the 5-item Junk Food scale were similar in Spanish (α = .61) and English (α = .57) at baseline. The Junk Food scale demonstrated convergent validity with BMI (r = .13, p &lt; .001) and self-reported diabetes self-care (r = -.33, p &lt; .001) , but not with A1C (r = .04, p = .328) , systolic BP (r = -.09, p = .011) , or diastolic BP (r = -.04, p = .312) . Demonstrating divergent validity, the Junk Food scale did not correlate with 4 scales assessing beliefs about medication (rs ≤ .06; ps ≥ .103) . There was no significant difference in change in Junk Food scores over time between the intervention and control arms (DID = -.02, SE = .03, , 95% CI [-.08, .04]) .
Conclusions: Although the Junk Food scale demonstrates mixed evidence for convergent validity, this 5-item measure may provide a useful assessment of unhealthy food consumption among English- and Spanish-speakers with T2D. To our knowledge, this is the first study to investigate the factor structure of the STC, which may inform its utility for research and practice.

Disclosure
L.D.Pappalardo: None. C.Schechter: None. R.Fang: None. C.J.Hoogendoorn: None. J.S.Gonzalez: Consultant; Virta Health Corp. E.A.Walker: None.

Funding
National Institutes of Health (R18 DK098742) Einstein–Mount Sinai Diabetes Research Center (P30 DK020541) New York Regional Center for Diabetes Translation Research (P30 DK111022)
63-OR: A Model-Based Clinical Trial Simulation Tool to Optimize Clinical Trial Designs for Type 1 Diabetes Prevention Studies
Authors: MORALES JUAN F. , MUSE RHODA , PODICHETTY JAGDEEP , BURTON JACKSON , DAVID SARAH , MARTIN FRANCIS , ATKINSON MARK A. , HALLER MICHAEL J. , CAMPBELL-THOMPSON MARTHA , ROMERO KLAUS , O'DOHERTY INISH , SCHMIDT STEPHAN , KIM SARAH 
Published: May 2022

Trials seeking to delay or prevent type 1 diabetes (T1D) continue to face multiple challenges, including both clinical endpoint (s) and cohort selection. While it is clear that individuals who possess islet cell autoantibodies (AAbs) are at elevated risk for developing T1D, it remains unclear as to what additional factors, including metabolic activities and anthropometric data, may contribute to this increased risk. The aim of this project was to inform T1D prevention trial designs by developing a quantitative joint model based-clinical trial simulation (CTS) tool. Individual-level data obtained from the NIH TEDDY and TrialNet TNnatural history studies were used in this tool’s development. To describe T1D disease progression quantitatively, both longitudinal and time-to-event variables were simultaneously quantified as a joint model, with results from a 2-hour oral glucose tolerance test (OGTT) assessed at each visit included as a time-varying longitudinal covariate affecting the T1D diagnosis event. Our study focused on individuals at risk of developing T1D with two or more AAbs. Among the investigated individuals, those with a high BMI and the presence of GADA AAb at baseline had less risk, while those with an elevated HbA1c value, high fasting OGTT value, increased fasting OGTT to 2-hour OGTT ratio, and the presence of the IA2A AAb at baseline had higher risk. The developed model based-CTS tool, where users can specify the trial design, participants’ characteristics and hypothetical drug effect, provides a framework to perform T1D prevention clinical trial simulations with the intention to assist in future trial design decision-making processes.

Disclosure
J.F. Morales: None. R. Muse: None. J. Podichetty: None. S. David: None. M.A. Atkinson: None. M.J. Haller: Advisory Panel; SAB Biotherapeutics. Consultant; MannKind Corporation, Sanofi. M. Campbell-Thompson: Consultant; TRex Bio. K. Romero: None. I. O'Doherty: None. S. Schmidt: None. S. Kim: None.

Funding
JDRF (grant #: 2-SRA-2020-903-A-N) ; NIDDK Central Repositories
630-P: Diabetes Management for People with Comorbid Substance Use Disorder
Authors: BALAPAL NEHA , SLAMA NATALIE , ASYYED ASMA , ITURRALDE ESTI 
Published: May 2022

Importance: Comorbid substance use disorder (SUD) is associated with poor clinical outcomes among people with diabetes, but limited research has examined targeted intervention strategies for patients with both conditions.
Methods: We conducted a rapid literature review using PubMed to examine past diabetes screening and intervention studies for patients with SUD (study 1) . To investigate potential intervention targets, we compared clinical factors and health care utilization among patients with SUD and diabetes comorbidity (comorbid group) to patients with one but not both of these conditions (SUD-only or diabetes-only groups; study 2) . Study 2 included electronic health record (EHR) data from 2,734 adults with SUD (of whom 8% had comorbid diabetes) who were treated for SUD in an integrated health care system in 20 (comorbid group N = 217; SUD-only group N = 2,517) . We also evaluated previously published data from the same health system for patients with diabetes and low rates of SUD (diabetes-only group, N = 264,844) .
Results: In study 1, there was limited literature found on comorbid SUD and diabetes. No studies were found on interventions in the behavioral health or SUD treatment setting. In study 2, comorbid diabetes relative to SUD-only was associated with higher rates of emergency department (ED) and hospital use (aOR = 1.85, 1.56; p values &lt; 0.05) , after adjusting for demographic and SUD factors. The comorbid group had higher rates of diagnosed cardiovascular disease, hypertension, and dyslipidemia (29%, 69.6%, 56.7%, versus 6.6%, 22.6%, 17% in SUD-only) . Relative to the diabetes-only group, the comorbid group had similar rates of HbA1c &gt; 9.0.
Conclusions and Relevance: Patients with diabetes who are receiving SUD treatment are vulnerable to poor cardiovascular health and frequent visits to the ED and hospital. Though understudied, models that integrate diabetes care into SUD treatment could be helpful.

Disclosure
E. Iturralde: None.
631-P: Youth with Type 1 Diabetes (T1D) and High Social Risk: Predictors of Glycemic Control
Authors: WAGNER DAVID V. , CLEMENTS MARK A. , RAYMOND JENNIFER , WONG JENISE C. , REED ALISON , NARANJO DIANA , JENISCH CELESTE , CRUZ CRISTIAN , MITCHELL SUSANNE , YGLECIAS LOREN , GARCIA JAQUELIN J. FLORES , SALCEDO-RODRIGUEZ ELIZABETH , SANCHEZ ALEJANDRA TORRES , DASIKA POOJITA , VIANA JULIA , WILLIAMS DAVID D. , FERRO DIANA , HARRIS MICHAEL A. 
Published: May 2022

Objective: A subset of youth with T1D experience ongoing challenges with diabetes self-management, often due to social risk. This 5-site study examined which social factors were associated with hemoglobin A1c (A1c) , specifically in youth with preexisting high A1c.
Methods: Youth with T1D for more than 1 year were included if between 12-17 years old and with at least one A1c value ≥10% in the past year. Chart review captured A1c values, and caregivers reported on social risk- with 16 risk variables (e.g., housing security, employment status) in initial analyses. Multivariable linear regression model included A1c from 1 year prior to enrollment as an outcome and backwards stepwise procedure retained covariates with p&lt;0.10.
Results: Participants (n=130) had a mean age of 14.4 (±1.6) years and mean A1c of 11.1 (±1.7) ; 49% reported male gender; 51% self-identified as Non-Hispanic White. A1c prior to study enrollment was predicted to be 0.68 lower in individuals whose caregiver had at least a college education and 0.65 higher when caregivers were divorced or separated.
Conclusion: Findings suggest that, in youth with preexisting difficulty with glycemic variability, caregiver education level and marital status are associated with A1c - and, while not causal, may reflect unique value when screening for risk. This cohort will be followed to determine which factors predict future health concerns and associated need for intervention.

Disclosure
D.V.Wagner: None. L.Yglecias: None. J.J.Flores garcia: None. E.Salcedo-rodriguez: None. A.Torres sanchez: None. P.Dasika: None. J.Viana: None. D.D.Williams: None. D.Ferro: None. M.A.Harris: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. J.Raymond: None. J.C.Wong: Consultant; Provention Bio, Inc., Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A.Reed: None. D.Naranjo: None. C.Jenisch: None. C.Cruz: None. S.Mitchell: None.

Funding
JDRF
633-P: Families' Lived Experience Guides Intervention Development: Addressing the Psychosocial Needs of Families in the First Year after Diagnosis
Authors: GARZA KIMBERLY P. , HOWARD KELSEY R. , WEISSBERG-BENCHELL JILL , FELDMAN MARISSA 
Published: May 2022

A diagnosis of T1D can be overwhelming. Offering psychosocial support throughout the first year may facilitate family adjustment. To our knowledge, no interventions exist that promote psychosocial adjustment in families immediately following diagnosis. Family-based interventions are rarely developed with a focus on the experiences of the families who have lived through the diagnosis. This study offers a novel approach to developing a family-based intervention for youth with T1D, with content developed from the lived experiences of youth and their parents. The goal of Teaming up for T1D with Telehealth (Triple T) is to support families post-diagnosis, combining brief, targeted telehealth sessions and access to a video library depicting common family experiences during the first year. We conducted age specific focus groups to explore challenges, fears, successes, and advice of youth and their families, diagnosed within the past 2 years. Children (8-12 years; n= 10) ; teens (13-17 years; n= 11) ; their caregivers (n= 27) and parents of children 7 or younger (n= 12) participated. Main themes were sorted into topics to be addressed by telehealth visits or videos. These themes informed the development of 20 videos with age-specific themes. There were five main topics: Reassurance that they will be “Okay”; Strategies for getting to “Okay”; Managing activities; Handling disclosure and questions; and Family teamwork. Test videos were reviewed by the original focus group participants for additional stakeholder feedback. Final videos were filmed with professional actors to be used in conjunction with telehealth sessions during the intervention. Using stakeholder experience in addition to clinical experience and empirical research to inform interventions represents a novel approach to developing interventions that may directly address the needs of families and inform future interventions and education following a T1D diagnosis.

Disclosure
K.P.Garza: None. K.R.Howard: None. J.Weissberg-benchell: None. M.Feldman: None.

Funding
Juvenile Diabetes Research Foundation
635-P: Maternal Social Support (SS) related to Reproductive Health (RH) and Healthy Lifestyle Behaviors among American Indian and Alaska Native (AIAN) Female Adolescents and Young Adults (AYA) to Minimize Risk for Gestational Diabetes (GDM)
Authors: CHARRON-PROCHOWNIK DENISE , SEREIKA SUSAN M. , ABUJARADEH HIBA , STOTZ SARAH A. , FISCHL ANDREA F. , GARROW HEATHER , O'BANION NANCY , GONZALES KELLY L. , CHALMERS LAURA , MOORE KELLY R. 
Published: May 2022

AIAN women have higher risk for GDM. Early preconception counseling (PC) about healthy lifestyle/weight and mothers’ support could reduce these risks. We describe and compare parallel measures of SS with RH/GDM risk: daughters’ perceived SS from mothers, and mothers’ perceived SS for daughters. Methods: Secondary analysis used baseline data from 113 mother-daughter (M-D) dyads from four sites participating in Stopping GDM, an online randomized trial to reduce risks of GDM. Perceived maternal SS was amounts (0=no support, to 5=a lot of support) and types of SS re: RH, healthy lifestyle behaviors, and seeking PC to prevent GDM (instrumental SS, e.g., help get birth control; informational SS, e.g., on pregnancy/GDM) . M-D independently completed online measures of perceived available maternal SS. We performed descriptive, within-dyad comparative/correlational analyses. Results: AIAN AYA (n=113; mean age 17±3yrs; BMI 29±8.3 kg/m2) and their mothers (n=113; age 44.7±9yrs; 45% had &gt; 2-4 college; 44% married) . AYA reported moderately high levels of maternal SS: total (16±5; range:0-20) ; instrumental (12±4; 0-15) ; informational (4±2; 0-5) . Mothers reported high levels of SS to give their daughters: total (20±1; range:15-20) ; instrumental (15±1; 10-15) ; informational (5±0; 0-5) . Mothers reported significantly higher levels of SS to give their daughters compared to their daughters’ perception of available maternal SS (p&lt;.001) . Daughters and mothers’ perceived available maternal SS were positively correlated: total: rS=.218, p=.024; instrumental: rS=.229, p=.016. Conclusion: Maternal SS perceived by AIAN AYA females for RH and GDM prevention was lower than their mothers’ perception of available SS for their daughters. Mothers could potentially provide SS for their daughters. M-D dyadic approach could be beneficial to minimize the risk of GDM.

Disclosure
D. Charron-Prochownik: None. S.M. Sereika: None. A.F. Fischl: None. N. O'Banion: None. K.L. Gonzales: None. L. Chalmers: None. K.R. Moore: Consultant; Novo Nordisk.

Funding
RNR014831 grant