bluuebunny/crossref_metadata_2025_split huggingface dataset:
627-P: Comparison of Attitudes of Physcians, Parents, and People with Diabetes towards Digitalization and New Technologies in Diabetes
Authors: KULZER BERNHARD , HERMANNS NORBERT , EHRMANN DOMINIC , ROOS TIMM , HEINEMANN LUTZ 
Published: May 2022

Aims: Are there differences in the attitudes of physicians, parents and people with diabetes (PwD) towards digitalization and new technologies in diabetes and how do these change from 20- 2021?
Methods: In 20 and 2021, PwD and diabetologists in Germany were asked via online surveys about their attitudes and assessment of digitalization and new technologies in diabetology. 2019: 324 diabetologists (43% female, average age 52.2 years) and 3.427 PwD (47.7% female, 56.6% type 1 diabetes (T1D) , 25.5% type 2 diabetes (T2D) , 8.1% parents of children with diabetes; Ø 49.2±19.3 years) . 2021: 3diabetologists (48% female, average age 53.7 years) and 2.417 PwD (47.5% female, 57.8% type 1 diabetes (T1D) , 20.7% type 2 diabetes (T2D) , 19.0% parents of children with diabetes; Ø 47.7 years) .
Results: Parents (T1D) (2019: 89.5% positive; 2021: 91.7%) PwD-TD1 (2019: 85.3%; 2021: 91.1%) have more positive attitudes towards digitalization than PwD-T2D (2019: 73.3%; 2021: 87.1%) or diabetologists (2019: 75.8%; 2021: 81.9%) . Within 2 years, positive attitudes increased in all 4 groups. There was a great agreement between all 4 groups regarding the most important topics for the future of diabetology: AID systems were in first place in the ranking, followed by interoperability of systems, software for analysing glucose data and artificial intelligence.
Conclusions: PwD have very positive attitudes towards digitalization and new technologies in diabetes with only very small differences between TD1 and TD2. These are significantly higher than those of physicians. All groups have very high expectations for the further development of AID systems in particular.

Disclosure
B.Kulzer: Advisory Panel; Bayer AG, Bayer AG, Becton, Dickinson and Company, Becton, Dickinson and Company, Berlin-Chemie AG, Berlin-Chemie AG, Dexcom, Inc., Dexcom, Inc., Insulet Corporation, Novo Nordisk, Roche Diabetes Care, Sanofi, Sanofi-Aventis Deutschland GmbH, Research Support; Novo Nordisk, Roche Diabetes Care. N.Hermanns: Advisory Panel; Abbott Diabetes, Research Support; Becton, Dickinson and Company, Roche Diagnostics, Speaker's Bureau; Berlin-Chemie AG, Novo Nordisk, Sanofi. D.Ehrmann: Advisory Panel; Dexcom, Inc., Consultant; mySugr, Roche Diabetes Care, Speaker's Bureau; Berlin-Chemie AG, Dexcom, Inc. T.Roos: None. L.Heinemann: Board Member; Lifecare, Inc., Consultant; Becton, Dickinson and Company, Roche Diabetes Care, Stock/Shareholder; Profil Institut für Stoffwechselforschung GmbH, Science Consulting in Diabetes GmbH.
632-P: Youth with T1D and High Social Risk Enrolled in an Intensive Community-Based Intervention: Two-Region Comparison of Risk
Authors: WAGNER DAVID V. , WONG JENISE C. , REED ALISON , YGLECIAS LOREN , OSPINA ANDREA BONILLA , NARANJO DIANA , NOYA CAROLINA E. , VIANA JULIA , JENISCH CELESTE , CRUZ CRISTIAN , HARRIS MICHAEL A. 
Published: May 2022

Objective: Novel Interventions in Children’s Healthcare (NICH) , a program for youth with T1D who experience high rates of avoidable health problems (e.g., DKA) , has been newly implemented in a second region. This study examines how youth with T1D referred for combined health problems and social risk compare to similarly referred youth in another region.
Methods: Participants (Oregon=51; Bay Area=24) were referred by medical providers due to avoidable ED visits, hospitalizations and/or chronically elevated A1C values. Caregivers reported on 15 social risks (e.g., housing insecurity, domestic violence) .
Results: Social risk prevalence was high at both sites, with an average of 7.6 in Oregon and 5.6 risks endorsed in the Bay Area. Oregon youth and their parents were significantly (p&lt;.05) more likely to have a mental health diagnosis and domestic violence exposure, while Bay Area youth were significantly more likely to identify as Black or Hispanic, and to have experienced parental incarceration.
Conclusions: While there are some differences in social risk distribution across sites, the rate of risk is extremely high across sites, highlighting the importance of interventions specifically designed to target social factors for this population. Likewise, rethinking standard diabetes care for this subgroup is warranted given the impact of social factors on diabetes outcomes.

Disclosure
D.V.Wagner: None. C.Cruz: None. M.A.Harris: None. J.C.Wong: Consultant; Provention Bio, Inc., Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A.Reed: None. L.Yglecias: None. A.Bonilla ospina: None. D.Naranjo: None. C.E.Noya: None. J.Viana: None. C.Jenisch: None.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust
639-P: Readiness to Change in Rural Adults at High Risk for Diabetes
Authors: WAGNER KATHERINE A. , SAMRA HAIFA ABOU , FERNANDES JESSIE , PUUMALA SUSAN 
Published: May 2022

Despite evidence that the Montana Diabetes Prevention Program halts the progression from prediabetes to type II diabetes, individuals who live in rural areas can face unique challenges associated with their rurality. The purpose of this study was to examine the relationships between readiness to change and attrition rates, blood glucose, hemoglobin A1C, and weight among a sample of 38 rural dwellers enrolled in one site of the Montana Diabetes Prevention Program. Based on a concept analysis for the purposes of this study, readiness to change measured behavioral commitment and motivation to engage in cognitions and tasks associated with sustainable behavior change leading to an expected outcome. Readiness to change scores, demographic information, and clinical variables were measured at baseline and six-months into the program utilizing a validated readiness to change instrument. A bivariate analysis and logistic regression were used to analyze attrition and outcomes data. Results indicated that the covariates of income and geography significantly modified the relationship between readiness to change and attrition (Pr &gt; ChiSq = 0.04) , but did not appear to be related to clinical outcomes. Based on these results, measurement of readiness to change should be considered an important baseline measure at intake in the Montana Diabetes Prevention Program to better understand the target population for the program and support participant engagement.

Disclosure
K.A.Wagner: None. H.Abou samra: None. J.Fernandes: None. S.Puumala: None.
67-OR: Measures of Social Determinants of Health and Risk of Incident Type 2 Diabetes
Authors: RAMM KATE , JACKSON NICHOLAS , CHUNG UN YOUNG , DURU O. KENRIK , SHEDD KELLY , SOETENGA SAMANTHA , LOEB TAMRA B. , ELASHOFF DAVID , HAMILTON ALISON B. , MANGIONE CAROL , MOIN TANNAZ 
Published: May 2022

Introduction: Social determinants of health (SDOH) impact well-being. We tested the association between incident diabetes risk and SDOH using 2 measures, the Area Deprivation Index (ADI) and Social Vulnerability Index (SVI) .
Methods: We examined 2015-2021 medical and claims data from the UC Data Warehouse for overweight/obese adults (age&gt;18 yrs; BMI&gt;25 kg/m2; &gt;23 if Asian) . We ran 4 cox proportional hazards regression models with an outcome variable of incident diabetes; 1) base model with age, sex, race, ethnicity, income, BMI, prediabetes and comorbidities, 2) base model + ADI, 3) base model + SVI, and 4) base model + ADI and + SVI. Since SDOH indices were missing for ∼17%, we added them using an interaction term with an indicator variable.
Results: Among 36,946 adults, 33,587 (91%) had &gt;1 follow-up assessment. Among these, mean age was 43 yrs, BMI 28 kg/m2, ADI 3.9 (SD 2.4) , SVI 0.34 (SD 0.24) ; 14% had prediabetes. Over 4.6 (SD 3.3) mean follow-up yrs, 715 (2%) developed diabetes. In the base model, incident diabetes risk significantly increased with each additional yr of age (HR 1.03) , unit BMI (HR 1.09) , prediabetes (HR 2.2) , and in Asian (HR 1.5) or other/multi-racial groups (HR 1.6) compared to Whites; risk decreased with hyperlipidemia (HR 0.72) . These associations were significant in all SDOH models (base +ADI, +SVI or +both) . In our SDOH models, incident diabetes risk was not associated with the degree of area deprivation or social vulnerability. However, diabetes risk decreased if ADI estimates (HR 0.54 95%CI 0.38, 0.77) or SVI estimates (HR 0.48 95%CI 0.36, 0.63) were present (vs. undetermined/unknown) . In the SDOH model with both ADI/SVI, diabetes risk decreased if SVI was present (HR 0.49 95%CI 0.34, 0.70) .
Conclusion: In our real-world cohort of overweight/obese adults, the degree of area deprivation or social vulnerability was not associated with risk of incident diabetes when traditional risk factors were available. More studies of SDOH measures are needed to inform national diabetes prevention efforts.

Disclosure
K.Ramm: None. C.Mangione: n/a. T.Moin: None. N.Jackson: None. U.Chung: None. O.Duru: None. K.Shedd: None. S.Soetenga: None. T.B.Loeb: None. D.Elashoff: None. A.B.Hamilton: None.

Funding
NIH/NIDDK 1R01DK124503
673-P: Successful Use of Dexcom G6 in Neonate with SGA and Chromosome 6q24-Related Transient Neonatal Diabetes Mellitus
Authors: LOS EVAN A. , ARTZ EVELYN , SAUNDERS CASSANDRA , WISE KAITLYN , WELSH JOHN 
Published: May 2022

Blood glucose in neonates with diabetes is variable due to frequent feeding, inexact exogenous insulin dosing and dynamic physiology. Rapid glucose fluctuation makes continuous glucose monitoring (CGM) ideal. We describe the successful use of CGM in an infant with small for gestational age (SGA) and chromosome 6q24-related transient neonatal diabetes mellitus, diagnosed by methylation study. A term male weighing 2650g (5th%) was born following uncomplicated pregnancy and delivery. Glucose checked per SGA-protocol revealed rising glucoses from initial 78 to &gt;300 mg/dL over 24 hours. Hyperglycemia managed with insulin drip until transitioned to subcutaneous dilute regular insulin (U-concentration) administered q6 hours (every other feed) . Trial of sulfonylurea titrated to maximum dose was ineffective.Initially glucoses checked hourly while on insulin drip and transitioned to every 3 hours once on subcutaneous insulin. Dexcom G6 placed in lateral thigh without incident on DOL and impermeable dressing applied to prevent soiling.CGM values were generally within 10% of heelstick POC values though specific MARD was not calculated. In the 7 days prior to CGM placement, there were POC glucoses &lt;80 mg/dL; in the 7 days after placement, there were none. Anecdotally, numerous times the CGM trend provided advanced notice of impending hypoglycemia and was able to be treated proactively (treatment decisions based on confirmatory heelstick) . The subject was discharged home on DOL 20.In followup, insulin degledec 0.5 unit/day was added and total prandial insulin requirements varied from 0-1 unit per day (total daily insulin dose approx. 0.1-0.3 units/kg/day) . By age 2.5 months weight was 6.1 kg (38th%) . CGM ambulatory glucose profile demonstrated mean glucose 185 mg/dL, &lt;70 mg/dL &lt;1%, 71-250 88%, &gt;250 11%.
In summary, Dexcom G6 CGM was successfully used in an infant with SGA and neonatal diabetes to optimize glucose control while minimizing hypoglycemia risk.

Disclosure
E.A. Los: Advisory Panel; Medtronic. K. Wise: None. J. Welsh: Employee; Dexcom, Inc.
675-P: DiabetesWise.org: An Innovative and Equitable Approach to Promote Diabetes Device Uptake
Authors: WONG JESSIE J. , HANES SARAH , NELMES SIERRA , HOOD KOREY K. 
Published: May 2022

Aim: To identify correlates of device uptake in people with insulin-requiring diabetes before and after interacting with DiabetesWise.org, a free, unbranded online resource.
Methods: The sample included 458 participants (Mage=37.1, SD=9.73; 66% female; 81% type 1) with minimal diabetes device use at enrollment. Participants used DiabetesWise.org, had their activity tracked, and completed online surveys. Chi-square and t-tests evaluated factors associated with past device use and new device (CGM/pump) uptake and prescriptions at 1- and 3-months post-use.
Results: Less than half (41%) the sample reported past CGM use. Past CGM use was associated with being female, younger age, type 1 (vs. type 2) diabetes, and receiving care in a large/academic medical center. By 1 month, 11% reported new prescriptions and 5% of participants reported new device uptake (all CGM starts) , which was associated with younger age. By 3 months, 16% reported new uptake and 20% reported new prescriptions (93% for CGM) , which were more common among those with type 1 diabetes.
Conclusions: DiabetesWise.org promotes diabetes device uptake and starts are unhindered by the personal, medical, or system-level barriers to prior device use. One in five users reported new prescriptions/uptake of diabetes devices. These findings support DiabetesWise.org as an effective avenue to promote device access and equity.

Disclosure
J.J.Wong: None. S.Hanes: None. S.Nelmes: None. K.K.Hood: Consultant; Cecelia Health, Havas Health, Insulet Corporation, LifeScan Diabetes Institute.

Funding
The Leona M. and Harry B. Helmsley Charitable Trust; NIH K23-DK121771
683-P: TBR (Time Below Range) in Routine Clinical Practice: A Retrospective Analysis of Routine CGM in Outpatient Care
Authors: CHAWLA PURVI M. , CHAWLA MANOJ S. 
Published: May 2022

Background: Patients with diabetes need monitoring to achieve good glucose control and avoid complications . Assessing the time in range (TIR) metrics is a novel way to identify glycaemic variability (GV) , Time above range (TAR) , Time in Range (TIR) and Time below range (TBR) .
Aim: To identify TBR- hypoglycemia (&lt; 70 mg/dl) in routine clinical practice through continuous glucose monitoring (CGM)
Methodology: This was a single centre analysis of Flash Glucose Monitoring (FGM libre pro) used as a means of CGM in type 1 & 2 DM patients as part of routine care in a specialty clinic over last one year. 227 adult participants were categorized based on their Hba1c levels. Time In Range metrics in different groups was determined. Statistical analysis was done to calculate the significance by p value.
Results: 17.6 % of participants had good glycemic control (HbA1c below 7 %) , 22.5 % had HbA1c levels of 7 to 8 %, 33.5 % had HbA1c within 8 to 9 %, and 26% had poor glycemic control with HbA1c above 9 %. Patients with HbA1c levels below 7% spent maximum time below range compared with those in other groups (p= 0.0016) . Those having HbA1c levels of 7 to 8 (p= 1.00) and 8 to 9 (p= 0.0008) spent nearly % of their time below range . No statistical differences in TBR was found between male and female participants and based on treatment regimen. 77.5 % of patients having A1C levels below 7 %, 54 % of patients with A1C levels between 7 to 8 %, 61.8 % patients with A1C levels between 8 to 9% and 40.6 % of patients with A1C levels above 9 %, spent more than 5 % of their time below range.
Conclusion: Our study found that although individuals with HbA1c levels &lt; 7 % were at maximum risk of hypoglycemia spending significantly more than 5 % of their time below range, patients with poor glycemic control also spent a large amount of time below range. Thus patients with DM are at an increased risk of hypoglycemia regardless of their levels of glycemic control and treatment regimen, and CGM and TIR evaluation should be used routinely.

Disclosure
P.M.Chawla: Speaker’s Bureau; Biocon, Boehringer Ingelheim International GmbH, Eris Lifesciences Ltd., Novo Nordisk, Sanofi. M.S.Chawla: Speaker’s Bureau; Biocon, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi.
69-LB: Targeting Equity in Type 1 Diabetes (T1D) Technology—Effect of Practice Transformations on Provider Prescribing Patterns of Continuous Glucose Monitors (CGM)
Authors: MATHIAS PRIYANKA M. , MAHALI LAKSHMI PRIYANKA , AGARWAL SHIVANI 
Published: May 2022

Background: CGM use is associated with improved outcomes in T1D, but racial-ethnic disparities in prescribing exist. We examined whether diabetes practice transformations could change prescribing behaviors to improve CGM prescription rates.
Methods: From January 2019 to December 2021, our diabetes center underwent a practice transformation targeted towards equity that included hiring clinicians to develop a specialty T1D clinic; training support staff to place trial devices at the point of care; improving prescribing workflows; and educating providers on CGM and inequity in practices. To examine effect, we collected monthly aggregate data from the electronic medical record and measured CGM prescription rates. We performed linear regression to examine change in prescriptions over time.
Results: We included 1,357 adults with T1D [mean age 38 years (±18) , 45% Hispanic (n=612) , 30% non-Hispanic Black (n=406) , 12% non-Hispanic White (n=164) ; and 74% publicly insured]. Over the practice transformation period, CGM prescription rates quadrupled (p&lt;0.001) with the largest improvement in non-Hispanic Black and Hispanic groups (Figure 1) .
Conclusions: Diabetes practice transformations can change prescribing behaviors to improve equity in CGM. Continued focus is needed on upstream interventions that effect downstream determinants of CGM use.

Disclosure
P. M. Mathias: None. L. Mahali: None. S. Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc.

Funding
Helmsley Charitable Trust (T1D Exchange Quality Improvement Collaborative)
694-P: Effects of Acceptance and Commitment Therapy on Self-Management in People with Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis
Authors: WANG MIAOMIAO , CHENG LI , GUO XIAODI , ZHU ZHENGRONG 
Published: May 2022

Background: Patients with type 2 diabetes mellitus always face various challenges of self-management which leads to disproportionately high rates of psychological problems. Acceptance and commitment therapy has the potential to enhance psychological well-being and promote self-management engagement.
Objectives: This review aimed to provide a comprehensive examination of the effectiveness of ACT among patients with T2DM and identify the key characteristics of effective interventions. Design: Systematic review and meta-analysis
Methods: Nine English and Chinese databases were searched to identify the eligible randomized controlled trails which investigated the effectiveness of ACT from inception to November 2021. The eligibility of studies, quality appraisal, and data extraction were performed by two reviewers independently. The risk of bias and the quality of evidence were assessed respectively. Mata-analysis were performed using the Review Manager 5.3.
Results: A total of ten studies with 712 participants were included in this systematic review. Acceptance and commitment therapy was significantly effective for improving the patients’ glycemic control (MD: -0.95; 95%CI: -1.38 to -0.52; P&lt;0.001; I2=62%) , acceptance for diabetes (MD: 7.80; 95%CI: 6.to 9.49; P&lt;0.001; I2=0%) , self-efficacy (SMD: 1.00; 95%CI: 0.80 to 1.21; P&lt;0.001; I2=14%) and anxiety (SMD: -1.15; 95%CI: -1.97 to -0.33; P=0.006; I2=90%) , but had no beneficial impact on self-care behaviors, distress, depression and psychological resilience. The certainty of evidence for outcomes were assessed as low to very low.
Conclusion: ACT may be helpful to improve patients’ psychology well-being and self-management for patients with T2DM. More rigorous studies with longer follow-up periods are warranted in view of the inconclusive findings and limited quality of evidence.

Disclosure
M.Wang: None. L.Cheng: None. X.Guo: None. Z.Zhu: None.
700-P: Use of Continuous Glucose Monitoring Does Not Alter Hypoglycemic Awareness in Patients with Type 2 Diabetes Mellitus
Authors: MEHFOOZ AYESHA , LEE YEE LIONG , WANG QI , CHOW LISA S. 
Published: May 2022

Background: There is limited evidence of continuous glucose monitoring (CGM) in patients with type 2 diabetes (T2D) . CGM use improves HbA1c and quality of life, however scant evidence exists on the effect of CGM use on hypoglycemia awareness in patients with T2D. Selecting patients with T2D at high risk and low risk for hypoglycemia, we hypothesized that CGM use would improve hypoglycemia awareness.
Methods: We conducted a 16 week, single center, randomized study on patients [n=40, 50% females, mean (SD) age 59 years (12.5) , BMI 34.kg/m2 (8.1) ] with T2D [screening HbA1c 7.6% (1.2) ] who were deemed to be either high risk (n=22) or low risk (n=18) for hypoglycemia over 5 years using our previously established scoring system. Each participant wore 2 CGM sensors. Within each risk category, participants were randomized to wearing either 1 unblinded+1 blinded sensor (Freestyle Libre/Freestyle Libre Pro) or 2 blinded sensors (2 Freestyle Libre Pro) . Every 2 weeks was an in-person visit for CGM replacement. Clarke and Gold questionnaires were performed at the screening visit (week 0) , visit 4 (week 8) and visit 8 (week 16) . Participants in the unblinded CGM group were instructed to use the CGM as they wished. Participants in the blinded CGM group were instructed to continue with their usual finger stick program.
Result: At baseline, there were no differences in the Gold or Clark questionnaires between participants at high or low risk for hypoglycemia over 5 years. At end-intervention, no differences were noted in the Gold or Clark questionnaires regardless of CGM assignment or baseline hypoglycemia risk category. The trajectory of Gold or Clark scores over the study were also not significantly different between groups regardless of CGM assignment or baseline hypoglycemia risk category.
Conclusion: In patients with T2D, the use of an unblinded CGM did not affect the awareness of hypoglycemia, even in patients at high risk for hypoglycemia, as assessed by Gold and Clark scores.

Disclosure
A.Mehfooz: None. Y.Lee: None. Q.Wang: None. L.S.Chow: Other Relationship; Dexcom, Inc.