bluuebunny/crossref_metadata_2025_split huggingface dataset:
453-P: Role of JARID2 in Regulating Inflammatory Genes via Epigenetic Mechanisms in Monocyte/Macrophages in Type 2 Diabetes
Authors: REDDY MARPADGA A. , TANWAR VINAY S. , ZHANG LINGXIAO , LANTING LINDA L. , WANG MEI , PANDEY PRIYATAMA , CHEN ZHUO , WU XIWEI , NATARAJAN RAMA 
Published: May 2022

The activation of monocytes and macrophages plays a central role in chronic inflammation associated with type 2 diabetes mellitus (T2D) and cardiovascular disease. However, the precise epigenetic mechanisms involved are unclear. From RNA-seq analysis we found dysregulated expression of several genes, including downregulation of JARID2 in human CD14+ monocytes obtained from T2D patients versus controls. JARID2 protein functions as a transcription repressor by facilitating the recruitment of polycomb repressor complex 2 and associated histone H3K27-trimethylation to target genes. RT-qPCR and RNA-seq analysis showed that high glucose +TNF-α (HT) , key pathological factors in diabetes, downregulated JARID2 in human monocytes along with genes involved in inflammation and cytokine related signaling networks. Western blotting also showed HT reduces JARID2 protein levels in human monocytes. Furthermore, JARID2 knockdown with siRNAs increased proliferation and enhanced LPS and HT induced inflammatory genes in human monocytes. ATAC-seq revealed that HT increased chromatin-accessibility at promoters of inflammatory genes like IL1B that were upregulated by JARID2 knockdown. Interestingly, microRNA-seq analysis revealed that CD14+ monocytes from T2D patients showed increased expression of several microRNAs with complementarity to the JARID2 3’-UTR, indicating cross-talk between epigenetic factors and microRNA-dependent mechanisms. Mouse orthologous Jarid2 was downregulated in macrophages from diabetic db/db mice and in macrophages from normal C57BL/6 mice treated with HT, similar to human JARID2. These results demonstrate that JARID2 plays a key role in chromatin remodeling and restraining inflammatory genes in monocytes, and its downregulation in T2D can augment inflammation. Further, understanding of epigenetic regulators like JARID2 can lead to novel therapies for chronic inflammatory diabetic complications.

Disclosure
M.A.Reddy: None. V.S.Tanwar: None. L.Zhang: None. L.L.Lanting: None. M.Wang: None. P.Pandey: None. Z.Chen: None. X.Wu: None. R.Natarajan: None.

Funding
National Institutes of Health (DK065073) to RN AR-DMRI Endowment Pilot grant to MAR
46-LB: A New Approach to Understand Diabetes Burnout—Examining Potential Burnout Profiles?
Authors: ABDOLI SAMEREH , MILLER KATHERINE L. , HESSLER DANIELLE M. 
Published: May 2022

Aim: The study aimed to identify latent profiles of diabetes burnout and examine if there are significant differences in psychosocial well-being, diabetes outcomes, and demographic characteristics between individuals with varying burnout profiles.
Methods: A national sample of adults with T1D (n=1099) completed an online cross-sectional survey across the U.S. We used Diabetes Burnout Scale (DBS) to collect data on diabetes burnout (i.e., exhaustion, detachment, lack of control) . We also measured diabetes distress, depressive symptoms, glycemic control, and demographic characteristics. Data were analyzed using latent class analysis (LCA) , and the resulting profiles were validated using Chi-square and Kruskal Wallis test.
Results: Results showed a seven latent burnout profiles: (a) fully burned out (n=275, 25.02%) ; (b) exhausted (n=148, 13.47%) ; (c) Dissociated (n= 132, 12.56%) ; (d) overextended (n= 135, 12.28%) ; (e) disengaged (n=90, 8.18%) ; (f) loss of control (n=48, 4.37%) . Among participants, 275 (25.02%) were categorized as not having any symptoms of burnout. Examination of the profiles suggested a non-linear relationship between exhaustion, detachment, and lack of control. The results revealed that there were significant differences in diabetes distress, depressive symptoms, and demographic characteristics between individuals with different burnout profiles. Among profiles, fully burned-out profile was a stronger predictor for glycemic control.
Conclusion: This is the first study examining statistically different profiles of diabetes burnout in adults with T1D. The identification of burnout profiles and the developmental model can inform targeted interventions to address burnout in each specific profile and prevent burnout to result devastating consequences.

Disclosure
S. Abdoli: None. K. L. Miller: None. D. M. Hessler: None.
482-P: Do Varied Off-Loading Modalities Have Differing Impacts Upon Users' Fall Risk?
Authors: CREWS RYAN T. , ROSENBLATT NOAH J. 
Published: May 2022

Aim: Adherence to offloading devices for diabetic foot ulcers (DFU) is poor and postural instability influences adherence. Prior research suggests an ankle-high removable cast walker (RCW) in tandem with a contralateral shoe lift might increase users’ balance relative to a traditional knee-high RCW without a lift. This study compared compensatory responses to perturbations under both conditions.
Methods: Twenty-five individuals (48% male; age: 68±8 years) with diabetic peripheral neuropathy participated. Participants completed trials under three conditions: bilateral standardized shoes, knee-high RCW, and ankle-high RCW with contralateral shoe lift. Stepping thresholds (ST) were assessed for two types of perturbations:1) From a stopped position, a treadmill rapidly accelerated at 3.5m/s² to reach a set peak-velocity and then decelerated and stopped. The smallest peak-velocity to elicit a step was identified as the ST. Participants were separately oriented on the treadmill to elicit anterior and lateral ST; 2) A waist mounted spring scale was pulled until a target load was reached, then the spring was rapidly released. ST was the lowest load necessary to force a step upon release. Anterior and posterior waist-pull perturbations were done.Participants also rated their stability in each footwear condition via a 10cm visual analog scale. Data analyses focused upon the primary comparison of the two offloading conditions.
Results: The knee-high RCW resulted in significantly decreased ST for two of the four tests (treadmill anterior: mean difference .037m/s2, p=.048 and anterior waist-pull: mean difference 2.2lbs, p&lt;.001) relative to the ankle-high RCW with a contralateral lift. Participants reported a large and statistically significant reduction in perceived stability with the knee-high RCW (mean difference= 0.93cm, p=0.030) .
Conclusions: Future prospective studies should assesses whether the differences noted in this study translate into differences in RCW adherence by patients with DFU.

Disclosure
R.T.Crews: None. N.J.Rosenblatt: None.

Funding
National Institute of Diabetes and Digestive and Kidney Disease
485-P: DFUCare Deep-Learning–Based Mobile App for Diabetic Foot Ulcer Monitoring
Authors: SENDILRAJ VARUN , PILCHER WILLIAM C. , BHASIN MANOJ K. 
Published: May 2022

In 2021, 1 out of adults suffered from diabetes mellitus globally. A major complication resulting from this is diabetic foot ulcers (DFU) , which can lead to amputation if improperly managed. Current clinical approaches to DFU have significant limitations, such as the high cost involved in the diagnosis and time-consuming care. In light of this, we have developed DFUCare, a mobile app that uses the built-in camera and deep learning to diagnose and quantify patients' diabetic foot ulcers. DFUCare is trained on an extensive foot dataset containing over 5000 images of normal and infected DFU patients. For binary classification of infected and non-infected patients, we use a combination of transfer and ensemble learning. Using transfer learning, DFUCare uses the pretrained InceptionResNetV2 model for deep learning derived feature extraction. With an ensemble approach, we compare the deep learning derived feature extraction results to handcrafted color and textural feature extraction results to come up with a final prediction of infected vs. non-infected patients. In the end, we achieved top-level results with a binary accuracy of .9014, AUC of .9437, specificity of .9023, and precision of .8901. In addition, using standardized metrics and computer vision algorithms, DFUCare can determine the dimensions of the DFU to quantify the severity over time. With all of the information stored in the cloud, doctors and patients can use the share feature in the mobile app to send medical reports to anyone in the world. In the future, we are planning to add clinical, biological, and epidemiological features along with macroscopic image features to improve the performance of the tool in predicting infection and healing. This novel approach has the potential to deliver a paradigm shift in diabetic foot care among patients by being a cost-effective, remote, and convenient healthcare solution.

Disclosure
V.Sendilraj: None. W.C.Pilcher: None. M.K.Bhasin: None.
490-P: Macrophage-Regulating Drug Promotes Tissue Proliferation in a DFU Real-World Case
Authors: CHEN SHYI-GEN , LIN YUN-NAN , CHEN JUI-CHING , KUO YUR-REN 
Published: May 2022

A 53-year-old female with type 2 DM (HbA1c 11.7%) , peripheral artery disease (PAD) , hypertension, and hyperlipidemia was sent to the emergency room of Kaohsiung Medical University Hospital due to presence of an infected DFU with exposed tendon and ischemic necrosis (Figure 1a) . Ankle brachial index of her right leg was 0.8 and angiography revealed severe stenosis over posterior/anterior tibial artery. The ulcer was downgraded from Wagner grade IV to II after a 10-day treatment by broad-spectrum antibiotics and angioplasty for infection and ulcer severity control. However, the tissue proliferation was halted by persistent inflammation and ischemia (Figure 1b) . The growth of granulation tissue was limited despite using fat grafting to boost mesenchymal tissues. Pseudomonas contamination occurred after a 3-month care. We tried artificial dermis after further debridement and intravenous antibiotics but noted poor ingrowth of cells. The patient declined the recommended surgical reconstruction with flap coverage so ON101, a topical macrophage-regulating drug, was applied twice a day. The ulcer area measured digitally by imitoMeasure, was 7.23cm2 before treated by ON1 (Figure 1c) and reached closure (Figure 1d) after 16 weeks. Wound healing is often hindered by DM or PAD despite of multiple interventions. Macrophage-regulation can be deemed as a novel approach to promote tissue repair and salvage difficult wounds.

Disclosure
S.Chen: Employee; Oneness Biotech Co., Ltd. Y.Lin: None. J.Chen: Employee; Oneness Biotech Co., Ltd. Y.Kuo: None.
494-P: Introducing a Patient with Diabetes Experiencing the Social Determinants of Health to Students through Cinematic Virtual Reality
Authors: WARDIAN JANA L. 
Published: May 2022

Background: Cinematic virtual reality (cine-VR) is an innovative educational technique allowing users to immerse themselves in three-dimensional sensory environments. Cine-VR gives access to life-like medical encounters without risk or harm to the patient and offers insight into the lived experience of patients. Storytelling is a powerful tool to help health professions students to immerse themselves in another’s experience. We utilized a diabetes cine-VR training to highlight social determinants of health and impact on patient engagement. The purpose of this study was to compare the effectiveness of web-based diabetes cine-VR training to improve diabetes attitudes and empathy among health professional students.
Methods: Our institution utilized the cine-VR web-based training for several healthcare profession student programs. We conducted paired t-tests to assess changes in diabetes attitudes and empathy at baseline and after the training. All analyses used SPSS version 26.0 (SPSS Inc.) . Statistical significance was defined as P&lt;0.05.
Results: We had a total of 127 students participate including Doctor of Physical Therapy students (60) , Pharmacy students (10) , and Physician Assistant students (57) . Following viewing the 12 modules, we observed improvements in four of the diabetes attitude subscales: “Seriousness of type 2 diabetes” (P&lt;0.001) ; “Value of tight glucose control” (P=0.01) ; “Psychosocial impact of diabetes” (P&lt;0.001) ; and “Attitude toward patient autonomy” (P&lt;0.001) . In addition, we observed significant improvements in empathy (P&lt;0.001) .
Conclusions: Diabetes is a complex disease that involves an individual’s physical, social, and emotional well-being. To holistically meet the needs of people with diabetes, we must train our health professions students to recognize and appreciate the social needs of their patients. Our findings support the use of cine-VR trainings to improve diabetes attitudes and empathy.

Disclosure
J.L.Wardian: None.

Funding
Medicaid Equity Simulation Project funded by the Ohio Department of Medicaid and administered by the Ohio Colleges of Medicine Government Resource Center.
507-P: Eighteen-Month Follow-Up of Peer Support for Diabetes Management in Shanghai Integration Model
Authors: LIU YUEXING , CAI CHUN , WU XIAOYU , TANG PATRICK Y. , COUFAL MUCHIEH M. , SHEN LI , QIAN YIQING , LUU SAMANTHA , FISHER EDWIN B. , JIA WEIPING 
Published: May 2022

In 9 Community Health Centers (CHCs) , peer leaders led neighborhood activities, co-led meetings on diabetes management, and followed up with individuals and families, all under the Shanghai Integration Model coordinating primary (CHCs) , hospital, and specialty diabetes care. Previously reported were significant changes in HbA1c, other clinical markers, and diabetes distress from baseline to the end of the active program at 12 months. Changes were pronounced among those exceeding criteria for heightened concern at baseline. Here we report extended impacts for all participants (1009) with baseline and 18-month data, controlling for all individual characteristics. Evaluation indicators and criteria for heightened concern were: HbA1c ≥ 8%, SBP ≥ 130 and DBP ≥ 80 mmHg, LDLc ≥ 2.6 mmol/L, BMI ≥ 26 kg/m2, PHQ8 ≥ - moderate depression, EQ5D quality of life and 4-item measure of diabetes distress - top tertiles. Reductions from baseline to 18 months were significant for HbA1c, SBP and DBP, and PHQ8 depression (ps: 0.00to 0.0088) . Among those exceeding criteria for heightened concern, reductions from baseline to 18-months were significant for all variables (ps ≤ 0.0001) including, e.g., HbA1c from 9.06% to 8.50% (SDs = 0.96, 1.55) . Research staff blinded to outcomes rated implementation of the peer leader program, yielding high- and low-implementation CHCs. For all participants, changes from baseline to 18 months were significantly greater in high- than low-implementation CHCs for HbA1c (p = 0.0246) and SBP (p &lt; 0.0001) . Among those at heightened concern, reductions were greater in high- vs. low-implementation CHCs for HbA1c, SBP and DBP (ps: &lt; 0.0to 0.0073) . Conclusion: Improvements in clinical and quality of life measures following peer leaders promoting diabetes self management as part of the Shanghai Integration Model were sustained over 18 months, especially for those with baseline measures indicating heightened concern and in high implementation CHCs.

Disclosure
Y.Liu: None. W.Jia: None. C.Cai: None. X.Wu: None. P.Y.Tang: None. M.M.Coufal: None. L.Shen: None. Y.Qian: None. S.Luu: None. E.B.Fisher: Advisory Panel; Lilly, Consultant; WellDoc, Research Support; Merck & Co., Inc.

Funding
Shanghai Municipal Grants Award (GWIV-3.1) Shanghai Public Health Youth Award (GWV-10.2-YQ24) Shanghai Municipal Health Commission (201940141) Shanghai 6th People's Hospital (ynlc201812) The Merck FoundationSanofi China National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK092926)
524-P: CME Activity Series Highlights Changes in Clinicians’ Knowledge and Competence about Novel Approaches to Reduce DKD Progression
Authors: KARANDREA SHPETIM , AGARWAL NEHA , JAMROGIEWICZ AMANDA 
Published: May 2022

Diabetic kidney disease (DKD) is one of the most common complications of diabetes, significantly impacting morbidity and mortality. Novel approaches to target DKD progression are needed, and non-steroidal mineralocorticoid receptor antagonists (MRAs) have recently emerged as a viable option, however, clinicians may not be aware of them. Based on this gap, CMHC organized 4 accredited virtual symposia from 2020 to 2021 to educate multi-disciplinary clinicians and assess knowledge/competence changes using pre-/post assessment questions. The activities took place between Oct. 2020 - Oct 2021 with the participation of 829 healthcare professionals (MD/DO, PAs, RNs, NPs, PharmDs) representing specialties that treat high-risk diabetes patients. A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p &lt;0.05) . A significant increase in knowledge regarding the pathophysiology of DKD and emerging non-steroidal MRAs in DKD was observed (43% and 34% relative increase in knowledge compared to baseline, p &lt;0.0001) . Additionally, a significant increase in competency regarding identifying patients at-risk for DKD progression and management of DKD patients was demonstrated (37% relative increased to baseline, p&lt;0.0001) . At post-activity evaluation, 99.7% indicated that information via these activities is useful for their practice. Furthermore, the majority of participants indicated that they intended to change their practice based on information received, including monitoring clinical trial advances with non-steroidal MRAs, evaluating the risk of potential hyperkalemia with DKD treatments, and screen for risk of DKD progression. It is evident from the outcomes of these educational activities that they led to significant improvement in knowledge and competence related to novel DKD treatment options and commitment to change among learners.

Disclosure
S.Karandrea: None. N.Agarwal: None. A.Jamrogiewicz: None.

Funding
Bayer HealthCare Pharmaceuticals (24656) Bayer HealthCare Pharmaceuticals (66351473) Bayer HealthCare Pharmaceuticals (25319) Bayer HealthCare Pharmaceuticals (67463661)
526-P: e-Health Literacy Rates and Applicability of a Patient-Facing Mobile App Intervention in a Predominantly African-American and Latinx Cohort with Type 2 Diabetes
Authors: KAUR SAVNEET , MAHALI LAKSHMI PRIYANKA , COSAR EMINE , JARIWALA SUNIT 
Published: May 2022

Introduction: Racial and ethnic minorities have a higher burden of type 2 diabetes in part due to limited access to health-promoting resources and self-management tools. We developed and implemented a patient-centric mobile application, DiabetesXcel, to provide guideline-based education (via animated videos) and adherence support via goal setting and tailored push notifications.
Methods: Patients provided verbal or e-consent via REDCap generated e-mail links virtually (in-light of COVID-19) and completed baseline sociodemographic and e-health literacy (EHL) surveys (eHEALs) ; and DQoL (Diabetes quality of life) , DSMQ (Diabetes Self-Management Questionnaire) and DKQ-24 (Diabetes Knowledge Questionnaire) . Participants were guided on downloading the app and its functionality was explained in detail. Laboratory data were obtained by chart review from the Epic EHR.
Results: Of the 50 patients, mean age was 46.9 (± 9.2) years, 70% were female, and 82% identified as Blacks and Hispanics. Overall, the cohort, with an average 13.1 ± 8.3 years since diagnosis, had high prevalence of complications (60%) , and poor glycemic control (HbA1C &gt; 7.5, 58%) . At baseline, scores of satisfaction (22.6 ± 6.9) , worry (10.9 ± 8.4) , impact (15.5 ± 5.2) and total DQoL scores (48.9 ± 15.6) indicated low quality of life (QoL) . DSMQ (21.8 ± 6.9) and DKQ (18.4 ± 3) were low across patients with and without complications (p= 0.5 and 0.8, respectively) . Interestingly, 88% had moderate-good EHL scores.
Conclusion: Most patients in our cohort demonstrated good e-health literacy scores. We expect that our mobile health application will promote diabetes education and self-management skills in our underserved minority community and favorably impact clinical outcomes. We eventually plan to disseminate the app and promote its uptake across marginalized populations on the national level.

Disclosure
S.Kaur: None. L.Mahali: None. E.Cosar: None. S.Jariwala: None.

Funding
New York Regional Center for Diabetes Translation Research
530-P: Complex Diabetes Management in Primary Care: Confidence and Opportunities for Specialty Support
Authors: MENDEZ CARLOS E. , MATTOX ELIZABETH A. , KADIYALA SUSHMA , XHIKOLA MAJLINDA , YANTSIDES KONSTANTINA , OIEN ANGELA D. , O'SHAUGHNESSY IRENE , HANSEN ANN E. , LUCAS JESSICA , HAZEN KYLE , SEMEAH LUZ M. , LEEY JULIO A. 
Published: May 2022

Access to specialized diabetes care is limited due to shortage of endocrinologists and distance to specialty clinics. In addition, referrals to out-of-network providers frequently results in suboptimal care coordination. Tele-mentoring models such as ECHO (Extension for Community Healthcare Outcomes) extends specialty knowledge to primary care providers. Prior to the implementation of a series of ECHO sessions, we assessed provider confidence in managing type 2 diabetes (T2D) .
Methods: Prescribing providers (PP) from three VA Health Care Systems in Florida (North Florida/South Georgia) , Texas (Valley Coastal Bend) and Wisconsin (Milwaukee) were invited to participate. We asked questions about practice patterns, prescription habits, and confidence level treating T2D.
Results: A total of 49 PP completed the assessment. Mean age was 42.5 years and 74% were females. They were clinical pharmacists (63%) , physicians (22%) , ARNP (8%) , and the rest were trainees. Clinical experience &lt; 5 year was present in 14.2%, whereas 67% had &gt; years. Half of the providers felt very or extremely confident managing a complicated case (A1c&gt;8% on two oral agents) , whereas only 14% of providers felt either “not at all” or somewhat confident. Most of the providers felt very or extremely confident obtaining a diabetes-focused history (63%) , educating patients about complications (69%) , or changing insulin regimens (61%) . Although most of the providers prescribed a glucose meter very often or always (81%) , only 6% of them prescribed a continuous glucose monitor frequently. When sending a referral, 32% mentioned either lack of local endocrinologists or long waiting time as main barriers. Providers felt that patients prefer to stay with their local VA PCP for diabetes care instead of seeing a specialist (65%)
Conclusions: A third of providers perceive significant barriers to access specialized diabetes care. There are opportunities to improve provider confidence and skills managing diabetes.

Disclosure
C.E.Mendez: Advisory Panel; Monarch Medical Technologies . K.Hazen: None. L.M.Semeah: None. J.A.Leey: None. E.A.Mattox: None. S.Kadiyala: None. M.Xhikola: None. K.Yantsides: None. A.D.Oien: None. I.O'shaughnessy: None. A.E.Hansen: None. J.Lucas: None.

Funding
Veterans Rural Health Resource Center - 00RH