bluuebunny/crossref_metadata_2025_split huggingface dataset:
496-P: Biomedical Expertise in the Face of Social Media: How Is Diabetes-Related Information That Stems from Social Media Discussed in Clinical Encounters?
Authors: KJÆRULFF EMILIE M. , NEXO METTE A. , BJERRE-CHRISTENSEN ULLA , LANGSTRUP HENRIETTE 
Published: May 2022

Background and Aim: In today’s digital world, people with type 1 and 2 diabetes turn to peers on social media to exchange information and support. However, little is known about what the online sharing of diabetes-related information implies for the clinical encounter. This study examines how information that stems from social media is discussed in clinical encounters between healthcare professionals (HCPs) and people with diabetes (PWD) .
Methods: We conducted semi-structured interviews with 25 PWD aged 22-76 (type 1: n= 17, type 2: n=8) and HCPs (nurses n=9, medical doctors n=7, dieticians n=3) . The participants were recruited from the diabetes outpatient care setting in Denmark. Two researchers independently developed a thematic coding framework that was compared, revised, and then applied to analyze each interview. Subsequently, overarching themes were identified across the whole data set.
Results: The first theme suggests that HCPs tend to have a ‘blind spot’ towards information that stems from social media: Most HCPs have not asked whether PWD retrieve information from social media and most PWD present information that is accessed on social media without naming their source. The second theme reflects that clinical dialogues about online information rest upon trustful relationships: PWD find online peer exchanges valuable and request for HCPs to acknowledge this. Still, PWD navigate large amounts of information and treatment advice online, and while PWD may seek to discuss their information in clinical encounters, initiating these dialogues is sensitive to the reactions of HCPs.
Discussion: The results suggest that HCPs should encourage curious dialogues about how PWD retrieve diabetes-related information. This serves for HCPs to learn what PWD gain from peers online and for HCPs to be able to offer their expertise to support PWD who are navigating large flows of information and advice online.

Disclosure
E.M.Kjærulff: None. M.A.Nexo: None. U.Bjerre-christensen: None. H.Langstrup: None.

Funding
Innovation Fund Denmark (Ref.no. 9163-00016B)
50-LB: Perceived Control over Eating Improves following Initiation of Carbohydrate-Restricted Nutrition Therapy in a Continuous Remote Care Model
Authors: ADAMS REBECCA N. , VANTIEGHEM MICHELLE , VOLK BRITTANIE M. , ATHINARAYANAN SHAMINIE J. , MCKENZIE AMY L. 
Published: May 2022

Background: Nutrition is an important component of metabolic disease prevention and treatment, yet eating and perceived control over eating (PCOE) are complex behaviors. Most people who attempt lifestyle changes have setbacks that can interfere with confidence and motivation for sustained change. The Virta Health virtual clinic provides medically-supervised nutrition therapy for metabolic disease focused on carbohydrate restriction and provides education and tools to: (1) understand how foods impact metabolic health; (2) facilitate autonomy for food choices; and (3) disentangle physiological and emotional food cues, to foster patients’ eating confidence even if they struggle with adherence. This analysis explored whether Virta patients’ PCOE improved during early treatment as these concepts were taught.
Methods: As part of standard clinical care, Virta patients (N=5940, Mean (M) age = 54 years, 72% white, 61% female, 73% T2D, M BMI = 36) responded to 4 items (total score range 4-20) assessing PCOE before the dietary intervention and at follow-up (M days = 60, SD = 15) . Paired t-tests were conducted to assess changes in PCOE over time among all patients and separately within subgroups based on dietary adherence (M ketones during treatment ≥ or &lt; 0.5 mM) .
Results: PCOE improved from pre-treatment (M=13.3, “slightly” in control) to the first follow-up (M=15.7, “somewhat” in control) in all patients (p&lt;0.0001) and within both subgroups of dietary adherence (more-adherent group: +3.0 from 13.3, p&lt;0.0001; less-adherent group: +1.7 from 13.3, p&lt;0.0001) .
Conclusions: Consistent with treatment aims, patients’ PCOE improved. Importantly, patients who did not meet dietary adherence targets still gained confidence for controlling eating, though to a lesser extent. We predict that a healthier relationship with food, which includes greater PCOE, will help patients maintain motivation and get back on track following a setback; future research should investigate whether greater PCOE is associated with long-term adherence and metabolic health outcomes.

Disclosure
R. N. Adams: Employee; Virta Health Corp. M. Vantieghem: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. B. M. Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S. J. Athinarayanan: Employee; Virta Health Corp. A. L. Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp.
502-P: Increasing Provider Referrals to Diabetes Self-Management Education and Support Services: Recommendations from Virtual Focus Groups with Providers in New York State
Authors: ARENA LAURA , ESQUIVEL NIKIE S. , AUSTIN RACHAEL , MILLSTEIN SUSAN , KAELIN-KEE JAN 
Published: May 2022

Background: In New York, Medicaid began covering diabetes self-management education and support (DSMES) services in 2009, but participation in these services remains low. This study sought to understand barriers and facilitators to referring and enrolling eligible Medicaid members to DSMES, and to yield recommendations for increasing referrals and enrollment.
Methods: We conducted 14 virtual focus groups with primary care providers, endocrinologists, and certified diabetes care and education specialists (CDCESs) in New York City and the rest of the state. We used an inductive-deductive coding process to identify common themes and recommendations across participant types.
Results: Participants recommended resources for addressing knowledge gaps about the benefits of DSMES and how to refer eligible Medicaid members: an online resource guide and directory of accredited services by location and insurance type; automated provider prompts; materials for exam rooms; and reimbursement guidance. Recommended strategies for disseminating resources to increase provider and patient awareness of DSMES included an advertising campaign targeting physicians and people with diabetes; academic detailing; e-mail blasts from credible sources (e.g., health department, Medicaid) ; and direct outreach (e.g., personal phone calls) to eligible Medicaid members.
Conclusions: Increasing participation in DSMES hinges upon increasing provider referrals and addressing barriers to participation. CDCESs in NY reported limited capacity to provide DSMES to referred patients in a timely manner, highlighting a need to expand the workforce to meet current and future demands should referrals increase with improved awareness and buy-in. Although the strategies and recommendations identified in this study reflect the perspectives of NY providers, they may have broad applicability to other states in which Medicaid covers DSMES.

Disclosure
L.Arena: None. N.S.Esquivel: None. R.Austin: None. S.Millstein: None. J.Kaelin-kee: None.

Funding
Centers for Disease Control and Prevention (CDC NU58DP006523)
504-P: Success of Aligned Clinician–Patient Education Improves Clinicians’ Ability to Use GLP-1 RAs in Practice and Patients’ Understanding of GLP-1 RAs
Authors: LARKIN AMY , LE ANNE 
Published: May 2022

We sought to determine if online aligned education for clinicians and patients could improve understanding and use of GLP-1 RAs for T2D. For clinicians, a live-streamed virtual symposium was held as part of the 2021 Metabolic and Endocrine Disease Summit (MEDS) summer (July) and fall (October) meetings, followed by an enduring available in August, 2021. Pre/post questions were used to assess changes in knowledge, confidence and practice. For patients, the online text, integrated visuals and patient video activity, which launched in June 2021, used a pre/post knowledge question and post-activity intent to change and confidence questions to assess impact. Absolute improvements were calculated for all questions, data collected through November 1, 2021. Clinician Activity Learners: 581 (Summer) and 364 (Fall) . Demographics: 47%-56% were nurse practitioners, 22% physician assistants, and 9%-12% physicians. Knowledge changes: 13%-16% increase in recognizing GLP-1 RAs with CV benefits/indications, 6%-7% increase in identifying weight loss as a benefit of GLP-1 RAs, 12%-23% increase in selecting patient education to help mitigate side effects. After the education, 80%-86% reported confidence in starting a patient with CVD/obesity on a GLP-1 RA. Enduring Learners: 1,662 clinicians (as of November 1, 2021) . Patient Activity: 11,029 learners have participated in the patient/caregiver activity, “Understanding the Use of GLP-1 Receptor Agonists for Type 2 Diabetes.” Knowledge changes: 22% increase in recognizing how GLP-1 RAs work (39% pre to 61% post) . Intent-to-act: 70% plan to talk to their HCP about if taking a GLP-1 RA can help manage their T2D better. Confidence changes: 78% reported increased confidence in talking to my HCP about GLP-1 RAs for T2D. These outcomes are a strong indicator that aligned clinician and patient activities are successful at improving both clinicians’ and patients’ understanding and use of GLP-1 RAs for T2D.

Disclosure
A.Larkin: None. A.Le: None.

Funding
Independent Educational Grant from Novo Nordisk.
510-P: DKA Prevention on Insulin Pumps: Lessons Learned from a Large Pediatric Pump Practice
Authors: DOYLE ELIZABETH , WEINZIMER STUART A. , TAMBORLANE WILLIAM V. 
Published: May 2022

While the Type 1 Diabetes Exchange data noted that diabetic ketoacidosis (DKA) is more common in those utilizing injection regimens than insulin pumps, DKA remains a risk for pump users, as it can precipitously develop if insulin infusion is interrupted. We sought to obtain more recent DKA admission data in T1D youth using insulin pumps and the impact of CGM on DKA rates.
Methods: We characterized DKA data in insulin pump users from episodes between 12/20 and 6/2021 in an academic pediatric endocrine practice in which 68% were pump users.
Results: Among 591 pump patients aged &lt;25 years (y) , 28 events occurred (3.16 events per 100 patient-y. Mean age was 13.6±3.4y; 85.7% were 12-19y old. More events were in males (60.7%) , 53.6% were white, 71.4% non-Hispanic. Mean HbA1c was 10.22.3%, diabetes duration 6.1±4.0y, and 57.1% used CGM; 28.6% of patients were new to pump therapy (&lt;1y) .Admission pH levels ranged between 7.0-7.31, with 28.6% of events classified as “moderate” and 46.4% as “severe.” Average length of stay was 2.0±0.7 days. While there was no significant difference in pH levels, CGM wearers had higher admission bicarbonate values (11.8 vs. 9.3, p=0.04) . Clinicians assessed the cause of DKA to be related to concurrent illness (10.7%) , insulin omission (14.3%) , pump infusion site failure (57.1%) or other pump malfunctions (14.3%) . For most (60.7%) , this was the first documented DKA event. Alcohol consumption was a contributing factor in only one event.
Conclusions: DKA events were relatively uncommon; most episodes occurred in adolescents in poor diabetes control. Notably, most events could have been avoided if users followed standard trouble shooting guidelines. Thus, education on DKA prevention should be reinforced at each visit, particularly for teens on pumps with higher A1c levels. Moreover, while CGM wearers had higher admission bicarbonate values, over 50% of those hospitalized for DKA wore a CGM, suggesting even pump users using CGM require frequent reinforcement of DKA prevention education.

Disclosure
E.Doyle: None. S.A.Weinzimer: Consultant; Dompé, Research Support; Abbott Diabetes, Speaker's Bureau; Abbott Diabetes, Dexcom, Inc. W.V.Tamborlane: Consultant; AstraZeneca, Boehringer Ingelheim International GmbH, Medtronic, Novo Nordisk, Sanofi, Takeda Pharmaceutical Company Limited.
518-P: “What Can I Eat?” Healthy Choices for American Indians and Alaska Natives with T2D: Facilitators’ and Participants’ Voices from a Virtual Diabetes Nutrition Education Program
Authors: STOTZ SARAH A. , BREGA ANGELA G. , MCNULTY MONICA C. , ADEDOYIN IBUKUNOLUWA , AUSTIN GEMALLI , BEGAY KELLI R. , COUTURE NILOFER , GARROW HEATHER , JIANG LUOHUA , O'BANION NANCY , PAVLI DAWN , PONTIUS HEATHER , SCARTON LISA , YANSON JESSIE , MOORE KELLY R. ,   AI/AN WCIE STUDY GROUP
Published: May 2022

“What Can I Eat? (WCIE) Healthy Choices for American Indians and Alaska Natives (AI/AN) with T2D is a 5-lesson diabetes nutrition education program culturally adapted for AI/ANs with T2D. Registered dietitian nutritionists (RDNs) taught classes synchronously via Zoom at 5 reservation-based or urban inter-tribal sites nationwide throughout 2021. Each class included a didactic session, interactive learning activities, physical activity, a mindful eating activity, and goal setting. Participants were recruited through diabetes registries at each collaborating site. Participants were randomized to either the immediate or wait list control group. Virtual classes were taught weekly for 4 weeks (classes 1-4) with a 5th class 3 months after class 1. Participants and facilitating RDNs completed short answer feedback surveys after each class. A sample of participants (n=24) and all RDN/site coordinators (n=10) engaged in virtual focus groups after completing WCIE to understand their experiences of the program. Focus groups were audio recorded, transcribed, and analyzed using qualitative thematic analysis, as were the short answer post-class feedback surveys from participants (n=186) and RDNs (n=58) . Key themes emerged: 1) class satisfaction largely focused on peer-to-peer interaction, camaraderie, and broader support (e.g., tribe) ; 2) pros, cons, and tips to improve virtual classes; 3) preference for AI/AN RDN educator; 4) recommendations to improve recruitment and retention. These findings will guide program modifications prior to piloting in-person and peer-educator-led WCIE classes.

Disclosure
S.A.Stotz: n/a. N.O'banion: None. D.Pavli: None. H.Pontius: None. L.Scarton: None. J.Yanson: None. K.R.Moore: Consultant; Novo Nordisk. Ai/an wcie study group: n/a. A.G.Brega: None. M.C.Mcnulty: None. I.Adedoyin: None. G.Austin: None. K.R.Begay: None. N.Couture: None. H.Garrow: None. L.Jiang: None.

Funding
American Diabetes Association (4-18-SMSC-01)
519-P: “What Can I Eat?” Healthy Choices for American Indians and Alaska Natives with T2D: Randomized Wait-List Controlled Trial Outcomes from a Nutrition Diabetes Education Program
Authors: MOORE KELLY R. , STOTZ SARAH A. , BREGA ANGELA G. , MCNULTY MONICA C. , ADEDOYIN IBUKUNOLUWA , AUSTIN GEMALLI , COUTURE NILOFER , GARROW HEATHER , O'BANION NANCY , PAVLI DAWN , PONTIUS HEATHER , YANSON JESSIE , JIANG LUOHUA ,   AI/AN WCIE STUDY GROUP
Published: May 2022

“What Can I Eat? (WCIE) Healthy Choices for American Indians and Alaska Natives (AI/ANs) with T2D” is a 5-lesson diabetes nutrition education program culturally adapted for AI/ANs with T2D. Classes were taught synchronously via Zoom at 5 reservation-based or urban inter-tribal clinical sites nationwide in 2021. Classes were taught by registered dietitian nutritionists (RDN) and topics included the diabetes plate, sugar sweetened beverages, heart healthy choices, food label reading. Class activities included didactic sessions, hands-on interactive learning, physical activity, mindful eating, and goal setting. Participants were recruited through diabetes registries at each collaborating site and randomized to either the immediate or the wait list group. The former group started classes immediately upon randomization; the latter started classes 3 months after randomization. Participants (N=58) were AI/AN adults with T2D (baseline data: mean age 58.6 +/-11.1 years, 26% male; BMI 33.8 (+/- 7.1)) . Before participation, each enrollee received a “class kit” including class activity resources and tools to collect evaluation data (i.e., scale, A1C kit, blood pressure monitor, and paper impact surveys) . Classes 1-4 were taught weekly for 4 weeks; the 5th class was taught 3 months after class #1. Data were collected at 3 timepoints: baseline, 1 month (after class 4) and 3 month (after class 5) . Outcomes included diabetes self-efficacy, behavior (physical activity and diet) , and clinical measures (BMI, blood pressure, A1c) . Linear mixed models were used to assess intervention effects on changes in outcome measures from baseline. No significant changes from pre to post were observed in behavior or clinical outcomes. Compared to the wait list group, the immediate group had greater increase in self-efficacy for using the diabetes plate at 1 and 3 months (ps&lt;0.01) and for making healthy food choices at 1 month (p=0.047) .

Disclosure
K.R.Moore: Consultant; Novo Nordisk. D.Pavli: None. H.Pontius: None. J.Yanson: None. L.Jiang: None. Ai/an wcie study group: n/a. S.A.Stotz: n/a. A.G.Brega: None. M.C.Mcnulty: None. I.Adedoyin: None. G.Austin: None. N.Couture: None. H.Garrow: None. N.O'banion: None.

Funding
American Diabetes Association (4-18-SMSC-01)
527-P: Needs of mHealth Diabetes Services from Patients with Poorly Controlled Type 2 Diabetes Mellitus: A Qualitative Study
Authors: XIE QINQIN , CHENG LI 
Published: May 2022

Aims: To explore the care needs to integrate mHealth technology to promote diabetes self-management engagement from the perspectives of patients with poorly controlled type 2 diabetes mellitus (T2DM) . Design: A phenomenological study using individual, semi-structured, face-to-face-based interviews.
Methods: Purposive sampling of 15 patients with poorly controlled T2DM were recruited from a tertiary hospital in Guangdong, China. Face-to-face semi-structured interviews were conducted to gain in-depth insight into the care needs regarding mHealth perceived by patients with poorly controlled type 2 diabetes. Interviews were audio-recorded and transcribed verbatim. Data were analyzed using the thematic analysis approach.
Results: Four themes and fourteen subthemes emerged from the interview data: (1) informational needs (subthemes: symptoms management, self-care monitoring, complication prevention, and public awareness) , (2) emotional needs (subthemes: psychological flexibility and health coping) , (3) functional needs of mHealth services (subthemes: continuity of care, personalized coaching, family participation) , (4) technical needs related to online applications (subthemes: accessibility, convenience, efficiency, usability, and trustworthy)
Conclusion: This study shed light on the complex and changeable needs of patients with poorly controlled T2DM due to complications and comorbidities. Healthcare providers could incorporate the identified needs in the development of mHealth-based interventions to optimize the health outcomes of patients with poorly controlled type 2 diabetes. Keywords: poor glycemic control; type 2 diabetes mellitus; health needs; mHealth diabetes services.

Disclosure
Q.Xie: None. L.Cheng: None.

Funding
National Natural Science Foundation of China (Grant No.71904214)
536-P: Impact of Physical Activity (PA) and Macronutrient Intake on CGM Glucometrics in Youth with T1D
Authors: LA BANCA REBECCA O. , VOLKENING LISA K. , DASSAU EYAL , MEHTA SANJEEV N. , LAFFEL LORI M. 
Published: May 2022

Aim: Maintaining in-range glucose on days with PA is challenging for youth with T1D, often requiring fine-tuning of diet and insulin. We examined how PA and macronutrient intake impact glycemic outcomes in youth with T1D.
Methods: Youth and parents completed 3-day PA and diet records and youth wore 3-day masked CGM (iPro) every 3 months for 18 months. Days were classified as active (≥60 min PA) or inactive. Diet data were analyzed using Nutrition Data System for Research (NDSR) . Daytime (6 AM-11:59 PM) CGM glucometrics were: % time (T) in range (TIR) 70-180 mg/dL, %T&lt;70, %T&gt;180, and glucose CV. Analyses included complete days for PA, diet, and CGM data. Separate longitudinal mixed models for daily carb, fat, and protein intake (adjusted for age, T1D duration, sex, pump vs. MDI) , assessed changes in glucometrics on active vs. inactive days.
Results: Youth (N=136, 49% male, 73% pump users) were ages 8-17 yrs (12.9±2.6) with T1D duration 6.0±3.1 yrs and daily insulin 0.9±0.3 U/kg. At baseline, A1c was 8.0±0.9%, daytime %TIR 50±22% (12.0 hrs) , %T&lt;70 5±8% (1.2 hrs) , %T&gt;180 44±25% (10.6 hrs) , CV 37±11%; macronutrient intake was 49±9% carb, 35±8% fat, 16±4% protein. In all models of macronutrient intakes, %TIR increased by ∼5.3% (76 min; p=.01) with pump use; by 2.8% (40 min; p=.02) on active days; by 1.4% (20 min; p=.03) with 10% increase in carb intake; and by 1.7% (24 min; p=.02) with 10% decrease in fat intake. PA and carb intake did not impact %T&lt;70; %T&lt;70 decreased by 0.6% (9 min; p=.03) with 10% increase in fat intake. PA did not impact %T&gt;180; %T&gt;180 decreased by ∼5.6% (81 min; p=.02) with pump use; by 1.7% (24 min; p=.02) with 10% increase in CHO intake; and by 2.2% (32 min; p=.01) with 10% decrease in fat intake. CV decreased by 1.3% on inactive days (p=.04) ; by 1.1% with 10% decrease in CHO intake (p&lt;.01) ; and by 1.3% with 10% increase in fat intake (p&lt;.01) .
Conclusion: PA and macronutrient intake have varying effects on glycemic outcomes. The findings reinforce the need to tailor insulin dosing algorithms for diet and PA.

Disclosure
R.O.La banca: None. L.K.Volkening: None. 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. S.N.Mehta: 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
National Institutes of Health (K12DK094721, P30DK036836) ; Iacocca Foundation