bluuebunny/crossref_metadata_2025_split huggingface dataset:
32-LB: Role of Telehealth in Improving Health Care Quality in Type 2 Diabetes in a Rural Community-Based Clinical Practice
Authors: GURURAJ SUPRAJA , ASFA AMIR , HANLEY LESLIE C. , YADAV YOGESH R. , BASHORE RANDALL T. , BASU RITA , BASU ANANDA 
Published: May 2022

Use of continuous glucose monitoring (CGM) facilitates better management of type 2 diabetes (T2D) in outpatient clinics in academic medical centers. In a Quality Improvement project, we evaluated the effects of telehealth aided by CGM on HbA1c and percent time in range (TIR 70-180 mg/dl) in patients with T2D over a 6-month duration. Diabetes management advice based on intermittent CGM use was provided via phone by an academic endocrinologist to the clinical pharmacist at a rural community clinic. Inadequately controlled (HbA1c &gt; 8%) T2D patients (n=27) on at least one antidiabetic drug were included and were monitored over a 6 month period, baseline (V1) , 3 months (V2) and 6 months (V3) . All patients received standard of care (SOC) treatment. On each visit, 12 patients (age 59 8y, BMI 36.2 3.6kg/m2, HbA1C 9.3 1.3%) received a professional CGM for 2 weeks. Thereafter, the devices were removed and analyzed. The PCP implemented medication changes based on recommendations by the endocrinologist to the clinical pharmacist. The other 15 patients (age 60 8y, BMI 32 4 kg/m2, HbA1C 9.1 1.6%) underwent the same schedule without CGM or telehealth consultations. There were no significant differences in age or HbA1c between groups at baseline. HbA1c (%) decreased (Δ -1.0 ± 1.4; p=0.03) , and CGM TIR (%) increased (Δ +24.3 ± 38.7; p=0.05) at V3 vs. V1 in the telehealth group. However, weight, CGM time below and above ranges (%) did not differ (p&gt;0.05) statistically. In contrast, there were no significant differences in HbA1c (Δ +0.4 ± 1.7; p=0.3) between V3 and V1 in the SOC without telehealth group. Our results show that intermittent CGM use coupled with tele-consultation with diabetes expert improves glucose control and care quality in patients with T2D in community based health practice. This strategy could potentially mitigate existing health care disparities between suburban/rural-based community health practices and academic medical centers, thus closing the gaps in quality of care.

Disclosure
S. Gururaj: None. A. Asfa: None. L. C. Hanley: None. Y. R. Yadav: None. R. T. Bashore: None. R. Basu: Consultant; Sparrow Pharmaceuticals Inc, Research Support; Abbott Diabetes, AstraZeneca. A. Basu: Speaker’s Bureau; Zealand Pharma A/S.

Funding
Virginia Department of Health (GS11963)
32-OR: The Advancing Care for T1D Obesity Network (ACT1ON) Sequential Multiple Assignment Randomized Trial Pilot Re-randomization Results
Authors: IGUDESMAN DARIA , CRANDELL JAMIE , POKAPRAKARN TEERANAN , CORBIN KAREN , ZAHARIEVA DESSI P. , ADDALA ANANTA , THOMAS JOAN , CASU ANNA , RIDDELL MICHAEL , PRATLEY RICHARD E. , KOSOROK MICHAEL R. , MAAHS DAVID M. , MAYER-DAVIS ELIZABETH J. 
Published: May 2022

Background: Sequential Multiple Assignment Randomized Trials (SMARTs) efficiently address practical treatment comparison questions and adapt dynamically based on response. They may be useful for development of approaches to co-manage weight and glycemia T1D, which is critical yet challenging.
Methods: Our SMART pilot with three diet periods enrolled young adults with T1D (BMI 27-39.9 kg/m²) . Participants were re-randomized after ∼3 months on the hypocaloric Look AHEAD (Low Fat) or Low Carbohydrate (Low Carb) ; or Mediterranean (Med, not calorie restricted) diet if &lt;2% weight was lost, HbA1c increased ≥0.5%, diet was unacceptable, or hypoglycemia increased. We present descriptive statistics for weight, HbA1c, and re-randomization for diet period 1 pre-COVID before shifting to a virtual protocol.
Results: The proportion re-randomized was 57.9% and did not vary by diet. Weight was lost overall but insufficient weight loss was the most common reason for re-randomization for Low Fat and Med. An HbA1c increase ≥0.5% was most common on Med. Low diet acceptability was the most common reason for re-randomization on Low Carb.
Conclusions: We achieved safe weight loss among young adults with T1D but observed heterogeneity in reasons for re-randomization by diet, although differences were not statistically significant. A fully-powered efficacy trial may confirm our findings.

Disclosure
D.Igudesman: None. R.E.Pratley: Other Relationship; Bayer AG, Corcept Therapeutics, Dexcom, Inc., Hanmi Pharm. Co., Ltd., Merck & Co., Inc., Metavention, Novo Nordisk, Pfizer Inc., Poxel SA, Sanofi, Scohia Pharma Inc., Sun Pharmaceutical Industries Ltd. M.R.Kosorok: n/a. D.M.Maahs: Advisory Panel; Abbott Diabetes, Eli Lilly and Company, Medtronic, Novo Nordisk, Sanofi, Consultant; Aditx Therapeutics, Inc., Biospex. E.J.Mayer-davis: None. J.Crandell: n/a. T.Pokaprakarn: None. K.Corbin: None. D.P.Zaharieva: Research Support; Insulet Corporation, International Society for Pediatric and Adolescent Diabetes, Leona M. and Harry B. Helmsley Charitable Trust. A.Addala: None. J.Thomas: None. A.Casu: None. M.Riddell: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Consultant; Eli Lilly and Company, Jaeb Center for Health Research, Speaker's Bureau; Dexcom, Inc., Eli Lilly and Company, Novo Nordisk.

Funding
National Institutes of Health 1DP3DK113358
326-OR: Type 2 Diabetes, Chronic Kidney Disease, and Major Cardiovascular Events in Patients with Established Cardiovascular Disease
Authors: SPRENGER LUKAS , MAECHLER MAXIMILIAN , VONBANK ALEXANDER , LARCHER BARBARA , MADER ARTHUR , LEIHERER ANDREAS , MUENDLEIN AXEL , DREXEL HEINZ , SAELY CHRISTOPH H. 
Published: May 2022

Type 2 diabetes (T2DM) and chronic kidney disease (CKD) both confer a high risk of cardiovascular disease (CVD) , and these conditions frequently coincide. The aim of this study was to investigate the single and joint effects of T2DM and CKD on major cardiovascular events (MACE) in patients with established cardiovascular disease.
We prospectively investigated 1738 patients with established cardiovascular disease - angiographically proven coronary artery disease (CAD) or sonographically proven peripheral artery disease (PAD) - over 10.0±4.7 years.
MACE occurred more frequently in T2DM patients (n=575) than in non-diabetic subjects (42.5% vs. 29.8%, p&lt;0.001) and in patients with CKD (eGFR &lt;60ml/min/1.73m2; n=302) than in those who did not have CKD (52.2% vs. 30.1%, p&lt;0.001) . When both, T2DM and CKD were considered, 996 subjects had neither T2DM nor CKD, 440 had T2DM but not CKD, 172 did not have diabetes but had CKD, and 130 had both T2DM and CKD. Compared to the incidence of MACE among patients with neither T2DM nor CKD (26.5%) , MACE occurred more frequently in patients with T2DM who did not have CKD (38.2%; p&lt;0.001) as well as in non-diabetic patients with CKD (48.0%; p&lt;0.001) ; the incidence of MACE was highest in patients with both, T2DM and CKD (57.8%; p&lt;0.001) , in whom it was higher than in those with T2DM but not CKD (p&lt;0.001) or those without T2DM but with CKD (p=0.007) ; the incidence of MACE was higher in non-diabetic CKD patients than in T2DM patients who did not have CKD (p=0.040) . In Cox regression analysis, T2DM (HR=1.53 [1.29-1.83]; p&lt;0.001) and CKD (HR=1.85 [1.51-2.26]; p&lt;0.001) proved to be mutually independent predictors of MACE after adjustment for age, sex, BMI, hypertension, history of smoking, LDL-C, HDL-C and HbA1c.
We conclude that T2DM and CKD in patients with established cardiovascular disease are mutually independent predictors of MACE. Cardiovascular disease patients with both CKD and T2DM are at an extremely high risk for MACE.

Disclosure
L.Sprenger: None. M.Maechler: None. A.Vonbank: None. B.Larcher: None. A.Mader: None. A.Leiherer: None. A.Muendlein: None. H.Drexel: None. C.H.Saely: None.
327-OR: Preliminary Outcomes of a Social Media–Based Diabetes Intervention among Low-Income Chinese Immigrants
Authors: HU LU , ISLAM NADIA , JIANG NAN , TAMURA KOSUKE , JAGANNATHAN RAM , KHARMATS ANNA Y. , BUBU OMONIGHO , SEVICK MARY ANN 
Published: May 2022

Purpose: Mobile health holds strong promise to increase access to diabetes self-management education (DSME) programs in underserved communities. In this report, we examined the preliminary outcomes of a social media-based DSME intervention in low-income Chinese immigrants with type 2 diabetes (T2D) .
Methods: We conducted a single-group pilot study in 30 Chinese immigrants with T2D living in NYC in 2020. Over 12 weeks, participants received 2 brief culturally and linguistically tailored DSME videos each week via WeChat, a free and popular social media app among Chinese immigrants. Participants completed baseline and 6-month surveys with self-efficacy, diabetes self-care behaviors, dietary intake, and physical activity measures. Paired t-tests were used to examine changes over time.
Results: Of the 30 participants, mean (SD) age was 61.2 (6.7) years, 70.0% were women, 63.3% reported high school education, 84.0% reported annual family income of &lt; $25,000, 63.3% were married, and 86.7% had limited English proficiency. Compared to baseline, there were significant improvements in participants’ self-efficacy, diabetes self-care behaviors, dietary intake and physical activity at 6 months (see Table 1) .
Conclusions: Our social media-based DSME intervention demonstrated promising results in improving psychosocial and behavioral outcomes in low-income older Chinese immigrants with T2D.

Disclosure
L.Hu: None. N.Islam: None. N.Jiang: None. K.Tamura: None. R.Jagannathan: None. A.Y.Kharmats: None. O.Bubu: None. M.Sevick: None.

Funding
NIH K99MD0128 (PI Dr. Lu Hu) ; NIH R00MD0128 (PI Dr. Lu Hu) , Dr. Anna Kharmats was supported by a postdoctoral training grant from the National Institutes of Health (5T32HL129953-04)
339-OR: Oral Small-Molecule GLP-1R Agonist Danuglipron Robustly Reduces Plasma Glucose and Body Weight after Eight Weeks in Japanese Adults with Type 2 Diabetes Mellitus
Authors: ONO RYOSUKE , FURIHATA KENICHI , ICHIKAWA YOSHIHIKO , NAKAZURU YOSHIOMI , BERGMAN ARTHUR , GORMAN DONAL N. , SAXENA ADITI R. 
Published: May 2022

Danuglipron is an oral small molecule glucagon-like peptide-1 receptor (GLP-1R) agonist shown to reduce plasma glucose and body weight after 28 days of treatment in adults with type 2 diabetes mellitus (T2DM) . This randomized, double-blind (sponsor-open) , placebo-controlled, Phase 1 study investigated the safety, tolerability, pharmacokinetics, and pharmacodynamics of danuglipron in Japanese patients with T2DM. A total of 37 patients with T2DM inadequately controlled on diet and exercise alone were randomized to twice-daily (BID) oral doses of placebo or multiple, ascending doses of danuglipron titrated to 40 mg, 80 mg, and 120 mg for 8 weeks. Multiple, oral doses of danuglipron were generally safe in Japanese participants with T2DM and resulted in approximate dose-proportional increases in exposure and significant reductions in fasting plasma glucose (FPG) , 24-hour mean daily glucose (MDG) , glycated hemoglobin (HbA1c) , and body weight (Table) . Most adverse events (AEs) were mild or moderate, with AEs of nausea, vomiting, abdominal discomfort, diarrhea, and headache reported most frequently. There were no deaths and no serious AEs related to dosing of danuglipron. No clinically significant adverse trends in labs, electrocardiogram, or vital sign abnormalities were apparent.

Disclosure
R.Ono: Employee; Pfizer Japan Inc. K.Furihata: Other Relationship; Eli Lilly and Company, Pfizer Japan Inc. Y.Ichikawa: Employee; Pfizer Inc., Stock/Shareholder; Pfizer Japan Inc. Y.Nakazuru: Employee; Pfizer Japan Inc., Stock/Shareholder; Pfizer Inc. A.Bergman: Employee; Pfizer Inc., Stock/Shareholder; Pfizer Inc. D.N.Gorman: Employee; Pfizer Inc. A.R.Saxena: Employee; Pfizer Inc.

Funding
Sponsored by Pfizer Inc.
342-OR: Low Incretin Effect Is Associated with Longitudinal Decline of Beta-Cell Function and Insulin Sensitivity in Obese Youth
Authors: GALDERISI ALFONSO , LAT JESSICA O. , SAMUELS STEPHANIE , PIERPONT BRIDGET , VAN NAME MICHELLE A. , SANTORO NICOLA , CAPRIO SONIA 
Published: May 2022

Background: We assessed the longitudinal trajectory of beta-cell function with respect to baseline incretin effect in youth with obesity.
Methods: At baseline and two years, youth with obesity and 2-h glucose ≥ 120mg/dL underwent a 3-hour OGTT and isoglycemic intravenous glucose infusion (to quantify the incretin effect) . Participants were stratified into three tertiles based on the baseline incretin effect. The oral minimal model quantified beta cell function (oDI) and insulin sensitivity (SI) .
Results: Thirty participants completed the assessments [follow-up: age 18.6±2.4y, 19F; BMI 38.6±7.4 kg/m2, NGT/IGT/T2D 12/17/1]. At 2 years, 2-h glucose improved in the high incretin group (p=0.047) , but was stable in the middle- and low- incretin groups (panel G) . At 2 years, the baseline high-incretin group exhibited a lower 60-min glucose (p=0.026) than the low-incretin group, with similar 120-min glucose (p=0.696) , despite the low-incretin cohort’s relative increase in early insulin secretion (panel D, F) . The low-incretin tertile also exhibited a reduced β cell function (oDI) at follow-up (panel I) (p=0.044) mainly due to lower insulin sensitivity (panel H) (p=0.013) .
Conclusion: Low incretin effect is associated with a longitudinal decline of beta cell function and decreased insulin sensitivity, despite greater first-phase insulin secretion.

Disclosure
A.Galderisi: None. J.O.Lat: None. S.Samuels: None. B.Pierpont: None. M.A.Van name: Research Support; Provention Bio, Inc. N.Santoro: None. S.Caprio: None.

Funding
National Institute of Diabetes and Digestive and Kidney Diseases/NIH/DHHS (16-004945)
348-OR: Glycine and Branched-Chain Amino Acids (BCAA) Metabolic Signature in Youth with Obesity and Type 2 Diabetes (T2D)
Authors: AYASH HEBA EL , MOHAMMAD MAHMOUD A. , SHAWAR REEM S. , KANCHI RUPA S. , SHARMA SUSAN , PUYAU MAURICE R. , COARFA CRISTIAN , BACHA FIDA 
Published: May 2022

BCAAs are associated with increased risk for T2D in adults, while glycine (Gly) appears to be have an inverse relationship. β-cell function is central to the development of T2D in youth. The relationship of Gly and BCAA to β-cell function in youth is not clear.
We investigated the relationship between Gly vs. the BCAA: Leucine (Leu) , Isoleucine (Ile) and Valine (Val) , to insulin sensitivity (IS) and β-cell function in youth across the spectrum of glycemia.
Adolescents (65 female/62 male; 15.5±1.9 y.o.; 30 with normal weight normal glucose tolerance (NW-NGT) , 33 obese-NGT, 34 prediabetes, and 30 T2D) underwent assessment of AA concentrations (mass spectrometry) , fasting and at steady state (SS) of a 3-hr hyperinsulinemic-euglycemic clamp (in-vivo IS) ; insulin secretion by 2-hr hyperglycemic clamp; adipokines, body composition (DXA) and visceral fat (MRI) . The disposition index (DI) (measure of β-cell function) = first phase insulin x IS per fat free mass (DIFFM) . We performed analysis of variance (adjusting for sex, race-ethnicity and Tanner stage) and correlation analyses.
Fasting and SS-Gly were lower and SS-BCAA higher in the groups with obesity compared with NW with post-hoc significant differences in T2D vs. NW (p&lt;0.0for fasting and SS-Gly, SS-Ile, and p=0.02 for SS-Val) and in prediabetes vs. NW (for Gly, Val and Ile) . Fasting and SS-Gly negatively and SS-BCAA positively associated with %body fat, waist/hip, and visceral fat, while Gly positively and BCAA negatively related to adiponectin. Fasting and SS-Gly (r=0.4, p&lt;0.001) positively and SS-BCAA (r=-0.4 for Val, Leu, Ile, p&lt;0.001) negatively related to ISFFM. Gly positively (r=0.27, p=0.005) , SS-Ile (r=-0.26, p=0.006) inversely related to DIFFM.
Gly is positively related to IS and β-cell function and negatively to adiposity measures, with opposite relationships observed for BCAA. A metabolic signature of low Gly and elevated BCAA may constitute a biomarker to identify youth at risk for β-cell failure.

Disclosure
H.El ayash: None. M.A.Mohammad: None. R.S.Shawar: None. R.S.Kanchi: None. S.Sharma: None. M.R.Puyau: None. C.Coarfa: None. F.Bacha: Other Relationship; AstraZeneca, Takeda Pharmaceutical Company Limited, Research Support; National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Agriculture.

Funding
USDA-ARS
35-LB: Classification in Koreans with Oral Antidiabetic Agents by Diabetes Education and Psychological Support Needs Using Q Methodology
Authors: CHA EUNSEOK , SHIN MYOUNGHWAN , JANG HYESUN , JOUNG KYONG HYE , KIM HYUN JIN , FAULKNER MELISSA S. 
Published: May 2022

Objective: To classify diabetes attitude, wishes and needs affecting diabetes self-management behaviors in persons with type 2 diabetes (T2D) taking oral medication.
Methods: Q-methodology, a mixed method of inquiry with bottom up-logic, was used to identify psychological phenotypes. Data using 33 Q-samples collected from 51 Q-Korean sorters (35men; 16 women) were analyzed by factor analysis using varimax orthogonal rotation (PQ Method Program, Version 2.35) . The Summary of Diabetes Self-Care Activity measure and A1C in the past 6 months were included to obtain comprehensive understanding for managing diabetes.
Findings: A total of 34% variance was explained by 4 factors: Factor 1 (n=18) : moderate management with low confidence (age=60.0±12.2; A1C=7.06±1.98) , Factor 2 (n=15) : good management with high confidence (age= 68.3±9.7; A1C=6.60±0.59) , Factor 3 (n=6) : good management, necessitating assurance from trustful others including health care providers and logistic support (age=65.8±8.4; A1C=6.53±0.86) , Factor 4 (n=12) : poor management with low confidence and behavioral skills to be improved (age= 56.4±14.1; A1C= 7.53 ±1.14) .
Conclusions: Psychosocial screening affecting diabetes self-management behaviors needs to be regularly assessed to provide precision health in T2D education and support. Since those in a younger age were associated with poor diabetes management, further investigation is warranted to identify life stage care needs for T2D education and support.

Disclosure
E. Cha: None. M. Shin: None. H. Jang: None. K. Joung: None. H. Kim: None. M. S. Faulkner: None.

Funding
Korea Research Foundation (NRF-2019R1A2C1087199)
353-OR: Determining the Sequence of Microvascular Complications: Results of Multistate Markov Modelling in the Diabetes Control and Complications Trial (DCCT)
Authors: LOVBLOM LEIF ERIK , BRIOLLAIS LAURENT , TOMLINSON GEORGE , PERKINS BRUCE A. 
Published: May 2022

Screening for neuropathy is complex and underperformed in practice. If neuropathy rarely occurs first, screening for it could be delayed until retinopathy or nephropathy are documented. To address this, we aimed to definitively determine the sequence of microvascular complications in the natural history of type 1 diabetes (T1D) . Using data available from the public NIDDK Repository (1983-2012) , independent of the DCCT/EDIC research group, we performed a multistate analysis using biostatistics techniques for complex trivariate processes of the 1441 participants with T1D. Retinopathy (‘Eye’, E) , nephropathy (‘Kidney’, K) , and neuropathy (‘Nerve’, N) were each screened repeatedly and defined by the early-stage phenotypes (Figure 1) . Our model accounted for intermittent ascertainment and differing screening schedules. At baseline, participants had mean age 27±7 years and duration 6±4 years. Markov model simulations started in the absence of complications (Ø) . Eye was the most common initial complication (49%) , followed by nerve (28%) , and kidney (22%) . Median time to first complication was 5.3 years. 4% had no complications through follow-up. While retinopathy is conclusively most common, the high frequency of other initial complications reinforces the current practice of unselected early screening for all three, including neuropathy.

Disclosure
L.Lovblom: None. L.Briollais: None. G.Tomlinson: None. B.A.Perkins: Advisory Panel; Abbott Diabetes, Insulet Corporation, Sanofi, Board Member; Novo Nordisk, Other Relationship; Abbott Diabetes, Insulet Corporation, Medtronic, Novo Nordisk, Research Support; BMO Bank of Montreal, Novo Nordisk.

Funding
The Canadian Institutes of Health Research and the public NIDDK Central Repository.
36-LB: Feasibility and Acceptability of a Family-Based mHealth Intervention in Low-Income Chinese Families with Type 2 Diabetes
Authors: HU LU , CHENG SHEN , ISLAM NADIA , WYLIE-ROSETT JUDITH , WU BEI , FELDMAN NAUMI , SCHOENTHALER ANTOINETTE , OGEDEGBE OLUGBENGA , JIANG NAN , TAMURA KOSUKE , BUBU OMONIGHO , SEVICK MARY ANN 
Published: May 2022

Objective: To examine the feasibility and acceptability of implementing a family-based mhealth intervention tailored for low-income Chinese immigrant families with type 2 diabetes (T2D) in New York City (NYC) .
Methods: We recruited 11 patient-family partner adult dyads to receive the intervention. Both the patient and partner were asked to watch 2 brief videos each week for 12 weeks via the social media app WeChat. The culturally and linguistically tailored videos addressed diabetes self-management and provided guidance on how to support the patient’s self-management. Feasibility was evaluated via participant retention and video watch rates. Acceptability was assessed at 12-weeks via a 9-item survey using a 5-point Likert scale (1=strongly agree to 5=strongly disagree) , and a single item on which participants rated satisfaction using an 11-point Likert scale (0=not at all satisfied to 10=totally satisfied) . Participants also were asked about barriers to watching the videos.
Results: The care dyads were mostly middle-aged, married, with less than a high school education, limited English proficiency, and an annual household income &lt;$25,000. Most family members were spouses of the patient. The retention rate was 90.9% at 12 weeks. The mean (SD) video watch rate was 76.7% (7.0%) . Lack of time was the most common barrier to watching videos. Participants reported high satisfaction (mean ± SD: 9.1 ± 1.7 for patients and 10.0 ± 0 for family members) . All strongly agreed or agreed that videos were easy to receive and open on WeChat, and provided helpful information about diet and physical activity. Most strongly agreed or agreed that they would recommend the program to others and preferred video-based diabetes education to in-person programs.
Conclusions: A family-based mHealth intervention is feasible and acceptable among low-income Chinese immigrant families with T2D in NYC.

Disclosure
L. Hu: None. K. Tamura: None. O. Bubu: None. M. Sevick: None. S. Cheng: None. N. Islam: None. J. Wylie-rosett: None. B. Wu: None. N. Feldman: None. A. Schoenthaler: None. O. Ogedegbe: None. N. Jiang: None.

Funding
National Institutes of Health (K99MD012811) ; National Institutes of Health (R00MD012811) ; National Institutes of Health (P30DK111022)