bluuebunny/crossref_metadata_2025_split huggingface dataset:
1004-P: Executive Dysfunction Predicts Lower Self-Care Readiness in Teens with Type 1 Diabetes
Authors: VITALE REBECCA J. , TINSLEY LIANE J. , VOLKENING LISA K. , LAFFEL LORI M. 
Published: May 2022

Aim: Management of type 1 diabetes (T1D) is a complex multi-step process in which executive function (EF) skills (planning, organization, problem solving) are critical for optimal control. In teens with T1D, EF may be important in transitioning from parent-supervised care to self-care.
Methods: In an 18-month study, teens aged 13-17 years with T1D and parents completed the Diabetes Family Responsibility Questionnaire (DFR) and Readiness for Independent Self-Care Questionnaire (RISQ) every 6 months. Teen EF was assessed by parent proxy-report using Behavior Rating Inventory of Executive Function (BRIEF) . T-score ≥60 defined risk of executive dysfunction for the Global EF Composite (GEC) , Behavioral Regulation Index (BRI) and Metacognition Index (MI) . EF, demographic, and T1D treatment variables were used to predict change in RISQ over time using longitudinal mixed models with false discovery rate adjustment.
Results: 169 teens (54% male) participated with baseline age 15.9±1.3 years, T1D duration 8.4±3.7 years, HbA1c 8.6±1.2%, 74.6% insulin pump use, and 21.3% continuous glucose monitor (CGM) use. 31.4% of teens had a parent-reported GEC score ≥60. After adjusting for age, gender, and parent-reported DFR (pDFR) , those with GEC ≥60 had parent-reported RISQ (pRISQ) 4.1 points lower than those with GEC &lt;60, p=0.016. BRI (adjusted for age, CGM use, pDFR, and HbA1c) did not predict change in pRISQ while MI (adjusted for age, gender, and pDFR) did; those with MI ≥60 had pRISQ 5.3 points lower than those with MI &lt;60, p&lt;0.001. In models using teen-reported DFR and RISQ (tRISQ) , GEC and MI similarly predicted lower tRISQ. In all models, lower age (p&lt;0.05) and greater parent involvement (p&lt;0.001) also predicted lower RISQ.
Conclusion: EF, especially metacognition, appears important for acquisition of self-care behaviors for teens with T1D. Evaluating EF during adolescence may identify teens with executive dysfunction who may need extra support during the transition process.

Disclosure
R.J.Vitale: None. L.J.Tinsley: None. L.K.Volkening: 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 T32DK007529NIH P30DK036836NIH R01DK095273JDRF 2-SRA-2014-253-M-B
1007-P: Health Disparities in the Effect of the COVID-Pandemic on Loss-to-Follow-Up Rates among High-Risk Pediatric Patients with Type 1 Diabetes (T1D)
Authors: GUPTA MEENAL , CARLIN KRISTEN , ROBERTS ALISSA J. , MALIK FAISAL , DESAI ARTI 
Published: May 2022

Objective: Historically marginalized groups have higher rates of poor glycemic control linked to barriers in access to care. We sought to examine whether there was a differential effect of the COVID-pandemic on loss-to-follow-up (LTFU) rates among high-risk youth with T1D based on language for care, race, and ethnicity.
Methods: Retrospective cohort study of pediatric patients with T1D (HbA1c ≥9%) seen at a tertiary care diabetes clinic between 1/1/18-2/29/20 (pre-COVID period) and 3/1/20-1/31/21 (COVID period) . LTFU was tracked monthly and defined as patients not seen in the preceding 6 months. Preferred language for care, race, and ethnicity data were obtained from visit registration data. Generalized estimating equations were used to examine associations between time-periods (pre-COVID versus COVID) and LTFU rates, adjusted for patient age. In two models, separate interaction terms for (1) language for care and (2) race and ethnicity were introduced to assess for effect modification.
Results: 1359 patients were included (9.5% with language other than English [LOE]; 33.5% from historically marginalized racial and ethnic groups) . We found a 1.27 higher odds (95% CI: 1.08, 1.49) of LTFU after the onset of the pandemic, with differential effects based on language for care. Among patients with LOE, the odds of LTFU in the COVID period was 4.14 higher (95% CI: 2.35, 7.29) compared to the pre-COVID period. LTFU rates did not significantly differ between time periods among English-speaking patients (OR 1.12 [95% CI: 0.95, 1.33]) . Patient’s race and ethnicity did not modify the effect of the COVID-pandemic on LTFU rates.
Conclusion: The COVID-pandemic has exacerbated LTFU rates in high-risk youth with T1D and disproportionately impacted patients whose preferred language for care is a LOE. Interventions to improve LTFU rates should include targeted efforts to reduce health disparities in access to care in this high-risk population.

Disclosure
M.Gupta: None. K.Carlin: None. A.J.Roberts: None. F.Malik: n/a. A.Desai: None.
101-LB: Utility and Safety of Backup Insulin Regimens Generated by the Bionic Pancreas—A Randomized Study
Authors: MAURAS NELLY 
Published: May 2022

The bionic pancreas (BP) is initialized with body weight only, makes all insulin dosing decisions autonomously, and uses meal announcements without carbohydrate counting. In the event of device malfunction, BP users may need guidance for managing their glucose. The BP generates and continuously updates a table with back-up insulin doses for either injection or pump users, including a long-acting insulin dose, a four-period basal insulin profile, short-acting meal doses for breakfast, lunch, and dinner depending on meal size (Usual, Less, More) , and a glucose correction factor. At the end of the 13-week Pivotal RCT of the BP in type 1 diabetes, participants in the BP group (6-83 years old) were randomized 1:1 to their Pre-study Insulin Regimen (N=148) or BP Guidance (N=149) , and took insulin by injection or pump according to their pre-study modality, for a 2-4 day Transition Phase. There was high adherence to the regimen in the BP Guidance group and no episodes of severe hypoglycemia or DKA. Glycemic outcomes in the BP Guidance group were similar to those the Pre-study Insulin Regimen group, and comparable to their own pre-randomization baseline. Both groups had higher mean glucose and less time in range in the Transition Phase than while using the BP during the RCT (Table) . A back-up insulin regimen automatically generated by the BP can be safely implemented if need arises to discontinue use of the BP.

Disclosure
N. Mauras: Research Support; AbbVie Inc., Beta Bionics, Inc., Novo Nordisk, Pfizer Inc.

Funding
Funding from National Institute of Diabetes and Digestive and Kidney Diseases (grant #1UC4DK108612-01) Funding and bionic pancreas devices from Beta Bionics, Inc. Fast-acting insulin aspart and insulin aspart provided by Novo Nordisk Insulin lispro by Eli LillyBlood glucose meters and test strips (Contour?Next One Blood Glucose Monitoring System) provided by Ascensia Diabetes Care, Basel, CH. Continuous glucose monitor sensors and transmitters were purchased from Dexcom, Inc. at a discounted price.
101-OR: Cell-Specific Role of Insulin in a Model of Restenosis in Insulin-Sensitive and Insulin-Resistant Conditions
Authors: GONZALEZ MAREL , LIU ZHIWEI , WANG JOHNY Z. , ZHANG CINDY X. , GIACCA ADRIA 
Published: May 2022

Angioplasty and stenting are widely used in the treatment of atherosclerosis. However, these procedures may fail due to post-angioplasty restenosis, which remains a problem for patients with diabetes. Currently, the vascular role of insulin is unclear. Its role on endothelial cells (EC) is vasculoprotective, whereas its effects on vascular smooth muscle cells (SMC) are mainly mitogenic according to in vitro data. We have previously shown a suppressive effect of insulin treatment on neointimal growth in rodent models of restenosis in insulin sensitive conditions that was abolished in insulin resistant conditions. The objective of this study was to determine the EC-and SMC-specific effects of insulin treatment on neointimal growth in a murine model of restenosis in insulin sensitive and insulin resistant conditions. Mice were generated by crossing insulin receptor (IR) floxed mice with tamoxifen inducible Cre recombinant mice under the control of Cdh5 (vascular endothelial cadherin) or SMMHC (smooth muscle heavy chain) promoters. Mice were fed with a low-fat (LFD) or a high-fat-high-sucrose (HFSD) diet and implanted with insulin pellet (0.U/day) or vehicle (control) prior to femoral artery wire injury. We found that compared to IR-floxed controls, tamoxifen-induced IRf/f-Cdh5-Cre+ or IRf/f-SMMHC-Cre+ mice showed a 94% and 80% decrease in IR expression in ECs or SMCs, respectively. In LFD-fed insulin sensitive conditions, insulin decreased neointimal area (NA) and intima-to-media ratio (I/M) in controls (Cdh5 and-SMMHC-floxed and wildtype-Cre+ mice) but not in endothelial and SMC IR deficient mice. In HFSD-fed insulin resistant conditions, insulin had no effect in either controls or endothelial and SMC IR deficient mice. These data demonstrate that insulin action in both ECs and SMCs is required for the anti-restenotic effect of insulin in insulin sensitive conditions, which is abolished but not reversed in insulin resistance even when endothelial IR is deficient.

Disclosure
J.Z. Wang: None. C.X. Zhang: None. A. Giacca: None.
1013-P: Risk Factors for Hyperglycemic and Hyperketotic Emergencies in COVID+ Youth with Type 1 Diabetes (T1D)
Authors: TSAI SARAH , TALLON ERIN M. , FERRO DIANA , ZARSE ERICA , WILLIAMS DAVID D. , SHYU CHI REN , CLEMENTS MARK A. 
Published: May 2022

Recent studies report increased frequency of hyperglycemic and hyperketotic emergencies in youth with T1D and coronavirus disease 20 (COVID-19) . Morbidity and mortality risk may be increased in individuals who develop diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar syndrome (HHS) with concurrent COVID-infection.
Using a Cerner RealWorld DataTM COVID-dataset with de-identified information from 490,373 individuals with COVID- (12/2019-9/2020) from 87 U.S. healthcare systems, we examined demographic and clinical characteristics of youth with established T1D and suspected or confirmed COVID-infection. We then used generalized mixed models to evaluate the association of body mass index (BMI) , race and ethnicity, and hemoglobin A1c (HbA1c) to two outcomes: (1) DKA and (2) concurrent DKA and HHS (DKA+HHS) . We used a validated cohort selection algorithm to identify 383 youth (&lt;18 years old; 50.7% female) with T1D. Of these, 35.8% were non-Hispanic White, 27.4% were Hispanic, and 14.9% were non-Hispanic Black/Other (NHB/O) . The most common comorbid conditions were fluid and electrolyte disorders, documented for 64.2% of the cohort. Other frequent comorbid conditions included cardiac arrhythmias (19.3%) , chronic pulmonary disease (17.2%) , and depression (16.2%) . Thirty-nine percent of youths in the cohort experienced DKA only, 1.0% experienced HHS only, and 4.2% experienced DKA+HHS. After adjustment, we found HbA1c to be the only factor associated with increased odds of DKA alone (adjusted odds ratio [AOR]: 1.22; 95% CI (1.09,1.36) ; p&lt;0.001) . Odds of DKA+HHS were markedly increased in NHB/O individuals (AOR: 4.47; 95% CI (1.07,18.72) ; p=0.04) .
Demographic and clinical care factors that associate with increased risk of DKA or DKA+HHS differ among youth with T1D and COVID-infection. Whether risk factors associated with DKA, HHS or DKA+HHS differ among youth with T1D with or without COVID-infection requires further study.

Disclosure
S.Tsai: Stock/Shareholder; Dexcom, Inc. E.M.Tallon: None. D.Ferro: None. E.Zarse: None. D.D.Williams: None. C.Shyu: n/a. M.A.Clements: Consultant; Glooko, Inc., Research Support; Abbott Diabetes, Dexcom, Inc.
1031-P: Psychosocial Problems in Indonesian Children and Adolescents with Type 1 Diabetes (T1D) during COVID-Pandemic
Authors: FADIANA GHAISANI , SOESANTI FRIDA , PULUNGAN AMAN 
Published: May 2022

Objectives: The COVID-pandemic has presented challenges for individuals with chronic diseases in resource-limited settings. Lockdowns and restrictions have decreased access to health care and disrupted medical support. Those challenges might affect the psychological status of children and adolescents with T1D.
Methods: The study was conducted with ethics approval in the Endocrinology Clinic Cipto Mangunkusumo Hospital, Jakarta, Indonesia June 2020-June 2021. Demographic background, COVID-knowledge, challenges and psychosocial problems were assesed using a questionnaire. Surveys were given in person and online.
Results: There were 148 respondents (23 adolescents, 1parents, 14 relatives) . Median age was 13 (3-18) , 51% female. During the pandemic, median A1C was 8.2% and complications that occurred were frequent hyperglycemia (23%) , hypoglycemia (14%) , and ketoacidosis (8%) . Most patients used national health insurance (90%) in public hospital (80%) . Most of the respondents reported being affected by lockdowns in their area (73%) , although many could still visit healthcare facilities (44%) . Despite getting exemption for healthcare visit in lockdown period, about almost half of them felt that their check-up routines were disrupted (41%) mainly due to fear of getting infected with COVID-during visit (34%) . Many children had some psychological problem (51%) such as irritability (26%) , distress (12%) , anxiety (11%) and insomnia (10%) . As many as 37% of them needed psychological support from either health care workers or their relatives.
Conclusions: The COVID-pandemic has presented new challenges for diabetes management in children and adolescents living in resource-limited settings. Patients’ routine visits, access to essential diabetes care and psychological states have been affected. Given the ongoing nature of waves during the pandemic, further studies about the impact of COVID-pandemic on psychological well-being are needed.

Disclosure
G.Fadiana: None. F.Soesanti: None. A.Pulungan: None.
1040-P: Associations between Sleep Characteristics and Changes in Body Weight and Fat from 6–8 Weeks to 6 Months Postpartum in Black and White Women
Authors: WANG XUEWEN , KISHMAN ERIN 
Published: May 2022

The literature indicates Black women tend to lose less weight after pregnancy than White women. Sleep duration and quality have been associated with body weight and fat in other populations. Thus, the purpose of this study was to determine whether associations between sleep characteristics and changes in body weight and fat during postpartum in Black and White women were different. Black (n=29) and White (n=76) women who gave birth to a singleton infant at ≥37 weeks gestation participated in the study. They were instructed to wear an actigraph monitor to measure sleep at 6-8 weeks, 4 months, and 6 months postpartum for 7 days, and to complete a sleep diary. Total sleep time, wake time after sleep onset, and the sleep fragmentation index (an estimate of sleep disruption) were determined. Percent body fat (by dual-energy X-ray absorptiometry) and body weight were determined at 6-8 weeks and 6 months postpartum. A race by sleep characteristic interaction term was included in linear regression models to determine whether Black and White women had different bivariate correlations between sleep characteristics at each time point and changes in body weight and percent body fat from 6-8 weeks to 6 months. Results indicate significant interaction terms of sleep fragmentation index at 6-8 weeks and race for both weight and fat change (p=0.006, and 0.028, respectively) . Specifically, in Black women, sleep fragmentation index at 6-8 weeks were negatively associated with changes in percent body fat and weight (p= 0.027 and 0.032, respectively) , so that greater sleep disruption at 6-8 weeks was associated with less reduction in weight and percent body fat. In White women, these significant associations were absent.
In conclusion, these results suggest different contributions of sleep characteristics to postpartum weight and fat changes in Black and White women. The reasons for the differences need further investigation.

Disclosure
X.Wang: None. E.Kishman: None.

Funding
National Institutes of Health (R21MD012740)
1041-P: Differences in Meeting Trimester-Specific HbA1c Goals in T1D Pregnancies Utilizing CGM vs. SMBG in a T1D Specialty Clinic
Authors: MALECHA EMILY , GAO VALERIE , WESTFELDT ELIZABETH , SNELL-BERGEON JANET K. , POLSKY SARIT 
Published: May 2022

Glycemic control significantly affects the risk for developing adverse gestational health outcomes in pregnancies affected by type 1 diabetes (T1D) . Utilizing continuous glucose monitoring (CGM) in T1D pregnancies has been shown to improve maternal glucose control. We examined the effect of CGM use in meeting HbA1c goals by trimester in T1D pregnancies in a real-world setting.We did a retrospective chart view to identify T1D pregnancies managed at the Barbara Davis Center (BDC) for T1D with either CGM therapy (n=82) or self-monitoring of blood glucose (SMBG) (n=78) over a 6.5-year period (1/1/14 to 8/31/20) . CGM use was defined as &gt;60% wear in the 2nd and 3rd trimesters. HbA1c goals were defined as ≤6.5% in Trimester 1 (T1) and ≤6% in Trimester 2 (T2) and Trimester 3 (T3) , per guidelines by the American Diabetes Association. Baseline characteristics and HbA1c were obtained from the electronic medical record system.CGM users had a significantly higher rate of commercial insurance use (Table) , while other baseline characteristics were similar between groups. CGM users were more likely to meet HbA1C goals in all trimesters (Table) . More than half of SMBG users did not meet HbA1C goals in any trimester (Table) .CGM use significantly increased the likelihood of meeting trimester-specific HbA1c goals in each trimester throughout pregnancy among women with T1D in this real-world study.

Disclosure
E.Malecha: None. V.Gao: None. E.Westfeldt: n/a. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. S.Polsky: Advisory Panel; Medtronic, Other Relationship; diaTribe, Research Support; Dexcom, Inc., Eli Lilly and Company, Leona M. and Harry B. Helmsley Charitable Trust, Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi-Aventis U.S.

Funding
National Institutes of Health (P30-DK116073)
1043-P: Association between Maternal COVID-Infection and Gestational Metabolic Dysfunction in an Urban Academic Center
Authors: FORREST ALEXANDRA D. , CHANDRASEKARAN SUCHITRA , HIGGINS MELINDA , FERRANTI ERIN 
Published: May 2022

Objective: Nonpregnant individuals with diabetes mellitus (DM) or hypertension (HTN) experience greater complications of COVID-infection. Gestational DM (GDM) and hypertensive disorders of pregnancy (HDP) confer increased maternal and fetal morbidity; but whether the association of DM and HTN with COVID-illness in the non-pregnant state also exists in pregnancy is unclear. Therefore, we investigated associations between COVID-and GDM and HDP in a large urban inner-city population.
Study Design: We performed a case control study among women with and without COVID-infection; controls were matched for gestational age and time of COVID-test between 3/2020 and 10/2020. Maternal demographic and clinical data including COVID-infection status were abstracted. Chi-square, logistic and linear regression were used for analysis.
Results: A total of 87 women with and 9women without COVID-infection were included in the study. There was no significant association between COVID-infection and GDM (10.3% COVID positive, 9.9% COVID negative, p=0.89) . Similarly, there was no association between COVID-infection and HDP (37.9% COVID positive, 37.3% COVID negative, p=0.911) . Despite no associations between COVID-infection and GDM or HDP, subjects with COVID-infection were more likely to be obese based on pre-pregnancy BMI (p = 0.047) .
Conclusions: Unlike in the non-pregnant state, COVID-infection was not significantly associated with GDM or HDP in our diverse, urban inner-city population. Our data suggest that beyond gestational metabolic dysregulation, maternal obesity alone may increase a woman’s vulnerability to COVID-infection in pregnancy. Given that the COVID-pandemic is still rampant, and that obesity affects one third of reproductive age women, future studies are essential to elucidate the mechanisms underlying this association.

Disclosure
A.D.Forrest: None. S.Chandrasekaran: None. M.Higgins: None. E.Ferranti: None.
1044-P: Impact of Pregnancy on Microvascular and Cardiac Outcomes in Youth-Onset Type 2 Diabetes
Authors: TRYGGESTAD JEANIE B. , KELSEY MEGAN M. , ARSLANIAN SILVA A. , CHERNAUSEK STEVEN , DREWS KIMBERLY , ESCANAME ELIA N. , GEFFNER MITCHELL , ISGANAITIS ELVIRA M. 
Published: May 2022

This analysis compared microvascular and cardiac outcomes from women in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study, originally diagnosed with youth-onset Type 2 diabetes between the ages of 10-17 yrs, who experienced a pregnancy lasting 20 wks during the course of the study vs. those without. Pregnancy information was obtained prospectively by self-report followed by medical record review. Neuropathy and nephropathy were assessed annually. Retinopathy, echocardiography, and arterial stiffness were assessed twice during the study. Women with a history of pregnancy prior to the initial assessment were excluded. Of the 4women in TODAY, 116 reported a pregnancy lasting ≥ 20 weeks, with 67 having a single pregnancy and 49 with multiple pregnancies. The mean age at first pregnancy was 21.6 yrs. and mean diabetes duration 8 yrs. At study entry, women who reported a pregnancy during the trial were older (14 yrs. vs. 13.6 yrs., p=0.05) with lower household income (51.5% vs. 37.8% below $25,000, p=0.002) . Primary study outcome, defined as HbA1c &gt;8% or inability to wean from insulin, was similar between the two groups. In Cox regression models adjusted for participant characteristics from study entry including age, race/ethnicity, household income, diabetes duration, HbA1c (&gt;6%) , and BMI, women with a pregnancy had an increased risk of hyperfiltration, 2.76 (1.38-5.49) , p=0.0vs. those without a pregnancy. No differences were observed in rates of retinopathy, neuropathy, or macro- and microalbuminuria in women with vs. without a history of pregnancy. In fully adjusted models, history of pregnancy did not impact echocardiographic measures or arterial stiffness obtained prior to the reported pregnancy versus the measures after the pregnancy. These results suggest that pregnancy increases the risk of hyperfiltration in women with youth-onset T2D, but not other micro or macrovascular complications.

Disclosure
J.B.Tryggestad: None. M.M.Kelsey: Other Relationship; Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Rhythm Pharmaceuticals, Inc. S.A.Arslanian: Advisory Panel; Eli Lilly and Company, Novo Nordisk, Other Relationship; AstraZeneca, Research Support; Eli Lilly and Company, Novo Nordisk. S.Chernausek: None. K.Drews: None. E.N.Escaname: None. M.Geffner: Advisory Panel; Novo Nordisk, Pfizer Inc., Research Support; Novo Nordisk. E.M.Isganaitis: Research Support; AstraZeneca, Dexcom, Inc., Insulet Corporation.

Funding
U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254