bluuebunny/crossref_metadata_2025_split huggingface dataset:
487-P: Posttranslational Modifications of Apolipoproteins C-I, C-II, and C-III and Peripheral Artery Disease in Multiethnic Study of Atherosclerosis (MESA)
Authors: REAVEN PETER , HANSEN SPENCER , HU YUEMING , FURTADO JEREMY , SINARI SHRIPAD , BILLHEIMER DEAN , NEDELKOV DOBRIN , BUDOFF MATTHEW , MCCLELLAND ROBYN , KOSKA JURAJ 
Published: May 2022

Apolipoproteins (apo) C-I, C-II and C-III in circulation are in several post-translational forms with distinct effects on lipoprotein metabolism. ApoC-I and apoC-II exist as dominant native and minor truncated (C-I’; C-II’) forms; apoC-III appears as unglycosylated (C-III0a) , or glycosylated with zero (C-III0b) , one (C-III1, most abundant) or two (C-III2) sialic acids. The association of these proteoforms with peripheral artery disease (PAD) in a general population is unstudied. Total apoC-I, C-II and C-III concentrations and relative amounts of their proteoforms were measured in baseline plasma of 5,681 MESA participants. The ankle-brachial index (ABI) was assessed at baseline, 3 and years. Prevalent PAD was defined as baseline ABI ≤ 0.9. Incident PAD was follow-up ABI ≤ 0.9 or a hospital-based diagnosis of PAD to include revascularization. After adjustment for baseline characteristics, lipid lowering therapy and plasma lipids, low baseline ABI was associated with low C-III0b to C-III1 ratio (C-III0b/III1, p=0.01) and high C-III2 to C-III1 ratio (C-III2/III1, p&lt;0.01) . Prevalent PAD (n=226) was only associated with C-III2/III1 (OR 1.16, 95% CI: 1.01-1.33, p=0.03) . Lower ABI at follow-up was associated with lower C-III0b/III1 and higher C-III2/III1 at baseline (p&lt;0.both) . Incident PAD (n=244) was associated with C-III2/III1 (HR 1.22, 1.06-1.41, p=0.01) . Total apoC-I, C-II and C-III concentrations, or apoC-I and C-II truncations were not associated with ABI at baseline and follow-up, or with cross-sectional and prospective PAD determinations. ApoC-I and apoC-II and their truncations do not appear linked with PAD. In contrast, we find different associations of apoC-III0b and apoC-III2 with prevalent and incident PAD that are independent of other risk factors, including plasma lipids. Our data provide further support that proteoforms may have unique properties not captured by “total” apolipoprotein measures.

Disclosure
P.Reaven: Research Support; AstraZeneca, Dexcom, Inc. J.Koska: None. S.Hansen: None. Y.Hu: None. J.Furtado: Research Support; Eli Lilly and Company, Pfizer Inc. S.Sinari: None. D.Billheimer: None. D.Nedelkov: None. M.Budoff: Research Support; Amarin Corporation, Novo Nordisk, Speaker's Bureau; Boehringer Ingelheim International GmbH, Lilly. R.Mcclelland: None.

Funding
National Institutes of Health (R01-HL138969)
488-P: Diabetes-Related Major and Minor Amputation Risk Increased during the COVID-Pandemic
Authors: BANKS JAMINELLI 
Published: May 2022

Background: Along with significant case transmission, hospitalizations, and mortality experienced during the global COVID-pandemic, there existed a disruption in the delivery of health care across multiple specialties.
Objective: The aim of our review was to analyse the possible relationship between COVID-infection and amputations. Methods We conducted a 2-year retrospective cohort study with prospective long-term follow-up of all diabetic patients admitted for a foot lesion at 353-bed, nonprofit, faith-based teaching hospital. Study variables included patient demographics and clinical parameters related to infection and diabetes. The average follow-up after hospital discharge was 2 years. Failure of conservative treatment was the main outcome measure. Independent predictor variables were selected by logistic regression analysis.
Results: A total of 849 consults were identified for use in the study, 356 consults for 20 and 493 consults for 2021. We excluded trauma/noninfectious consults. This represents a 38% increase in the number of podiatric consults over the time frame. On average, 42% of consults required podiatric surgical intervention for management/prevention of infection in 2021 compared to 44% in 2019. Amputation rates have fallen from 37.08% to 32.45% from 20to 2021. Rates of minor amputations decreased from 22.75% to 19.07%, rates of moderate amputations decreased from 5.06% to 4.87%, rates of major amputations decreased from 9.27% to 8.52% from 20to 2021, respectively.
Conclusion: The effect of the pandemic on the health-care system has had a deleterious effect on people with diabetes-related foot problems resulting in more severe infections, more emergencies, and necessitating more amputations.

Disclosure
J.Banks: None.
49-OR: Ten Years of the National Diabetes Prevention Program: Ten Years of Impactful Changes
Authors: ELY ELIZABETH 
Published: May 2022

In 2010, Congress authorized the creation of the National Diabetes Prevention Program to build a nationwide delivery system for a lifestyle change program (LCP) proven to prevent or delay the onset of type 2 diabetes. In 2012, the Diabetes Prevention Recognition Program (DPRP) approved its first CDC-recognized organization. Over the last years, CDC has recognized ∼4000 organizations to deliver the LCP to 500,000+ participants. This analysis looks at the impact of changes to the DPRP national quality standards on participant outcomes. The initial version of the DPRP Standards covered the period 1/1/12-12/31/14. Later versions were released on 1/1/15, 3/1/18, and 5/1/21. Data for participants who entered the LCP during each version were analyzed with respect to enrollment, starting body mass index (BMI) , and % weight change. Enrollment during version 1 climbed to 24,614 based on in-person delivery. Version 2 introduced virtual delivery and enrollment reached 227,329. Version 3 reflected changes to accommodate the Medicare Diabetes Prevention Program. In-person enrollment increased 36% from 2018 to 2019, while online enrollment decreased over that period. Version 3 saw the public health emergency that caused most in-person enrollment to halt while organizations shifted to virtual platforms. In-person enrollment during 2020 ranged from a low of 763 in April to almost normal numbers of 2000+/month by September. Mean BMI was highest for those who started the LCP in 2012 (version 1) and 2021 (version 4) at 36.2 and 36, respectively. Those enrolled in organizations using combination (in-person + virtual) delivery had the highest mean BMI, regardless of version. Mean % weight loss for those who completed 9+ months of the LCP was highest during version 1 (6.3) . Version 3 produced the lowest at 5.2, which was also the mean % in 2020. The DPRP has endured program changes, as well as external factors. The evidence-based LCP continues to enroll participants looking to reduce their risk of developing type 2 diabetes.

Disclosure
E.Ely: None.
499-P: Optimizing Diabetes Education before Total Pancreatectomy with Islet Cell Autotransplantation (TPIAT)
Authors: ELLISON RACHEL E. , TELLEZ SIOBHAN E. 
Published: May 2022

Background: Caregivers of pediatric recipients of a TPIAT must receive extensive education prior to discharge home. Retrospective review found caregivers were often surprised by the amount of education required and were not prepared to learn while their child was recovering from surgery. Expectations of preparedness were not uniformly reinforced with caregivers, despite available resources. We aimed to provide caregivers with comprehensive education pre-surgery in line with programmatic goals to reduce the inpatient length of stay (LOS) post-TPIAT.
Method: We reviewed education time and days for 17 pre-intervention patients (September 2019-August 2020) , and 20 post-intervention patients (August 2020-October 2021) . Diabetes education time was consistently documented in the chart and represented the largest proportion of education needed prior to discharge. Pre-intervention patients received a printed binder of diabetes education and met with diabetes educators at least once in the 6 months prior to surgery. Post-intervention patients received an email with digital links to the timeline and expectations of pre-surgery education, modules for education on diabetes, medication administration, and feeding tube care, and received follow-up phone calls. The intervention was developed using the Plan-Do-Study-Act (PDSA) model of improvement.
Results: Prior to the intervention, patients averaged 7minutes of inpatient education spread over an average of 6.4 days. After implementation, patients averaged 575 minutes spread over 4.7 days. There was no cost associated with the development of the intervention.
Conclusion: We created our intervention in response to the goal of reducing LOS and adapted it to the low-resource and staffing constraints of a pandemic. We generated a free, sustainable tool that used existing resources. Though our project is ongoing, we are encouraged that inpatient education has been reduced from 7to 575 minutes and from 6.4 to 4.7 days.

Disclosure
R.E.Ellison: Other Relationship; AbbVie Inc. S.E.Tellez: None.
50-OR: Peer Support Improves Health Behaviors in People with Prediabetes
Authors: SCHMITTDIEL JULIE , FINERTIE HOLLY , RODRIGUEZ LUIS A. , THOMAS TAINAYAH , SANCHEZ PERLA , HEISLER MICHELE 
Published: May 2022

Up to one third of Americans have prediabetes, a condition of elevated glucose levels linked with greater diabetes incidence. Strong evidence shows that peer support is an effective strategy to improve outcomes for people with diabetes; however, no studies have examined whether peer support can be leveraged to improve outcomes in people with prediabetes. The “Using Peer Support To Aid in Prevention and treatment of Prediabetes (UPSTART) ” study is a pragmatic randomized controlled trial at Kaiser Permanente Northern California and the University of Michigan that randomized 351 people with prediabetes (A1c 5.7-6.4; BMI &gt;25 or BMI &gt;23 for Asian patients) from 10/19/2018-3/31/2021 to one of two study arms: a peer support intervention with 1:1 matching of prediabetes patients with coaches trained in motivational interviewing (intervention group) ; or enhanced usual care (control group) . All participants received information on healthy eating, active living, wellness, and diabetes prevention programs. Lifestyle and psychosocial factors were measured via baseline and six-month surveys. In our sample, 2of study patients were female; 1were Black; 147 were White; 31 were Hispanic/Latino; 30 were Asian; 24 were Multiracial or ‘Other’ race. At six months, intervention participants had higher participation in diabetes education and prevention programs (25.2% vs. 11.1%, p=.002) ; higher Patient Activation Measure (PAM) scores (68.9 vs. 65.7 on a 0-100 scale, p=.043) ; greater perceived social support (55.3 vs. 49.6 on a 12-72 scale; p&lt;.001) ; and greater whole grain consumption (19.2 vs. 14.5 days out of 30; p=.024) compared to controls. There were no differences in physical activity, vegetable, fruit, or soda consumption at six months. A peer-support program for people with prediabetes has a positive impact on factors linked to diabetes prevention and better health outcomes. Future research from this study will examine whether the intervention and these improvements are also associated with decreased A1c and weight.

Disclosure
J.Schmittdiel: None. H.Finertie: None. L.A.Rodriguez: None. T.Thomas: None. P.Sanchez: None. M.Heisler: n/a.

Funding
National Institutes of Health (R18DK113403)
500-P: Gaps in Patient Education upon Initial Diabetes Diagnosis among Adults Living with Type 1 and 2 Diabetes in the United States
Authors: XU EMILY , GOWEN REBECCA , STEVENSON JULIA , MONROY-SPANGENBERG ERIK , WOOD RICHARD 
Published: May 2022

Patient education is an essential component of diabetes care that can influence diabetes management self-efficacy and help prevent long-term health complications for people with diabetes (PWD) . The present study aims to understand unmet needs in patient education upon initial diabetes bolddiagnosis.
In December 2021, 1,056 adult PWD in the United States completed an online survey in which they indicated their satisfaction with the education they received from their healthcare provider (HCP) upon first being diagnosed with diabetes on a 10-point scale. Respondents who were diagnosed within the last years and gave a satisfaction score of 1-6 were asked to explain what information they wish they had received upon diagnosis. The subsequent 472 qualitative write-in responses (29% type 1, 74% female) were coded and analyzed.
Among all respondents, 47% were not satisfied with the information they received at diagnosis (satisfaction score of 1-6) . Over a fifth of type 1 (22%) and over a quarter of type 2 (27%) adults reported receiving little to no information about diabetes from their HCP upon diagnosis. Over a quarter (28%) of type 1 PWD reported being initially misdiagnosed or not properly diagnosed at all, and 7% reported a lack of empathy from their HCP upon diagnosis. Type 1 PWD also reported gaps in education on monitoring and managing blood glucose levels (22%) , diet and exercise management (12%) , and diabetes technology options (10%) . Type 2 PWD most commonly reported a need for more information on diet and exercise management (37%) ; 17% also reported a lack of education on monitoring and managing managingblood glucose levels.
These results highlight widely reported gaps in adequate diabetes education and support from healthcare providers at the time of PWDs’ initial diagnosis. Steps must be taken to provide PWD with improved education and empower PWD in their diabetes management with the help of free, accurate, and accessible resources.

Disclosure
E.Xu: Employee; dQ&A. R.Gowen: Other Relationship; Abbott Diabetes, Ascensia Diabetes Care, Beta Bionics, Inc., Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, LifeScan, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc., Virta Health Corp. J.Stevenson: Other Relationship; Abbott Diabetes, Ascensia Diabetes Care, Beta Bionics, Inc., Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, LifeScan, Medtronic, Roche Diabetes Care, Tandem Diabetes Care, Inc. E.Monroy-spangenberg: Employee; dQ&A, Stock/Shareholder; Senseonics. R.Wood: Other Relationship; Multiple companies and patient organizations (&gt;10) .
503-P: Online, Interactive Case Study Is Successful at Improving Pharmacists’ Knowledge, Competence, and Confidence Related to Use of CGM and Patient Education in Practice
Authors: LARKIN AMY , SCHRAND JULIE , LE ANNE 
Published: May 2022

Objective: We sought to determine if online, case-based medical education with patient vignettes could improve the knowledge, competence and confidence of pharmacists related to CGM use and education.
Methods: The CME activity was a 15-minute interactive case study with pharmacist-patient vignettes featuring a patient initiating CGM. A repeated pairs pre-/post-assessment study design and chi-square test (P &lt;.is considered significant) assessed educational effect, with Cohen’s d being used to assess educational impact (0.06-0.15 is a noticeable effect, 0.16-0.26 considerable, and &gt;0.26 extensive) . The activity launched February 23, 2021 and data were collected through April 12, 2021.
Results: In total, 359 pharmacists were included in the analysis. Matched learner data indicate that overall, 64% improved their knowledge and competence from pre-to-post (P&lt;.with extensive overall impact 0.96) . On a question-level: 49% of pharmacists (P&lt;.01) improved knowledge of differences among available CGM systems in the US. 29% of pharmacists (P&lt;.01) improved competence related to educating patients about time in range goals. 4% of pharmacists (P=NS; 87% were reinforced) improved competence related to patients education related to hypoglycemia as it relates to CGM use. Overall, 71% of pharmacists reported increased confidence in education patients on CGM use, for a total confidence shift of +89% for those with increased confidence.
Conclusion: This study demonstrates the success of an interactive case study directed at pharmacists on improving knowledge, competence and confidence related to CGM use. Case-based education with interactive polling questions and detailed explanations related to best choices should be employed more often to help pharmacists apply knowledge/skills into practice to expand their role on the healthcare team and improve patient management.

Disclosure
A.Larkin: None. J.Schrand: None. A.Le: None.

Funding
Developed through an Independent Educational Grant from Dexcom.
509-P: Trends in Diabetes Self-Management Education and Support Referrals in Kentucky: 2016–2019
Authors: BRYANT GEORGE C. , KECK JAMES , LACY MARY E. 
Published: May 2022

Background: Diabetes self-management education and support (DSMES) services are an integral part of quality diabetes care. However, despite strong evidence regarding its effectiveness and clear guidelines from the ADA recommending its use, &lt;10% of eligible patients have received DSMES. In this study, we examine rates of referral to DSMES across specific subgroups at an academic medical center in Kentucky.
Methods: We analyzed patterns of DSMES referrals at University of Kentucky HealthCare from 1/1/2016-12/31/20among adult patients (aged ≥ 18) with diabetes (ICD-9: 249, 250; ICD-10: E08-E13) . We restricted our sample to patients receiving primary care at UKHC with at least 365 days of follow-up and examined referral rates across the following subgroups: sex, race/ethnicity, age group, insurance type.
Results: In our sample of 3,854 patients with diabetes (mean (SD) age=56.8 (13.9) ; 50% female) , 9.3% of eligible patients were referred for DSMES. Referral rates were higher in non-Hispanic Black patients (14.5%) compared to non-Hispanic Whites (9.4%) and Hispanics (9.4%; p&lt;0.001) . Females were more likely to be referred for DSMES than males (12.3% vs. 8.7%; p&lt;0.001) and younger patients were more likely to be referred than older patients (27.5% of patients age 18-24 vs. 5.0% of patients aged 65+; p&lt;0.0001) . Referral rates were lower in patients with Medicare coverage (7.6%) compared to those with Medicaid (13.0%) or commercial insurance (11.6%; p&lt;0.0001) .
Conclusions: Results from our study highlight low referral rates for DSMES services in the primary care setting for patients with diabetes. Our findings also underscore disparities in key subgroups that can be targeted to improve DSMES referrals. Of particular significance are differences in DSMES referral rates across age categories. Older patients face diabetes-related challenges they may change as they age. The importance of continuing DSMES services across the lifespan should be highlighted.

Disclosure
G.C.Bryant: None. J.Keck: None. M.E.Lacy: None.

Funding
National Institutes of Health (UL1TR000117, UL1TR001998, KL2TR001996)
51-LB: Depression Scores and Suicide Attempt History Are Independently Associated with Hemoglobin A1c (HbA1c) in Adolescents and Young Adults with Type 1 Diabetes
Authors: GETTINGS JULIE M. , PANTESCO ELIZABETH J. , FLOYD ALFONSO , WILLI STEVEN M. 
Published: May 2022

Adolescents and young adults (AYA) with type 1 diabetes (T1D) are at an elevated risk for depression and suicide, and regular screening is an integral part of medical care. The Patient Health Questionnaire-9 Adolescent Version (PHQ-9; Johnson et al., 2002) is commonly used to screen for depression and suicide risk, and more information is needed about how ratings relate to diabetes management. The goal of this study was to quantify PHQ-9 scores, suicidal ideation (SI) in the past 2 weeks, and suicide attempt history (SAH) in AYA with T1D and to examine their relationships with HbA1c. The PHQ-9 was electronically administered to AYA with T1D (n = 759) at outpatient medical visits, and results from the PHQ-9, relevant background variables (age, sex, race, diabetes duration, BMI and systolic blood pressure) , and HbA1c values were obtained from the medical record. On average, AYA were 17.2 years old, had diabetes for 7.6 years, and had an HbA1c of 8.5%. On the PHQ-9, 72.6% scored in the normal range (0-4) , 19.9% in the subthreshold range (5-10) , and 7.5% at or above threshold (≥ 11) . SI was reported by 4.2% of the sample and 5.3% noted SAH. In linear regression models adjusted for relevant background variables, greater levels of PHQ-9 symptoms were associated with higher HbA1c (B = .06, p &lt; .001) . When examining categories of PHQ-9 scores, those with subthreshold depressive symptoms had marginally higher, (B = .331, p =.07) , and those at or above threshold had significantly higher, HbA1c (B = .799, p =.003) . SI was not associated with HbA1c, but SAH was associated with higher HbA1c (B = 1.13, p &lt; .001) . Notably, PHQ-9 scores (B = .05, p =.005) and SAH (B = .884, p =.007) were each independently associated with higher HbA1c after adjusting for the other. These findings highlight the importance of identifying and providing additional support for AYA with elevated PHQ-9 scores, as well as those with SAH even if current depression scores are not concerning.

Disclosure
J. M. Gettings: None. E. J. Pantesco: None. A. Floyd: None. S. M. Willi: Advisory Panel; Boehringer Ingelheim International GmbH, Medtronic, Other Relationship; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; Jaeb Center for Health Research, Provention Bio, Inc.
51-OR: Anxiety and Changes in Health Care Access and Health Behaviors during COVID-in Southwest Tribal Community Patients with Prediabetes and Diabetes
Authors: RENO JESSICA , ZHU YILIANG , SHAH VALLABH 
Published: May 2022

Objective: The impact of COVID-has been devastating to many, but particularly to rural populations of American Indians from Zuni Pueblo who suffer multiple vulnerabilities which places them at greater risk for infection and death. Very little is known about the change in health behaviors owing to the COVID pandemic among a chronically ill (diabetes) rural Zuni population. We evaluated the anxiety and stress about COVID-contributing to poorer mental health outcomes in Zuni Indians with PreDM and T2DM.
Methods: We conducted a survey among individuals with hyperglycemia in Zuni Indians. There were 300 participants who responded to the survey, of which 193 participants also had baseline clinical health data.
Results: Those with T2DM experienced higher pandemic-related anxiety than those with pre-DM (+3.9 vs. -0.6, p=0.0616, on a scale -30 to +30) . Those with T2DM were more likely to report decreased physical activity (54% vs. 44%) , decreased frequency in lab testing (21% vs. 10%) , and increased virtual contact with providers (61% vs. 48%) during the pandemic. We conducted regression analyses to describe correlations of anxiety and weight change with the changes in health behaviors. We found that participants with improved diet and exercise during the pandemic were less likely to experience weight gain (OR= 0.78, p=0.0017 and OR=0.75, p=0.0094, respectively) . We also found that those who reported worsening health care during the pandemic experienced increased anxiety (+4.9, p=0.0049) .
Conclusion: Our study provides important insights into (unintended) consequential effect of COVID crisis in rural Zuni which will contribute to a better understanding of how to preserve mental health and maintain health behaviors in patients with diabetes during the pandemics.

Disclosure
J.Reno: None. Y.Zhu: None. V.Shah: n/a.

Funding
National Institute of General Medical Sciences of the National Institutes of Health (P20GM103451)