A1c Testing Research Articles

Can the level of HbA1C predict diabetic retinopathy among type II diabetic patients?

BackgroundHemoglobin A1C (HbA1C) test is the best care evaluation measurement due to a strong correlation between the test results and diabetic complications. So, this cross-sectional study aimed to assess whether the level of HbA1C can predict Diabetic Retinopathy (DR) among Type 2 diabetes mellitus (T2DM) in the Iranian population.MethodOne hundred sixty-eight diabetic patients were selected via the convenience sampling method. Data were collected by research made questionnaire scale and laboratory test had been done. To estimate the cut off point for some variables statistical tests, formal measures of classification performance, model evaluation criteria and a decision Tree were used.ResultsThe prevalence of DR was 29.8%. The Receiver Operating Characteristic (ROC) curve and decision tree showed the optimal cut-off point for the HbA1C variable that separates the patient with and without DR is HbA1C = 8.15.ConclusionCurrent study showed an appropriate cutoff point for detecting the development of DR among diabetic patients. So, this cutoff point can be used as guide evidence in several clinical judgments on the Iranian population.

Suicidal Ideation and Depression in Hospitalized Patients With Metabolic Syndrome

Background and Objective The increase in the global prevalence of metabolic syndrome has become a major public health problem. Few studies have been conducted on the relationship between psychiatric disorders and metabolic syndrome in Iran; therefore, we investigated the association between depression and suicidal ideation amongst patients with metabolic syndrome. Materials & Method This study was a descriptive cross-sectional study to determine the prevalence of depression and suicidal ideation among 150 patients with metabolic syndrome referred to the Endocrinology Department of Afzalipour General Hospital, Kerman City, Iran, in 2019. The study data were obtained using the Beck scale for suicide ideation, Beck Depression Inventory (BDI-II), and demographic information questionnaire. The last hemoglobin (Hb)A1C test, body mass index (BMI), blood pressure, high-density lipoprotein (HDL), cholesterol, triglyceride test, and waist circumference were gathered according to ATP III guidelines. Analyses of variance, the t test, the Pearson test, multiple regression, and the Spearman test were performed for statistical analyses. Results About 52.6% of participants were male, 87.3% were married, and 77.4% lived in the city. Also, 59.4% had depression, and suicidal ideation was prevalent among them: 50% of the samples had suicide ideation, and 8% were ready to commit suicide. There were significant positive correlations between suicide ideation and mean age, duration of illness, BMI, mean HbA1C level, fasting blood sugar (FBS), and depression, but there was a significant negative correlation between suicide score and HDL level. Conclusion Awareness of these factors can help identify high-risk people. It is suggested that particular consideration be given to the various dimensions of psychiatric issues related to people with metabolic syndrome.

Ensuring Equitable Care in Diabetes Management Among Patients of Health Resources & Services Administration-Funded Health Centers in the United States.

To explore whether there are racial/ethnic differences in diabetes management and outcomes among adult health center (HC) patients with type 2 diabetes. We analyzed data from the 2014 Health Center Patient Survey, a national sample of HC patients. We examined indicators of diabetes monitoring (A1C testing, annual foot/eye doctor visits, and cholesterol checks) and care management (specialist referrals, individual treatment plan, and receipt of calls/appointments/home visits). We also examined diabetes-specific outcomes (blood glucose levels, diabetes-related emergency department [ED] visits/hospitalizations, and diabetes self-management confidence) and general outcomes (number of doctor visits, ED visits, and hospitalizations). We used multilevel logistic regression models to examine racial/ethnic disparities by the above indicators. We found racial/ethnic parity in A1C testing, eye doctor visits, and diabetes-specific outcomes. However, Hispanics/Latinos (odds ratio [OR] 0.26), non-Hispanic African Americans (OR 0.25), and Asians (OR 0.11) were less likely to receive a cholesterol check than Whites. Non-Hispanic African Americans (OR 0.43) were less likely to have frequent doctor visits, while Hispanic/Latino patients (OR 0.45) were less likely to receive an individual treatment plan. HCs largely provide equitable diabetes care but have room for improvement in some indicators. Tailored efforts such as culturally competent care and health education for some racial/ethnic groups may be needed to improve diabetes management and outcomes.

Onset of Ulcerative Colitis in a Patient with Type 2 Diabetes: Efficacy of a Plant-Based Diet for Both Diseases

No case has been reported in which ulcerative colitis occurred in a patient with type 2 diabetes mellitus and the patient was treated with a plant-based diet. A 56-year-old man with a 3-year history of diabetes noticed bloody stool about 2 months after his worst glycated hemoglobin A1c test. Endoscopy revealed diffuse inflammation in the rectum. He was diagnosed with ulcerative colitis (proctitis, mild severity). He underwent educational hospitalization. A plant-based diet (1400 kcal/day) was provided. The same dosage of metformin was continued, but no medication was prescribed for ulcerative colitis. At the end of hospitalization, fecal occult blood 271 ng/mL became negative. Glycated hemoglobin A1c 6.9% had decreased to 6.6%. Two months after discharge, glycated hemoglobin A1c decreased to normal for the first time in 3.5 years. Ulcerative colitis had been in remission without medication for one and a half years after the educational hospitalization. Thereafter, however, he experienced two flareups. Deterioration in glycated hemoglobin A1c preceded the flareups. We described a scarcely reported case in which ulcerative colitis occurred in a patient with diabetes and the patient was treated with a plant-based diet. The plant-based diet was effective for both diseases. It seemed that the status of diabetes influenced the onset and relapse of ulcerative colitis.

The Effectiveness of Unified Trans Diagnostic Treatment Protocols on Parent-Child Interaction and Blood Sugar Levels in Adolescents with Type 1 Diabetes

Objective: The parent-child relationship and the daily blood sugar control by adolescents can affect family functioning. This study aimed to evaluate the effectiveness of unified trans-diagnostic treatment protocols on parent-child interaction and blood sugar levels in adolescents with type 1 diabetes.
 Materials and Methods: The present study was quasi-experimental with a pretest and posttest design and a control group. The statistical population of the study included all adolescents aged 12-15 years with type 1 diabetes referred to the Iranian Diabetes Society and their parents in 2020. Out of this population, 44 were selected using the convenience judgmental sampling method and randomly divided into two groups (n= 22). The Child-Parent Relationship Scale (CPRS) was used to investigate the parent-child interaction, and hemoglobin pre-and post-program tests were used to assess blood sugar. Adolescents and parents in the experimental group received the program during 17 sessions. Data were analyzed using the analysis of covariance. Statistical analyses were performed by SPSS software version 22.
 Results: The means of corrected post-test scores of the Child-Parent Relationship Scale and hemoglobin A1c tests were significantly different in the experimental and control groups (P= 0.001).
 Conclusion: The unified trans-diagnostic treatment protocols affect parent-child interaction and blood sugar levels in adolescents with type 1 diabetes. It is possible to use this program to educate adolescents with diabetes and their families and preventive interventions.

Israeli COVID lockdowns mildly reduced overall use of preventive health services, but exacerbated some disparities

BackgroundDuring 2020, Israel experienced two COVID-19-related lockdowns that impacted the provision of primary and secondary preventive care.MethodsWe examined the month-by-month performance of selected preventive care services using data from Israel’s national Quality Indicators in Community Healthcare program. Process of care measures included hemoglobin A1c (HbA1c) testing, cholesterol testing, colon cancer screening and mammography. Intermediate outcome measures included low-density lipoprotein control and HbA1c control. Measures were stratified by sex and by area-level socioeconomic position (SEP). Diabetes and mammography are presented in this abstract due to space limitations.ResultsAnnual HbA1c testing among persons with diabetes decreased from 90.9% in 2019 to 88.0% in 2020. Performance of HbA1c tests during lockdown months was as low as half the usual amount. There were compensatory increases in testing during post-lockdown months that did not quite make up for the missed tests. In 2019, 9.0% of Israelis with diabetes had poor glycemic control (HbA1c ≥ 9.0); in 2020, it was 8.8%. In total, 4.5% fewer mammograms were performed in 2020 compared with 2019. Women in the lowest SEP level performed 10.4% fewer mammograms in 2020 than in 2019, while women in the highest SEP level performed 3.1% more mammograms.ConclusionsProlonged COVID lockdowns in 2020 were associated with marked decreases in the performance of preventive health services during those months. Compensatory spikes following the end of lockdowns partly, but did not completely, make up for the missed care. COVID lockdowns may have exacerbated socioeconomic disparities in some preventive health services.

Factors affecting blood sugar levels in type 2 diabetic patients referred to Imam Reza Clinic of Arak, Iran

Background and aims: An efficient diabetes control delays the emergence of the side effects of the disease. The present study aimed to assess factors associated with blood sugar indices in type 2 diabetic patients. Methods: This cross-sectional study was conducted among 201 diabetic individuals who were referred to Imam Reza Clinic in Arak, Iran, in 2019. To this end, all type 2 diabetes mellitus patients subjected to fasting blood sugar (FBS), 2-hour postprandial (2hpp), and hemoglobin A1c (HbA1c) tests during the recent one month were selected using a convenience sampling method. Additionally, a demographic checklist and the Health Literacy for Iranian Adults questionnaire were filled out through face-to-face interviews. Results: Based on the results, blood sugar levels, especially HbA1c were related to residence (P=0.012) and access to health clinics (P=0.028) so that those with easier access had lower blood sugar indices. Further, an inverse correlation was observed between the HbAlc value and health literacy (P=0.013). An increase in the education level improved blood sugar amount, although the relationship was not significant. Finally, the mean value of 2hpp was related to the family support level, thus better family support led to a lower amount. Conclusion: The results suggested a relationship between access to health clinics, residence, family support, health literacy, and occupation with blood sugar levels in diabetic subjects.

MEDICATION-FREE MANAGEMENT OFTYPE 2 DIABETESMELLITUS: EMPIRICAL AND MODELING-BASED CASE STUDY

This study addresses the possibility of medication-freemanagement of type 2 diabetesmellitus (DM). Typical glucose values, in terms of hemoglobin A1C (HbA1C) test resultsof less than6.0%, could be attained by consuming low carbohydrate meals and participating in physical exercises without pharmaceutical adjuncts. Four to six meals should be consumed in 12 hours, preferably during the days activities between six in the morning and six in the evening. It is important to walk for about one hour after the main meal, although a better practice is to wait two to three hours after the main meal before doing so. Such an approach assures low glucose levels at night. When possible, lifting weights to develop muscles can help regulate sugar levels in the blood and maintain homeostasis. There are empirical findings that HbA1C values could be reduced by 0.5 in 23 days. These findings were supported by simulation results based on Bergmans minimal model ofblood glucose control. The minimal model is modified to address the role of low-carb meals and physical exercises by simulation and is used to study the effects of different model parametersthat represent the liver and muscles. Simulation-based sensitivity analysis is presented, showing positive results toward mitigating type 2 DM.

Viscoelastic or Viscoplastic Glucose Theory (VGT #94): Using a VGT Energy Tool to Study Pancreatic Beta-Cell Insulin Resistance and Non-Alcohol Fatty Liver Disease Via Triglyceride and Glucose Index Biomarker of TyG for a Type 2 Diabetes Patient over 10 Years from Y2013 to Y2022 Based on GH-Method: Math-Physical Medicine (No. 684)

The primary purpose of this report is to study the role of triglyceride and glucose index biomarker (TyG) in diabetes and chronic disease control. The author utilized his collected 26 data sets of lab-tested triglyceride (TG) and finger-pierced fasting plasma glucose (FPG) over the past 10 years from 1/4/2013 through 4/21/2022. On average, the data has an averaged time interval of ~130 days between testing for TG and hemoglobin A1C (HbA1C) from clinical laboratories or hospitals. Furthermore, he has utilized 90-days or 130-days of moving average finger-pierced FPG data in this study. In this study, he has used his collected data from the past 10 years to examine his TyG levels. Diabetes conditions contend with glucose production amount along with the storage of glucose in the liver, and insulin secretion (quantity) or insulin resistance (quality) from the pancreatic beta cells. The additional TyG biomarker and triglycerides (TG) biomarker are also utilized in evaluating the situation of insulin resistance. This demonstrates the connectivity of diabetes with both glucose and lipids in blood vessels and their relation- ships with the health conditions of the liver and pancreas. The author has self-studied and researched his diabetes and its related complications during the past 13 years (see Methods section); therefore, he understands the linkage of glucose biophysical characteristics and their mathematical interpretations along with the actual development of his diabetic complications. For exam- ple, he explores and comprehends the precise mathematical relationships between glucose fluctuations with changes in weight/food/exercise/others and how difficult diet control along with persistent exercise can be for most type 2 diabetes patients. In addition, he has also proven that the glucose reduction rate relates to the self-repair rate of his pancreatic beta cells. Since the FPG level indicates the health conditions of pancreatic beta cells and it is served as the baseline of postprandial plasma glucose (PPG) and daily estimated average glucose (eAG). The additional knowledge of lowering his risk of having nonalcoholic fatty liver disease (NA- FLD) as well as various cardiovascular disease (CVD) via lowering his TyG level is extraordinarily beneficial. That is why in this study, he has established a “binary health target” for himself to accomplish: “either 80 TG and 100 FPG, or 90 TG and 90 FPG”. By Y2020, after 8-years of persistent lifestyle management efforts, he had finally achieved his goal of lowering his FPG below 100 mg/dL level. His plan for 2021 and beyond is to accomplish his target of ~4.5 TyG level by having combined achievements of either 80 TG and 100 FPG (TyG at 4.49) or 90 TG and 90 FPG (TyG at 4.50). This strategy provides a practical guideline on how to reduce his insulin resistance via lowering the combined TG and FPG level to a numerical value lower than 180. However, based on his experience, he can probably reduce his FPG level further to 90 mg/dL, but at the same time, the target of decreasing his TG level to 90 mg/dL is much more difficult to accomplish.

Annual wellness visits are associated with increased use of preventive services in patients with diabetes living in the Diabetes Belt

ObjectiveTo examine whether Annual Wellness Visits (AWVs) were associated with increased use of preventive services in Medicare patients with diabetes living in the Diabetes Belt. MethodsWe used a case-control design where outcomes were utilization of preventive services recommended for patients with diabetes (foot exam, eye exam, A1c test, and microalbuminuria test) and the exposure was AWVs using data for Medicare patients with diabetes in 2014 – 2015 residing in the Diabetes Belt (N = 412,009). ResultsOnly 13.4% of patients in 2014 and 17.4% in 2015 used AWVs. Eye exams (61% vs 53%), foot exams (93% vs 79%), A1c tests (81% vs 71%), and microalbuminuria tests (45% vs 28%) were more common among patients who had an AWV in the preceding year compared with those who did not. These differences remained significant after adjusting for patient demographics, comorbidities, county level medical resources, and geographic factors. ConclusionsAWVs were significantly associated with increased preventive care use among patients with diabetes living in the Diabetes Belt. Low AWV utilization by patients with diabetes in and around the Diabetes Belt is concerning.

Association of hemoglobin A1c time in range with risk for diabetes complications

IntroductionWe assessed the association between hemoglobin A1c time in range (A1c TIR), based on unique patient-level A1c target ranges, with risks of developing microvascular and macrovascular complications in older adults...

A Multimodal Intervention for Reducing Unnecessary Repeat Glycated Hemoglobin Testing

ObjectivesReducing unnecessary tests that do not enhance quality can promote health-care value. Glycated hemoglobin (A1C) is often ordered at a frequency exceeding the recommendation of once every 3 months. We conducted a quality improvement (QI) initiative aimed to reduce unnecessary repeat testing by 75% at a tertiary care academic hospital. MethodsA retrospective baseline analysis was conducted on laboratory data from 2019 that enumerated unnecessary A1C tests, defined as repeat tests ordered within 60 days. A multifaceted change intervention with iterative plan–do–study–act cycles was introduced in March 2019 to educate providers and to automatically cancel A1C tests requested within 60 days. Monthly totals of A1C testing processed were plotted on statistical process control charts. ResultsIn 2019, 11% of all A1C tests ordered were unnecessary. Between March 2020 and January 2021, 11% of the tests (N=14,247 tests) were unnecessary, of which 84% were cancelled with our intervention. Providers in cardiology and nephrology accounted for over half (55%) of the unnecessary tests ordered. ConclusionsA 2-pronged approach informed by root-cause analysis, and comprised of gatekeeping and provider education, can effectively promote resource stewardship for reducing unnecessary A1C testing.

Accuracy of Three Commercial Home-Use Hemoglobin A1c Tests.

Background: The COVID-19 pandemic and the rapid expansion of telemedicine have increased the need for accurate and reliable capillary hemoglobin A1c (HbA1c) testing. Nevertheless, validation studies of commercially available products suitable for home use have been in short supply. Methods: Three commercial home-use capillary blood sample HbA1c tests (Home Access, CoreMedica, and A1cNow+) were evaluated in 219 participants with type 1 or type 2 diabetes (4-80 years years of age, HbA1c 5.1%-13.4% [32-123 mmol/mol]) at four clinical sites. Comparisons were made between HbA1c measurements from the commercial tests and paired venous samples for which HbA1c was measured at two central reference laboratories. The primary outcome was percentage of commercial HbA1c values within 5% of the corresponding reference values. Results: HbA1c values were within 5% (relative difference) of paired reference values for 82% of Home Access samples, 29% of CoreMedica samples, and 46% of A1cNow+ samples. Absolute differences were within 0.3% of the reference value for 75% of Home Access samples, 28% of CoreMedica samples, and 44% of A1cNow+ samples and exceeded 0.5% for 8%, 55%, and 37%, respectively. Conclusions: None of the commercial home-use HbA1c tests produced the National Glycohemoglobin Standardization Program goal of ≥90% measurements within 5% of a DCCT venous reference. However, the Home Access product performed substantially better than the CoreMedica or A1cNow+ products. Telemedicine is likely to persist as a mainstay of diabetes care well after the COVID-19 era. As such, accurate home-based HbA1c assessment represents an urgent need for the diabetes community.

Implementing an Evidence-Based Protocol to Reduce Inappropriate Laboratory Test Ordering

Excessive or inappropriate laboratory test ordering is a major contributor to rising health care costs, incidental findings, and overdiagnosis. A community-based, free clinic in South Carolina lacked a standard protocol for laboratory test use, contributing to an overuse rate of 40% in comprehensive metabolic panels, lipid panels, and hemoglobin A1c tests. After a multidisciplinary, evidence-based protocol was implemented that involved a checklist and provider feedback, the rate of laboratory test overuse decreased by 50%. The purpose of this quality improvement project is to implement an evidence-based standardized protocol to improve utilization and best practice of laboratory test ordering.

A Telehealth Diabetes Intervention for Rural Populations: Protocol for a Randomized Controlled Trial.

BackgroundDiabetes self-management education and support (DSMES) is a crucial component of diabetes care associated with improved clinical, psychosocial, and behavioral outcomes. The American Association of Diabetes Care and Education Specialists, the American Diabetes Association, and the American Academy of Family Physicians all recommend DSMES yet accessing linguistically and culturally appropriate DSMES is challenging in rural areas. The Diabetes One-Day (D1D) program is an established DSMES group intervention that has not been adapted or evaluated in rural communities.ObjectiveThe specific aims of this paper are (1) to adapt the existing D1D program for use in rural communities, called rural D1D (R-D1D); and (2) to conduct a patient-level randomized controlled trial to examine the effects of R-D1D and standard patient education, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.MethodsThis is a protocol for a pilot type II hybrid implementation-effectiveness trial of a culturally adapted virtual DSMES program for rural populations, R-D1D. We will use Boot Camp Translation, a process grounded in the principles of community-based participatory research, to adapt an existing DSMES program for rural populations, in both English and Spanish. Participants at 2 rural primary care clinics (4 cohorts of N=16 plus care partners, 2 in English and 2 in Spanish) will be randomized to the intervention or standard education control. The evaluation is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Patient-level effectiveness outcomes (hemoglobin A1c, diabetes distress, and diabetes self-care behaviors) will be assessed using patient-reported outcomes measures and a home A1c test kit. Practice-level and patient-level acceptability and feasibility will be assessed using surveys and interviews.ResultsThis study is supported by the National Institute of Nursing. The study procedures were approved, and the adaptation processes have been completed. Recruitment and enrollment started in July 2021.ConclusionsTo our knowledge, this will be the first study to evaluate both effectiveness and implementation outcomes for virtually delivered DSMES, culturally adapted for rural populations. This research has implications for delivery to other rural locations where access to specialty diabetes care is limited.Trial RegistrationClinicalTrials.gov NCT04600622; https://clinicaltrials.gov/ct2/show/NCT04600622International Registered Report Identifier (IRRID)DERR1-10.2196/34255

Feasibility and Performance of Hemoglobin A1C Self-Testing During COVID-19 Among African Americans With Type 2 Diabetes.

The purpose of the study was to determine the feasibility of implementing A1C self-testing at home using the A1CNow® Self Check and to compare the accuracy of the A1CNow to a reference standard in African Americans with type 2 diabetes (T2D). African American adults with T2D were recruited from 13 different churches (N = 123). Phase 1, conducted during the early phase of the COVID-19 pandemic, examined the feasibility of A1C assessment using the A1CNow performed at home by untrained participants. Phase 2, conducted when in-person research resumed, compared A1C values concurrently measured using the A1CNow and the DCA Vantage™ Analyzer (reference standard) collected by research staff at church testing sites. In Phase 1, 98.8% of participants successfully completed at least 1 at-home A1C test; the overall failure rate was 24.7%. In Phase 2, the failure rate of staff-performed A1CNow testing was 4.4%. The Bland-Altman plot reveals that A1CNow values were 0.68% lower than DCA values, and the mean differences (A1CNow minus DCA) ranged from -2.6% to 1.2% with a limit of agreement between -1.9% to 0.5%. A1C self-testing is feasible for use in community settings involving African American adults with T2D. The A1CNow Self-Check underestimated A1C values when compared with the reference standard. Ongoing improvements in point-of-care devices have the potential to expand research and clinical care, especially in underserved communities.

1191-P: Predictors of Hemoglobin A1c Testing in Adults with Type 2 Diabetes Covered by Alabama Medicaid

Background: ADA Standards of Care recommend A1C tests at least twice per year for patients with diabetes. We evaluated predictors of A1C testing among adults with type 2 diabetes covered by Alabama Medicaid. Methods: We conducted a retrospective analysis of Medicaid claims data between 2011-2020 using person-year observations as the unit of analysis. Inclusion criteria were ages 19-64 years, type 2 diabetes diagnosis, continuous Medicaid enrollment for the full calendar year and the year prior. The primary outcomes were receiving ≥1 and ≥2 A1C test (s) during a calendar year. We conducted multivariable Poisson regression stratified by eligibility (i.e. disability, poverty) to evaluate the relationships of study year, demographics, clinical factors, and healthcare utilization with A1C tests using generalized estimating equations to account for individuals contributing >1 observations. Results: We analyzed 288,379 person-year observations; 69% were female; 49% were Black; 47% were 35-54 years old, 44% 55-64 years old; 51% were eligible based on disability, 49% based on poverty. Overall, 57% observations had ≥1 A1C test per year, 35% had ≥2 A1C tests. More observations eligible by disability had ≥1 A1C test (76% vs. 38%) and ≥2 A1C tests (49% vs. 20%) than those eligible by poverty. For observations eligible by disability, Black race and older age were associated with higher likelihood of having ≥1 A1C test. For observations eligible by poverty, year after 2011, female sex, and younger age were associated with higher likelihood of having ≥1 A1C test. For both groups, rurality, insulin use, endocrinology care, diabetes complications, and ambulatory care visits were associated with higher likelihood of having ≥1 A1C test. Conclusions: Just over one-third of adults with diabetes covered by Alabama Medicaid had at least 2 A1C tests per year. A1C testing frequency differed by Medicaid eligibility; poverty-based eligibility was associated with lower likelihood of having recommended A1C testing. Disclosure C.A.Presley: None. C.R.Howell: None. Y.Khodneva: None. K.R.Riggs: n/a. L.Huang: None. E.B.Levitan: Research Support; Amgen Inc. A.Cherrington: Consultant; Bayer AG, Other Relationship; Novo Nordisk. Funding National Institute of Diabetes and Digestive and Kidney Diseases R18DK109501PI: CherringtonUAB Diabetes Research Center P30 DK079626PI: Cherrington

1154-P: Leisure-Time Physical Activity Environment and Odds of Glycemic Control over Time among Veterans with New-Onset Type 2 Diabetes

Physical activity is protective against type 2 diabetes (T2D) incidence and supports T2D management. Access to local facilities such as gyms and parks enables leisure-time physical activity (LTPA) . We examined associations between T2D patients’ access to LTPA facilities and parks and whether repeated A1C follow-up tests were within a desired range. We analyzed data on 271,5 patients from the Veterans Administration Diabetes Risk Cohort who developed T2D from 2008-2018. We measured an A1C test as in-range if 5.0-7.0 (<80 years of age) or 5.0-8.5 (≥80 years of age) , density of facilities within street network buffers, and population-weighted distance to the closest 7 parks. We used generalized estimating equations with a logit link function to predict the log odds of an in-range vs. out-of-range A1C test. We tested environment-by-time interactions, controlling for individual and neighborhood demographics and baseline A1C. On average, patients were 60 years of age, male (95%) , white (71%) , and had A1C tests during follow-up. Higher facility density, but not park distance, was narrowly associated with lower odds ofan in-range A1C test (ORdensity=.99, 95% CI=.98, 1.0) . As years since T2D diagnosis increased, the odds of an in-range A1C test decreased (ORtime=.88, 95% CI=.88, .88) . For those living in higher facility density, the odds of an in-range A1C decreased over time by only a slightly lower factor than for those living in lower facility density (P<.0 for interaction term) . For those living farther from parks, the odds of an in-range A1C decreased over time by only a slightly higher factor than for those living closer to parks (P=.001) . As odds of in-range A1C tests decline over time, broader access to facilities and parks may not soften the decline since the modified effects were clinically negligible. Viable interventions for maintaining healthy A1C after diagnosis may include efforts to both increase access to and promote the use of the LTPA environment. Disclosure S.L.Orstad: None. P.M.Lopez: None. S.Adhikari: Research Support; Johnson & Johnson. D.C.Lee: None. R.Kanchi: None. M.D.Schwartz: None. F.Alemi: None. B.Elbel: None. L.Thorpe: None. Funding This study was funded by the Centers for Disease Control and Prevention (5 U01DP006299-02-00; PI: Lorna Thorpe)

915-P: Annual Wellness Visits and Preventive Care Utilization among Medicare Beneficiaries in the Diabetes Belt and Surrounding Areas

Objective: Medicare beneficiaries are eligible to receive free Annual Wellness Visits (AWVs) for assessing preventive care needs, identifying care resources, and scheduling visits. We previously reported that AWVs are associated with increased use of preventive care for patients with diabetes. In this study, our objective is to conduct a case-control study to examine whether AWVs are associated more strongly with preventive care use in the Diabetes Belt than in surrounding areas. Methods: We used a sample of ∼900,000 Medicare Fee-for-Service beneficiaries who lived in the Diabetes Belt and surrounding areas in 2014 - 2015. We identified patients who have used an annual foot exam, eye exam, A1c test, and microalbuminuria (MA) test and those who did not in 2015. We used the dates of service receipt and the last day of the year (12/31) as the event date for users and non-users, respectively. We looked one full year before the event date to identify any AWVs. We used propensity-score stratification to estimate log odds of 4 preventive care use of annual foot exam, eye exam, A1c test, and MA test. Results: For all four services, AWV users had significantly higher preventive care use compared to non-users. In 3 preventive services, AWVs were more strongly associated with preventive care use in the Belt than in the surrounding areas (foot exam, ORs = 2.38 vs 2.16, p < 0.001; A1c test, ORs = 1.44 vs. 1.36, p = 0.002; MA test, ORs = 1.70 vs. 1.44, p < 0.001; eye exam, ORs 1.22 vs. 1.19, p=0.063) . Discussion: AWVs appear to have stronger effects on preventive care use for patients with diabetes in the more healthcare resource-poor Diabetes Belt than in the surrounding areas. AWVs may help to reduce disparities in the use of recommended preventive care for patients with diabetes. Disclosure M.Sohn: None. T.L.Mcmurry: None. H.Kang: None. S.Kim: None. J.M.Lobo: n/a. Funding NIDDK R01DK113295

921-P: Diabetes Preventive Care for Medicare Beneficiaries: Comparing Efficiency between the Diabetes Belt and Surrounding Areas

Objective: Evidence-based preventive care services are crucial for people with diabetes to improve their health outcomes, but the utilization of the services among older adults is suboptimal. Our objective is to compare relative performance of the Diabetes Belt and surrounding counties in the uptake of preventive services among Medicare beneficiaries with diabetes given available health care resources in the counties. The Diabetes Belt includes 644 counties in the Appalachian and deep south areas of the US that have high diabetes prevalence. Methods: We used data envelopment analysis (DEA) to compute technical efficiency of counties for 2009-2015. Technical efficiency measures how many outputs a decision-making unit produces given a set of inputs. Inputs included the number of physicians and nurses per 1000 adults in the counties, and outputs included the number of foot exams, a1c tests, and microalbumin tests per 1000 Medicare beneficiaries with diabetes. The Diabetes Belt includes counties in the Appalachian and deep south areas of the US that have high diabetes prevalence. We performed t-tests to compare efficiency between the Diabetes Belt and surrounding counties. We excluded counties with 0 doctors or 0 nurses for >1 year in 2009-2015. Results: Of 1057 counties, 861 (496 in the Belt and 365 in surrounding areas) were included. During the study period, the average technical efficiency of the counties ranged from 79% to 83%, with only 2.- 3.4% of counties achieving 100% technical efficiency. Diabetes Belt counties had consistently lower efficiency than surrounding counties during the study period (p <0.05) . The mean efficiency was 78-81% in the Diabetes Belt and 81-85% in the surrounding counties. Discussion: Our results suggest that the degree of inefficiencies was higher in the Diabetes Belt compared to surrounding counties. Given relatively low available resources in these areas, more attention to improve diabetes preventive care is needed. Disclosure H.Kang: None. S.Kim: None. J.M.Lobo: n/a. M.Sohn: None. Funding National Institutes of Health (1R01DK113295-01A1)