Challenges In Diabetes Management Research Articles

Real-life Achievements of MiniMed™ 780G Advanced Closed Loop System in Youth With Type 1 Diabetes: AWeSoMe Study Group Multi-Center Prospective Trial.

We assessed real-life glycemic outcomes and predictors of composite measures of optimal glycemic control in children and adolescents with type 1 diabetes (T1D) during their initial 12 months of the MiniMed™ 780G use. This prospective observational multicenter study collected demographic, clinical, and two-week 780G system data at five timepoints. Optimal glycemic control was defined as a composite glycemic control (CGC) score requiring the attainment of four recommended continuous glucose monitoring (CGM) targets, as well as the glycemia risk index (GRI) of hypoglycemia and hyperglycemia and composite CGM index (COGI). Outcome measures included longitudinal changes in multiple glycemic parameters and CGC, GRI, and COGI scores, as well as predictors of these optimal measures. The cohort included 93 children, 43% girls, with a median age of 15.1 years [IQR 12.9,17.0]. A longitudinal analysis adjusted for age and socioeconomic index yielded a significant improvement in glycemic control for the entire cohort (ptime<0.001) after the transition to 780G. The mean HbA1c (SE) was 8.65%(0.12) at baseline and dropped by more than 1% after one year to 7.54%(0.14) (ptime<0.001). Optimal glycemic control measures improved at 12 months post 780G; CGC improved by 5.6-fold (p<0.001) and was attained by 24% of the participants, the GRI score improved by 10-fold (p=0.009) and was achieved by 10% of them, and the COGI improved by 7.6-fold (p<0.001) and was attained by 20% of them. Lower baseline HbA1c levels and increased adherence to AHCL usage were predictors of achieving optimal glycemic control. The AHCL 780G system enhances glycemic control in children and adolescents with T1D, demonstrating improvements in HbA1c and CGM metrics, albeit most participants did not achieve optimal glycemic control. This highlights yet ongoing challenges in diabetes management, emphasizing the need for continued proactive efforts on the part of healthcare professionals, youth, and caregivers.

Epidemiology, Technology, and Professional Perspectives on Diabetes in the United Arab Emirate: A Focused Review

Abstract Introduction The United Arab Emirates (UAE), among the rest of the Arab Gulf countries, exhibits a high prevalence of diabetes, primarily type 2 diabetes (T2D). Methods We aimed to provide an overview of the epidemiology, complications, and quality of care, including the use of technology in diabetes care. Also, we wished to explore the challenges of diabetes management and future directions in clinical practice and research. This is a focused review of the literature of selected relevant themes to serve the above objectives of the work. Results Several epidemiological studies have documented the increased prevalence of diabetes in the native population and expatriates. The vast majority focused on T2D. The prevalence of diabetes in the UAE is estimated at 12.3% for the 20 to 79 age group. Although the high prevalence was recognized and acknowledged as a national priority, several challenges exist in standardizing care across the population. There are gaps in research about the nationwide prevalence of all forms of diabetes. Some research studies have evaluated the role of technology in diabetes care, genetic predilection to complications, and particular aspects such as diabetes during pregnancy, neonatal diabetes, monogenic diabetes, and cardiovascular risk in diabetes. UAE recently became a focal point for health-related Ramadan fasting research, including diabetes. Conclusions Diabetes in the UAE considerably burdens the health care system. A concerted effort is needed to adopt more uniformity of diabetes care and research nationwide. This should address the use of unified methods to document the nationwide burden, explore possible differences in various epidemiological phenomena, access to health care, and impact on outcomes, and evaluation of the cost-effectiveness of different models of care.

A Scoping Review of Dementia and Diabetes Co-Morbidity Care

Diabetes mellitus is a common co-morbidity with dementia. Diabetes is usually a self-managed condition requiring an individual to have a high level of cognitive functioning; hence dementia makes managing diabetes very challenging for the individual with dementia and their caregivers. The purpose of this literature review was to synthesise what is currently known about diabetes and dementia co-morbidity care outcomes. Online databases (AMED, CINAHL, PROQUEST, EBM Reviews, TRIP, Medline and PsycINFO) were searched for the period 2012 – 2023, from which we selected 27 publications. Of the 27 publications 8 were literature reviews/expert discussion of the literature, 1 audit, 1 case report, 5 cohort studies, 2 cross sectional studies, 4 mixed methods studies, 2 realist reviews, 1 longitudinal observation study and 3 qualitative studies. Selected literature was from the UK, USA, Canada, Japan, Austria, Germany, France and Poland. Five themes permeated this literature: key principles of care, challenges of diabetes management as a consequence of dementia, complexity of care, quality of care and workforce issues. This review highlights the complexity of care for those with co-morbid diabetes and dementia, which are both progressive diseases which change over time. There is a need to develop the underpinning evidence base in order to provide guidelines for best practice, to support staff to deliver appropriate care to people living with this co-morbidity

Medication use and contextual factors associated with meeting guideline-based glycemic levels in diabetes among a nationally representative sample.

Based on the long-lasting diabetes management challenges in the United States, the objective was to examine glycemic levels among a nationally representative sample of people with diabetes stratified by prescribed antihyperglycemic treatment regimens and contextual factors. This serial cross-sectional study used United States population-based data from the 2015 to March 2020 National Health and Nutrition Examination Surveys (NHANES). The study included non-pregnant adults (≥20 years old) with non-missing A1C and self-reported diabetes diagnosis from NHANES. Using A1C lab values, we dichotomized the outcome of glycemic levels into <7% versus ≥7% (meeting vs. not meeting guideline-based glycemic levels, respectively). We stratified the outcome by antihyperglycemic medication use and contextual factors (e.g., race/ethnicity, gender, chronic conditions, diet, healthcare utilization, insurance, etc.) and performed multivariable logistic regression analyses. The 2042 adults with diabetes had a mean age of 60.63 (SE = 0.50), 55.26% (95% CI = 51.39-59.09) were male, and 51.82% (95% CI = 47.11-56.51) met guideline-based glycemic levels. Contextual factors associated with meeting guideline-based glycemic levels included reporting an "excellent" versus "poor" diet (aOR = 4.21, 95% CI = 1.92-9.25) and having no family history of diabetes (aOR = 1.43, 95% CI = 1.03-1.98). Contextual factors associated with lower odds of meeting guideline-based glycemic levels included taking insulin (aOR = 0.16, 95% CI = 0.10-0.26), taking metformin (aOR = 0.66, 95% CI = 0.46-0.96), less frequent healthcare utilization [e.g., none vs. ≥4 times/year (aOR = 0.51, 95% CI = 0.27-0.96)], being uninsured (aOR = 0.51, 95% CI = 0.33-0.79), etc. Meeting guideline-based glycemic levels was associated with medication use (taking vs. not taking respective antihyperglycemic medication classes) and contextual factors. The timely, population-based estimates can inform national efforts to optimize diabetes management.

Digital Health Solutions for Community-Based Control of Diabetes During COVID-19 Pandemic: A Scoping Review of Implementation Outcomes.

The COVID-19 pandemic has added to the pre-existing challenges of diabetes management in many countries. It has accelerated the wider use of digital health solutions which have tremendous potential to improve health outcomes for people with diabetes. However, little is known about the attributes and the implementation of these solutions. To identify and describe digital health solutions for community-based diabetes management and to highlight their key implementation outcomes. We searched Ovid Medline, CINAHL, Embase, PsycINFO, and Web of Science for relevant articles. A purposive search was also used to identify grey literature. Articles that described digital health solutions that aimed to improve community-based diabetes management were included in this review. We applied a thematic synthesis of evidence to describe the characteristics of digital health solutions, and to summarize their key implementation outcomes. We included 15 articles that reported digital health solutions that primarily focused on community-based diabetes management. Nine of the 15 innovations involved were mobile applications and/or web-based platforms, and five were based on social media platforms. The majority of the digital health solutions were used for diabetes education and support. High engagement, utilization, and satisfaction rates with digital health solutions were observed. The use of digital health solutions was also associated with improvement in self-management, taking medication, and reduction in glycated hemoglobin (HbA1c) levels. COVID-19 triggered digital health solutions have tremendous potential to improve health outcomes for people with diabetes. Further studies are needed to evaluate the sustainability and scale-up of these solutions.

Challenges of Type 2 Diabetes Mellitus Management From the Perspective of Patients: Conventional Content Analysis.

Patients with type 2 diabetes mellitus (T2DM) face significant challenges in the treatment process, which can have a negative impact on disease management. Proper management of the disease can reduce symptoms and complications, improve glycemic indices, and reduce mortality and readmission. Given the influential role of patients in prevention and self-care, this study was conducted to explore the challenges of diabetes management from the perspective of patients. Two rounds of focus group discussions with T2DM patients were conducted. The principal investigator of the study and a research assistant compiled a list of volunteer patients with names and contact information and selected participants based on their medical information. Participants were chosen via a purposive sampling technique. The questions were designed to encourage patients to share their views on how the treatment team communicates and participates in treatment, how they are trained, and the health care system. The discussion continued until data saturation. During 2 rounds of focus group discussions, the voices of the participants were recorded by 2 voice recorders, and one of the team members was a transcriber. After discussion, participant views were transcribed, and common issues were identified, sorted, and reported as categories and subcategories. According to the conventional content analysis, 88 primary codes were extracted from the detailed and in-depth description of the participants. The codes were summarized after repeated readings and classified based on their similarities and semantic relevance. Through analysis and comparison, 4 categories and 7 subcategories were identified: communication challenges (poor medical staff communication, lack of psychological support), challenges to participation in treatment (lack of patient participation), educational challenges (training program bugs, inadequate training), and challenges of the health care system (inefficiency of the care system, caregiver inefficiency). This study showed that the treatment team members should pay more attention to the challenges of care and treatment from the perspective of patients with T2DM. Therefore, recommendations for future policies to overcome these obstacles include establishing a multidisciplinary health care team; using trained health care workers to provide organized treatment and care services; holding individual counseling sessions with patients in need of counseling; and providing counseling services, involving patients in the treatment and self-care process, and designing a comprehensive diabetes education program with an emphasis on education. Necessary information should be provided to the patients, and effective communicate should address patient concerns.

"Fear That One Day I May Not Be Able to Afford Insulin": The Emotional Burden of Diabetes Costs During Emerging Adulthood.

Emerging adults (EAs) with type 1 diabetes (T1D) often experience challenges in diabetes management, in particular transitioning to financial independence. EAs 18-30 years of age with T1D completed online surveys about diabetes distress and an open-ended query about the most important worry among survey questions. Most of the 287 respondents (89.5%) endorsed "Agree" or "Somewhat agree" to the statement "I worry about the cost of diabetes." Responses did not differ by gender, age, diabetes duration, race/ethnicity, diabetes technology use, student status, income, or insurance status. However, a greater proportion of those not endorsing cost as a substantial burden achieved A1c <7% (92.9%) versus those who were neutral (46.2%) or who endorsed cost as a burden (50.6%) (P = 0.004). Furthermore, in open-ended responses, cost was the most frequently noted worry. Diabetes costs are a major concern for EAs, likely contributing to diabetes distress during this developmental stage, and clinicians should consider discussing diabetes costs with this population.

Expert Opinion on Diabetes Management Challenges and Role of Basal Insulin/GLP-1 RA Fixed-Ratio Combination in People with Type 2 Diabetes from Indonesia.

Indonesia is struggling with a rapidly growing burden of diabetes due to rapid socioeconomic transition. People with type 2 diabetes mellitus (T2DM) need appropriate treatment strategies to maintain glycemic control. New modalities with simplicity, such as fixed-ratio combination of basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA), further referred to as FRC, have proven to be an effective and practical therapeutic approach that may address this issue. In January 2021, a scientific expert meeting was held with the participation of endocrinologists from Indonesia to provide expert opinions regarding the optimal practical use of the FRC basal insulin/GLP1-RA. Topics discussed in the meeting included the challenges in diabetes management, clinical inertia with insulin therapy, local and international guideline positioning, initiation, titration, and switching of basal insulin and GLP-1 RA, including FRC, and the management of T2DM.

Analytical Challenges in Diabetes Management: Towards Glycated Albumin Point-of-Care Detection.

Diabetes mellitus is a worldwide-spread chronic metabolic disease that occurs when the pancreas fails to produce enough insulin levels or when the body fails to effectively use the secreted pancreatic insulin, eventually resulting in hyperglycemia. Systematic glycemic control is the only procedure at our disposal to prevent diabetes long-term complications such as cardiovascular disorders, kidney diseases, nephropathy, neuropathy, and retinopathy. Glycated albumin (GA) has recently gained more and more attention as a control biomarker thanks to its shorter lifespan and wider reliability compared to glycated hemoglobin (HbA1c), currently the “gold standard” for diabetes screening and monitoring in clinics. Various techniques such as ion exchange, liquid or affinity-based chromatography and immunoassay can be employed to accurately measure GA levels in serum samples; nevertheless, due to the cost of the lab equipment and complexity of the procedures, these methods are not commonly available at clinical sites and are not suitable to home monitoring. The present review describes the most up-to-date advances in the field of glycemic control biomarkers, exploring in particular the GA with a special focus on the recent experimental analysis techniques, using enzymatic and affinity methods. Finally, analysis steps and fundamental reading technologies are integrated into a processing pipeline, paving the way for future point-of-care testing (POCT). In this view, we highlight how this setup might be employed outside a laboratory environment to reduce the time from measurement to clinical decision, and to provide diabetic patients with a brand-new set of tools for glycemic self-monitoring.

The role of self-efficacy, well-being capability and diabetes care assessment for emotional and diabetes management challenges during the COVID-19 pandemic: Findings from a follow-up study

This study aimed to investigate the potential protective role of baseline resources and capabilities for experiencing challenges to emotional well-being and perceived access to and quality of diabetes care during the COVID-19 pandemic in a Danish type 2 diabetes population (N = 1608). We investigated how differences in self-efficacy, well-being capability, socioeconomic status, health status, and perceptions of diabetes care measured before the COVID-19 pandemic were related to experiences of well-being and diabetes management challenges during the pandemic. The study is based on a survey conducted shortly before the pandemic (autumn 2019) and a follow-up survey during the pandemic (autumn 2020), which included questions about impacts of the pandemic. We used this longitudinal data to quantitatively investigate in regression analyses how self-reported baseline indicators of chronic care access and quality (PACIC), self-efficacy (GSE), health (EQ VAS), and well-being capability (ICECAP-A), and registry-based socioeconomic indicators were associated with the probability of reporting negative impacts on emotional wellbeing and diabetes management. Results showed that respondents with higher baseline general self-efficacy and higher well-being capability scores, who more often considered care well-organised and were in better health before the pandemic, were less likely to report pandemic-related negative impacts on emotional well-being. Considering diabetes care well organised before the pandemic was associated with a lower probability of adverse impacts on diabetes care. The results thus broadly confirmed that several indicators of higher levels of baseline resources and capabilities were associated with a lower probability of reporting negative impacts of the pandemic. However, some variation in predictors was observed for general well-being outcomes, compared to diabetes-care specific challenges, and findings on socioeconomic status as indicated by education were mixed.

Yoga and Diabetes : The Impact of Yoga Practice on Diabetic Symptoms

“Diabetes mellitus”, is one of the most common non-communicable diseases worldwide. India faces several challenges in diabetes management, including a rising prevalence in urban and rural areas, lack of disease awareness among the public, limited health care facilities, high cost of treatment, suboptimal glycaemic control and rising prevalence of diabetic complications. Insulin therapy for diabetes is most commonly delivered via subcutaneous injections, up to four times a day. Long-term insulin therapy, compounded by the invasive nature of its administration, has caused problems with patient compliance, ultimately influencing patient outcomes. There is an increase in the prevalence of type 1diabetes also, but main cause of diabetic epidemic is type2 diabetes mellitus, which accounts for more than 90 percent of all diabetes cases. Type2 diabetes is a serious and common chronic disease resulting from a complex inheritance- environment interaction along with other risk factors such as obesity and sedentary lifestyle.

1031-P: Psychosocial Problems in Indonesian Children and Adolescents with Type 1 Diabetes (T1D) during COVID-Pandemic

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.

282-OR: The Emotional Burden of Diabetes during Emerging Adulthood: “Cost. Everything Else Is Secondary.”

Emerging adults (EA) with type 1 diabetes (T1D) have multiple developmental stage-specific challenges in diabetes management, including the transition to financial independence. The recently validated Problem Areas in Diabetes-EA (PAID-EA) survey is the first measure of diabetes distress (DD) in EA to include financial concerns. A sample of 287 participants with T1D ages 18-30 years completed an online survey including the 25-item PAID-EA, measures of DD and depressive symptomology, and clinical and demographic questions. To evaluate content validity, 2 open-ended questions asked for the most important worry mentioned and what worries were missed in the questions. Responses were analyzed using directed qualitative content analysis. As cost emerged as a major contributor to DD, responses to the PAID-EA item 21 (“I worry about the cost of diabetes”) were analyzed using Chi-square or Fisher’s exact test to assess participant factors associated with cost-related DD. Most participants (89%) provided open-ended responses (78% female, mean age 24 years) . Cost was the most frequent code in the qualitative analysis: 15% reported DD related to cost and 6% to insurance. Responses included worries about aging out of parents’ insurance and limitations on career choices to ensure payment for diabetes supplies. In all survey respondents, 90% replied “Agree” or “Somewhat agree” to PAID-EA item 21. Responses to this item did not differ by gender, age (&amp;lt; vs. &amp;gt;=25) , continuous glucose monitor use (Y/N) , insulin pump use (Y/N) , student status (full time vs. part time vs. no) , income (&amp;lt; vs ≥$75k) , or insurance status (parent vs. own vs. uninsured) . A greater proportion of those with HbA1c ≥ 7% endorsed worry about cost than with HbA1c &amp;lt; 7% (94% vs. 87%, p = 0.008) . Diabetes cost was a major contributor to DD in this sample of EA with T1D. Worry about diabetes costs was endorsed by nearly all participants, especially those not meeting glycemic targets. Managing the cost of diabetes care for EA may be an avenue to reduce DD. Disclosure R.J.Vitale: None. K.Wentzell: 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 T32DK007260NIH T32DK007529NIH P30DK036836

IDF21-0662 Diabetes CarePak: Creating & testing a bundling solution to improve access to safe insulin administration in Kenya

Background: The discovery of insulin in 1921 changed the lives of people living with diabetes (PLWD). Yet, millions still lack access to insulin. Additionally, an unrecognized number of PLWD cannot access or afford the commodities needed to measure their blood glucose (BG) or safely administer insulin itself. This inconsistent access (further exacerbated by COVID) forces PLWD to ration insulin, test strips, and ration or reuse needles/syringes, leading to increased rates of severe complications, including death. This represents a huge unmet need and a call-to-action for service delivery innovation. Aim: Diabetes CarePak project aims to:•develop a human-centered “co-packaging” solution that increases access to the combination of medication and associated supplies needed for safe administration of insulin and self-care to improve quality of life and health outcomes•demonstrate health system benefits and preliminary cost savings to the Kenyan government to advocate for broader uptake. Method: We partnered with > 100 individuals, in Kenya, with lived, clinical, or work expertise in diabetes, to actualize the “care package” included in the Kenya Ministry of Health (MOH) 2018 clinical management guidelines. Utilizing human-centered design (HCD), we conducted interviews and focus groups across three counties with PLWD, health care workers (HCW), and MOH officials to co-create the CarePak prototype, and the educational and training materials for PLWD and HCWs. The CarePak prototype, which included items such as a glucometer, test strips, lancets, needles/syringes (if applicable), and educational materials was given to 23 users with Type 1 (T1D) or Type 2 (T2D) diabetes, across five facilities within the three counties, to be used daily, at home, for two months. Nine users had T1D, eight users had T2D and used insulin, and 6 users had T2D and used oral medication. Fourteen users were female and eight were from a rural area. Users completed baseline and end-line questionnaires and pre-/post-HbA1c values were documented. Usability feedback was gathered through home, clinic, and virtual visits. Results: Emerging themes included limited diabetes management/self-care knowledge (PLWD were unaware of what type of diabetes they had, incorrect insulin injection techniques were observed), limited access to personal BG monitoring (>70% of the PLWD did not own monitoring equipment), frequent reuse of needles/syringes due to cost or unreliable availability, and frequent visits to multiple facilities to get all supplies due to stockouts. Following use of the CarePak, users reported changes in individual lifestyle management (e.g. increased self-monitoring of BG, changes in diet), clinical management changes (e.g. changes in insulin regimens using BG data over time), and improved clinical outcomes (e.g. fewer sores from needle reuse, an average HbA1C improvement of 2.8% over two months). Discussion: The HCD methodology, with PLWD at the center of the co-creation process, captured key diabetes management challenges, the need for a bundle of commodities, and ensured the CarePak was usable, feasible, and valuable. CarePak iterations continue in Kenya and work is expanding to additional countries in 2022. As COVID-19 continues to stress supply chains and PLWD, we have an obligation to address all aspects of self-care, otherwise we will continue to fail PLWD globally.

Challenges of diabetes management during COVID-19 infection

Abstract BACKGROUND: Diabetic patients are more susceptible to severe forms of COVID-19 infection. They also may have poor glycemic control due to infection and corticosteroids. We aimed to describe the frequency of diabetes and its management in patients with COVID-19 infection. PATIENTS AND METHODS: It was a retrospective study, including COVID-19 patients, hospitalized in the department of infectious diseases in Hedi Chaker hospital between November 2020 and February 2021. RESULTS: In total, 351 patients were collected. Diabetes was observed in 43.5 % of patients. Diabetes was type 2 in 94.1% of cases. Patients were without any treatment (29%), treated with oral antidiabetic drugs (52.3%), or with insulin (38%). Degenerative complications were found in 22.2 % of patients. Diabetic patients had severe clinical forms (oxygen over 10L per minute) in 75.2%. They were treated with corticosteroids on 91.5 %. (Between 4 mg (10.5%) and 24 mg (29.4%) of dexamethasone). A poor glycemic control was found in 72.5 %, treated with insulin in all cases. Regarding non-diabetic patients (198 patients), 14.2% of patients developed diabetes. For these patients, dexamethasone was prescribed at a posology over 12 mg in 60.7% of cases. The average duration of corticosteroids in those patients was 9 days. All patients were discharged with oral antidiabetics. CONCLUSION: People with diabetes should be educated regarding the management of their condition during COVID-19 infection, including medication changes. If neglected, it may result in increased morbidity and mortality. Funding and Conflicts of Interest No

Challenges of Diabetes Management among TBDiabetes co-morbid Patients in Udupi District

Introduction: India has witnessed a rise in TB-Diabetes co-morbid cases in the past few years. Both TB and diabetes create complications for each other not only in terms of the prognosis but also management. Glycaemic control is pivotal for the successful management of diabetes and the co-morbidity. Aim: To understand the barriers and challenges of successful management of diabetes among TB-Diabetes co-morbid patients in the Udupi district. Methods: This cross-sectional study was conducted in the Udupi district of Karnataka from January 2020 to June 2020. Purposively selected Healthcare providers under RNTCP, were interviewed using a semi-structured interview guide. Each interview was fully transcribed. Data collection was terminated on reaching data saturation. A manual thematic analysis of the interview data was done using an inductive approach. Codes and themes were generated by a critical review of the transcripts. Results: Healthcare providers stated that certain patients such as, elderly, the homeless, and those with habits like alcoholism, were particularly difficult to manage. Besides, poor socioeconomic status, misconceptions, and lack of treatment adherence often create difficulties. Finally, participants also stressed the shortage of staff which impedes efficient management of the comorbidity. Conclusion: This study identified several barriers and challenges of diabetes management among TB-Diabetes co-morbid patients. These impediments, such as alcoholism, misconceptions, staff shortage, if addressed could aid in the better management of diabetes and eventually the co-morbidity.

Augmenting Traditional Support Groups for Adolescents With Type 1 Diabetes Using Instagram: Mixed Methods Feasibility Study.

BackgroundIn-person support groups have been shown to benefit adolescents with type 1 diabetes (T1D) by helping to decrease perceived diabetes burden and improving knowledge related to chronic disease management. However, barriers exist to participation in traditional support groups, including the timing and location of meetings and resources needed to attend. Adolescents are increasingly utilizing online support groups, which may provide solutions to some of the challenges faced when implementing in-person support groups.ObjectiveThe purpose of this study was to assess the feasibility and acceptability of a hybrid support group model where traditional in-person support groups were augmented with Instagram participation between monthly support group sessions for adolescents with T1D.MethodsParticipants (13-18 years old with T1D for ≥6 months) were asked to post photos each week for 3 months based on predetermined topics related to diabetes management. At the end of each month, participants attended an in-person support group to discuss their photos using the Photovoice method. Feasibility was assessed through enrollment and retention, number of Instagram posts, poststudy questionnaire, and a template analysis of the focus groups.ResultsOf 24 eligible participants, 16 (67%) enrolled in the study, with 3 dropping out prior to support group participation. The number of photos posted over 3 months ranged from 14 to 41. Among the 11 participants who completed a follow-up questionnaire, the majority of participants (6/11, 55%) reported that they very much enjoyed participating in the hybrid support group, and more than three-quarters (9/11, 82%) of participants reported that they “related to the photos posted.” Over half of participants (8/11, 73%) reported “learning something new from the photos posted,” which arose from sharing knowledge and experiences related to navigating the common challenges of diabetes management. Additionally, the use of Instagram posts helped facilitate peer discussions during the in-person support groups.ConclusionsThe novel combination of using Instagram to augment traditional in-person support groups was feasible and acceptable to adolescents with T1D. The overall satisfaction with the hybrid support group model, combined with the observed engagement with peers between support group sessions over social media, suggests that a hybrid support group model may have the potential to provide more pronounced benefits to adolescents than in-person meetings alone. Future research should investigate the use of social media as part of the support group model and examine the potential improvement of self-esteem, benefit-finding, and social support using validated tools in adolescents with diabetes.

454-P: Pharmacist-Led Diabetes Self-Management Education and Reduction of Readmission Rates at a County Hospital

Pharmacist-led Diabetes Self-Management Education and Reduction of Readmission Rates at a County Hospital With 10.5% of the US population or 34.2 million people affected by diabetes, education is greatly needed. The American Diabetes Association (ADA) and the Association for Diabetes Care and Education Specialists (ADCES) state that Diabetes Self-Management Education or Training (DSME/T) improves diabetes management, which can avoid hospital admissions and readmissions. Although DSME/T has traditionally been provided by nurses and dieticians, pharmacists can play a part, given their expertise in medication management, non-pharmacological therapies, and monitoring. The ADA and ADCES recommend that people with diabetes receive DSME/T at diagnosis, annually, when factors influence self-management, and at transitions of care. Therefore, a pharmacist-led transitions of care program was developed to reduce readmissions for patients with diabetes at Zuckerberg San Francisco General Hospital and Trauma Center. This hospital serves a diverse, low-income, and unhoused patient population, increasing the challenges of diabetes management. Pharmacists and pharmacy trainees were given a refresher course on DSME/T. Low-health literacy handouts in several languages, as well as demonstration kits, glucometers, insulin and insulin supplies, were all utilized for patient education. The objective of the study was to determine whether using pharmacists as educators, could reduce hospital readmissions. In 2017, provision of DSME/T at this institution was less than 5% and increased to 74% by December 2019, with the implementation of this program. The rate of readmission for patients with diabetes who received DSME/T was 11.7% compared to 19.2% for those who did not; an absolute risk reduction in readmission of 7.5%. Pharmacists and pharmacy trainees should use DMSE/T to help reduce readmissions, improve outcomes, and increase the national levels of patients with diabetes receiving DSME/T. Disclosure L. Mulala: None. T. Lenhoff: None.

Impact of Covid19 Lockdown on Glycemic Control

Evidence shows that people with poor glycemic control are at greater risk of mortality due to Covid19. It is important to achieve and maintain good glycemic control to prevent negative outcomes during this pandemic (1). To study the effect of lockdown on glucose control we conducted an observational, retrospective cohort study involving 98 patients followed at endocrine clinic at an inner city, community hospital in Brooklyn, NY in the period February to May 2020. Of the cohort, 60% were women, mean age was 54.1 + 15.3 years, 70% was Hispanic, 24% was African American with a predominance of type 2 diabetes (86%). Mean HbA1c of prelockdown and lockdown phase was 9.77 ± 2.26% and 9.49 ± 2.17 % respectively and the difference was statistically significant (p < 0.001) both in patients with Type 1 and Type 2 diabetes. Mean BMI of prelockdown and lockdown phase was 30.5 ± 6.8% and 30.1 ± 6.05% respectively and the difference was not statistically significant (p = 0.33). Despite no significant change in BMI, the factors responsible for improvement in HbA1c might be a result of refined eating patterns (increased consumption of homemade food), increased adherence to medication and time to cope with the daily challenges of diabetes management (1). Reference: Maddaloni E, Coraggio L, Pieralice S, Carlone A, Pozzilli P, Buzzetti R. Effects of COVID-19 Lockdown on Glucose Control: Continuous Glucose Monitoring Data From People With Diabetes on Intensive Insulin Therapy. Diabetes Care Aug 2020, 43 (8) e86-e87; DOI: 10.2337/dc20-0954

Defining features of diabetes resilience in emerging adults with type 1 diabetes.

Emerging adulthood presents unique challenges for type 1 diabetes (T1D) management. Barriers to achieving optimal diabetes outcomes have been studied but less is known about how emerging adults overcome these challenges. Characterizing emerging adults' protective factors may help guide T1D care during this developmental period. We anticipated identifying social, cognitive, and behavioral protective factors and were open to additional themes. We analyzed transcripts from semi-structured qualitative interviews with 62 emerging adults (age 18-24 years) with T1D using hybrid thematic analysis. Interviews queried about participants' perspectives on diabetes management challenges, how they overcome challenges, and diabetes resilience. We categorized responses into three types of protective factors: (a) Social: Interpersonal strategies such as obtaining tangible support (especially from parents) and emotional support from friends, medical professionals, and community leaders. (b) Cognitive: Believing one can live a "normal" life with T1D, benefit-finding, and viewing diabetes management as an important part of life. (c) Behavioral: Proactively planning for diabetes challenges, maintaining a consistent routine while allowing for flexibility, balancing diabetes and non-diabetes activities, and using diabetes-specific and general technologies to support self-management. The adaptive approaches emerging adults with T1D use to handle the challenges of diabetes include seeking interpersonal support, managing their thoughts about T1D, and taking specific actions to prevent or resolve challenges. Helping emerging adults identify and strengthen their protective factors has potential to affect clinical outcomes. Strengths-based assessment and clinical attention to protective factors may prepare adolescents to successfully manage the challenges of transition to adult care.