Management Of Diabetes In Adults Research Articles

Psychosocial Facilitators and Barriers to Type 2 Diabetes Management in Adults: A Meta-Synthesis.

Globally, the cases of type 2 diabetes are increasing, and this is largely attributed to lifestyle changes. Though diabetes is primarily a metabolic disease determined by biological factors, psychosocial aspects play a crucial role in its progression and management. However, the literature on psychosocial dimensions of diabetes management is minuscule and scattered. This synthesis sought to understand the psychosocial facilitators and barriers to type 2 diabetes management and coping among adults. We have adopted a meta-synthesis to review available qualitative studies using Pub- Med and Scopus databases. Based on inclusion criteria, we have chosen 24 studies published between 2010 and 2023. We have considered studies across countries, among which 63% of the studies included were from Western countries, and most have employed qualitative descriptive design. The selected studies were analyzed thematically using a deductive framework. Six themes emerged as the psychosocial barriers and facilitators of managing and coping with type 2 diabetes: 1) cognitive-emotional factors, 2) faith, 3) constraints to behavioural change, 4) social constraints and support, 5) healthcare provider-patient relationship, and 6) awareness. Further, a conceptual framework was developed from the synthesis. The patients' experiences evident from this synthesis signify the crucial role of psychosocial factors in diabetes management and coping. This evidence emphasizes the need for integrated care so that psychosocial aspects are addressed by healthcare providers and behavioural health professionals, which may lead to the promotion of facilitators and the minimization of barriers.

Interaction between trouble sleeping and diabetes on metabolic dysfunction-associated fatty liver disease and liver fibrosis in adults results from the National Health and Nutrition Examination Survey 2017-2018.

Metabolic dysfunction-associated fatty liver disease (MAFLD), trouble sleeping, and diabetes, as major public health problems, were closely related. The study examined the interaction between trouble sleeping and diabetes on MAFLD and liver fibrosis in adults with MAFLD. The data were obtained from the National Health and Nutrition Examination Survey 2017-2018. Multivariate logistic regression model and subgroup analyses were conducted to assess the relationship between either trouble sleeping or diabetes on MAFLD and liver fibrosis. Relative excess risk due to interaction (RERI), attributable proportion of interaction (AP), and synergy index (S) were utilized to assess the additive interaction. Ultimately, 3747 participants were included, with 2229 known MAFLD subjects. Compared with participants without diabetes, those with diabetes had a higher risk of MAFLD [odds ratio (OR) = 5.55; 95% confidence interval (CI) = 4.07-7.56] and liver fibrosis risk (OR = 3.61; 95% CI = 2.67-4.89). We also found a significant association of trouble sleeping with an increased risk of MAFLD (OR = 1.54; 95% CI = 1.17-2.02) and liver fibrosis risk (OR = 1.51; 95% CI = 1.06-2.16), compared with those without trouble sleeping. Moreover, there was a significant interaction between diabetes and trouble sleeping on MAFLD [RERI = 1.76 (95% CI: -0.22 to 3.73), AP = 0.35 (95% CI: 0.08-0.63), S = 1.80 (95% CI: 1.02-3.16)] and liver fibrosis risk [RERI = 1.79 (95% CI: 0.37-3.21), AP = 0.44 (95% CI: 0.20-0.69), S = 2.44 (95% CI: 1.18-5.08)]. The findings highlight that trouble sleeping and diabetes had a synergistic effect on MAFLD and liver cirrhosis. The study highlights the importance of addressing both trouble sleeping and diabetes management in adults to mitigate the risk of MAFLD and liver fibrosis.

Exploring the Impact of Fasting and Fasting-Mimicking Diets on Type 2 Diabetes Management in Adults: A Systematic Review.

Type 2 diabetes poses significant global health challenges, affecting both the quality of life and healthcare systems. This systematic review evaluates the efficacy of fasting and fasting-mimicking diets (FMD) in managing type 2 diabetes, with a focus on their effects on glycemic control, lipid profiles, and overall metabolic health in adult patients. A comprehensive search of PubMed and Cochrane Library databases identified several studies utilizing various fasting protocols, including intermittent fasting and FMD. Data synthesis and bias assessment were conducted using established methodologies, including the Cochrane Risk of Bias 2 (RoB 2) tool. The review found that fasting interventions significantly improve glycemic control and reduce body weight, with some protocols notably lowering HbA1c levels (p<0.05), highlighting the strong potential of fasting in diabetes management. However, the results varied, suggesting that individual differences in metabolic responses and adherence levels influence outcomes. In conclusion, while fasting and FMD show promise for improving metabolic health and managing diabetes, more standardized research is needed to understand the underlying mechanisms, optimize protocols, and confirm long-term benefits. Future research should prioritize larger sample sizes and extended follow-up periods to inform comprehensive clinical practice guidelines.

1109-P: Barriers and Facilitators to Use of Continuous Glucose Monitors for Type 2 Diabetes in Youth

Objective: Youth-onset type 2 diabetes, most common among racial/ethnic minorities, threatens to widen health disparities due to severe complications in early adulthood and a 15-year reduction in life expectancy. Use of continuous glucose monitors (CGM) improves diabetes management in adults with type 2 diabetes, but socioeconomic and racial/ethnic disparities in diabetes technology use remain. We sought to examine factors impacting the acceptability of CGM use in adolescents and young adults (AYA) with type 2 diabetes. Methods: In this single center study, we conducted semi-structured interviews with AYA with type 2 diabetes and their parents to determine attitudes about CGM use, including barriers and facilitators. Interviews were audio-recorded, transcribed, and evaluated using thematic analysis. Results: Twenty AYA and 10 parents participated (n=30 total). AYA were mean age 16.5 years (SD 2.2, range 13.7-20.1) and had median diabetes duration of 1.3 years. Most were female (65%) and minority race/ethnicity (40% non-Hispanic Black; 10% Hispanic; 5% Asian). Seven (35%) used CGM. The primary benefit elicited was convenience over glucometer use. Important barriers included the impact of physically wearing the device and drawing unwanted attention, desire for AYA privacy, and adequate education about the device. Discussion: In this diverse sample of AYA with type 2 diabetes and their parents, CGMs were generally regarded as convenient, although concerns about worsening stigma and conflict with parents were prevalent. Our findings can guide the development of patient-centered approaches to CGM use for AYA with type 2 diabetes, a critical step toward reducing inequities in diabetes technology uptake. Disclosure V.Peyyety: None. M.Zupa: None. B.Hewitt: None. A.Rodriguez gonzalez: None. I.Mani: None. T.Prioleau: None. J.L.Mccurley: None. Y.Lin: None. M.Vajravelu: None. Funding Endocrine Fellows Foundation; National Institutes of Health (K23HL157763, K23DK129724, KL2TR001856, K23DK125719, UL1-TR-001857)

Beliefs about Healthy Sleep Habits in Adults with Diabetes Compared to Adults without Diabetes: A Reasoned Action Approach Elicitation Study.

Objective Sleep is part of a healthy lifestyle and in adults with diabetes, inadequate sleep is associated with risks of developing complications. The objective was to compare beliefs about healthy sleep habits (HSHs) in adults with versus without diabetes based on the Reasoned Action Approach. Methods A total of 56 adults with and 98 without diabetes answered open-ended questions regarding their beliefs about: avoiding screen use in bed; having a regular sleep schedule; or avoiding caffeine, alcohol, and cigarettes before bedtime. A qualitative content analysis was used to identify the most important beliefs, similarities, and differences between both groups. Results Both groups reported that adopting HSHs could improve sleep. Having a regular sleep schedule was perceived to facilitate diabetes management in adults with diabetes. Negative consequences specific to adopting each HSH were identified in both groups. Adopting HSHs was associated with mainly negative emotions (e.g., stress, anxiety, fear) in both groups. Avoiding screen use in bed was associated with anxiety of not knowing blood glucose levels at night in adults with diabetes. Partners, parents, and friends were considered the most important individuals who would approve of adopting HSHs, but they were often perceived as unlikely to adopt HSHs themselves in both groups. Adults with diabetes perceived more barriers to adopting HSHs. Facilitating factors for both groups included removing triggers of unhealthy sleep habits, behavior substitution, using reminders, time management, and social support. Discussion These beliefs can guide the development of behavioral sleep interventions, including interventions specifically for adults with diabetes.

Special Considerations for Management of Diabetes in Adult Patients with Intellectual and Developmental Disabilities.

Diabetes mellitus (DM) is a chronic health condition that is very prevalent worldwide. It has been demonstrated that individuals with intellectual and developmental disabilities (IDDs) are at a disproportionately high risk for developing diabetes. Persons with IDDs are estimated to be 2-3 times more likely to develop DM compared to the general population. The elevated risk of developing diabetes within the population of adults with IDDs is multifactorial and includes contributions from genetics, lifestyle, medication use and misuse, boundaries to appropriate medical care, a higher incidence of comorbid mental health disorders, and others. Further, inadequate screening for and management of diabetes for these patients results in heightened risk for adverse cardiovascular events and inferior health care outcomes. To improve patient outcomes for this unique patient population, health care providers need to be well trained in the optimal modalities of screening, diagnosis, and management of diabetes in adults with IDDs. This requires the development of effective diabetes intervention and health promotion programs aimed at patients with IDDs, utilizing a patient-centered approach to screening and management, and conducting further research to assess the impact of these interventions.

Patient Perspectives on the Ambulatory Glucose Profile Report for Type 1 Diabetes Management in Adults: A National Online Survey

ObjectivesContinuous and flash glucose monitoring devices produce data reports (e.g. ambulatory glucose profile [AGP]) that can be used by people with diabetes and health-care providers (HCPs). Clinical benefits of these reports have been published, but the patient perspective is underreported. MethodsWe conducted an online survey for adults with type 1 diabetes (T1D) using continuous/flash glucose monitoring to understand their use and attitudes toward the AGP report. Barriers and facilitators related to digital health technology were explored. ResultsThe survey included 291 respondents: 63% were <40 years of age, and 65% had been living with T1D for >15 years. Nearly 80% reviewed their AGP report, with 50% often discussing it with their HCP. Support from family and HCPs was positively associated with the use of the AGP report, and there was a positive relationship between motivation and better understanding of the AGP report (odds ratio=2.61; 95% confidence interval, 1.45 to 4.71). Nearly all respondents (92%) indicated that the AGP report is important for their diabetes management, but most indicated dissatisfaction with the cost of the device. Open-ended responses suggested some concern with the complexity of information from the AGP report. ConclusionsThe online survey showed that there may be few barriers to the use of the AGP report by people with T1D, with the main barrier being its cost of the devices. Facilitators for the use of the AGP report included motivation and support from both family and the HCP. Facilitating discussion between HCPs and patients may be a strategy to improve the use and potential benefit of the AGP.

Associations of Age at Diagnosis and Duration of Diabetes With Morbidity and Mortality Among Older Adults

Older adults vary widely in age at diagnosis and duration of type 2 diabetes, but treatment often ignores this heterogeneity. To investigate the associations of diabetes vs no diabetes, age at diagnosis, and diabetes duration with negative health outcomes in people 50 years and older. This cohort study included participants in the 1995 through 2018 waves of the Health and Retirement Study (HRS), a population-based, biennial longitudinal health interview survey of older adults in the US. The study sample included adults 50 years or older (n = 36 060) without diabetes at entry. Data were analyzed from June 1, 2021, to July 31, 2022. The presence of diabetes, specifically the age at diabetes diagnosis, was the main exposure of the study. Age at diagnosis was defined as the age when the respondent first reported diabetes. Adults who developed diabetes were classified into 3 age-at-diagnosis groups: 50 to 59 years, 60 to 69 years, and 70 years and older. For each diabetes age-at-diagnosis group, a propensity score-matched control group of respondents who never developed diabetes was constructed. The association of diabetes with the incidence of key outcomes-including heart disease, stroke, disability, cognitive impairment, and all-cause mortality-was estimated and the association of diabetes vs no diabetes among the age-at-diagnosis case and matched control groups was compared. A total of 7739 HRS respondents developed diabetes and were included in the analysis (4267 women [55.1%]; mean [SD] age at diagnosis, 67.4 [9.9] years). The age-at-diagnosis groups included 1866 respondents at 50 to 59 years, 2834 at 60 to 69 years, and 3039 at 70 years or older; 28 321 HRS respondents never developed diabetes. Age at diagnosis of 50 to 59 years was significantly associated with incident heart disease (hazard ratio [HR], 1.66 [95% CI, 1.40-1.96]), stroke (HR, 1.64 [95% CI, 1.30-2.07]), disability (HR, 2.08 [95% CI, 1.59-2.72]), cognitive impairment (HR, 1.30 [95% CI, 1.05-1.61]), and mortality (HR, 1.49 [95% CI, 1.29-1.71]) compared with matched controls, even when accounting for diabetes duration. These associations significantly decreased with advancing age at diagnosis. Respondents with diabetes diagnosed at 70 years or older only showed a significant association with the outcome of elevated mortality (HR, 1.08 [95% CI, 1.01-1.17]). The findings of this cohort study suggest that age at diabetes diagnosis was differentially associated with outcomes and that younger age groups were at elevated risk of heart disease, stroke, disability, cognitive impairment, and all-cause mortality. These findings reinforce the clinical heterogeneity of diabetes and highlight the importance of improving diabetes management in adults with earlier diagnosis.

1289-P: Role of Metformin and Lifestyle Modification in Management of Latent Autoimmune Diabetes in Adults

Introduction: Latent autoimmune diabetes in adults (LADA) is atypical heterogenic diabetes that is frequently misdiagnosed as type 2 diabetes (T2DM) . LADA can demonstrate features of type 1 or T2DM.1 The diagnosis of LADA is well established, however, there are no universally accepted treatment guidelines. Few studies report the impact of metformin on long-term management in LADA. Most LADA cases will ultimately require insulin treatment.2 This case highlights the importance of early diagnosis of LADA and the potential benefit of using metformin with lifestyle changes to help maintain glycemic control. Case presentation: A 27-year-old man with no past medical history presented with unintentional weight loss (30 lbs.) , frequent urination, blurry vision and dry mouth for 3 months. Physical exam was unremarkable, body mass index (BMI) : 24.5. Blood sugar: 381 mg/dL, HbA1c: 14% and C peptide: 0.97 ng/ml. He was diagnosed with T2DM and started on metformin 500 mg twice a day. Due to high clinical suspicion for atypical diabetes (young age, normal BMI and profound hyperglycemia) , immunological tests were done (reference ranges in parentheses) . GAD 65 antibody: 37.5 IU/mL (&amp;lt; 5 IU/mL) , Islet cell antibody 1:16 (&amp;lt;1:4) and Zinc Transporter 8 antibody: 97.2 U/mL (&amp;lt; 15.0 U/mL) . The results were suggestive of LADA. The patient continued treatment with metformin, regular exercise and low carbohydrate/sugar intake. After a year of adherence with treatment, results showed normal C peptide, controlled fasting and post-prandial blood sugars demonstrated by continuous glucose monitoring, 1,5 anhydroglucitol:13ug/mL (10.7-32.0 ug/mL) and HbA1c: 5.3%. Conclusion: Treatment with metformin combined with lifestyle changes appears to be beneficial in patients with LADA. This management has so far been able to preserve adequate beta-cell function, providing optimal glycemic control. Future studies are warranted to further evaluate the therapeutic mechanism of metformin in this patient population. Disclosure S.Velayati: None. M.Shanik: Consultant; Bigfoot Biomedical, Inc., Proteomics International, Research Support; Better Therapeutics, Speaker's Bureau; Abbott, Boehringer Ingelheim International GmbH, Novo Nordisk, Xeris Pharmaceuticals, Inc. I.J.Romao: None.

Diabetic kidney disease in children and adolescents: an update

Diabetic kidney disease (DKD), previously encountered predominantly in adult patients, is rapidly gaining center stage as a childhood morbidity and one that pediatric nephrologists are likely to encounter with increasing frequency. This is in large part due to the obesity epidemic and the consequent rise in type 2 diabetes in children and adolescents, as well as the more aggressive diabetes phenotype in today’s youth with more rapid β-cell decline and faster development and progression of diabetes-related complications along with lower responsiveness to the treatments used in adults. DKD, an end-organ complication of diabetes, is at the very least a marker of, and more likely a predisposing factor for, the development of adverse cardiovascular outcomes and premature mortality in children with diabetes. On an optimistic note, several new therapeutic approaches are now available for the management of diabetes in adults, such as GLP1 receptor agonists, SGLT2 inhibitors, and DPP4 inhibitors, that have also been shown to have a favorable impact on cardiorenal outcomes. Also promising is the success of very low-energy diets in inducing remission of diabetes in adults. However, the addition of these pharmacological and dietary approaches to the management toolbox of diabetes and DKD in children and adolescents awaits thorough assessment of their safety and efficacy in this population. This review outlines the scope of diabetes and DKD, and new developments that may favorably impact the management of children and young adults with diabetes and DKD.

Telehealth Behavioral Intervention for Diabetes Management in Adults With Physical Disabilities: Intervention Fidelity Protocol for a Randomized Controlled Trial

BackgroundDiabetes mellitus is a major health problem among people with physical disabilities. Health coaching has been proven to be an effective approach in terms of behavioral changes, patient self-efficacy, adherence to treatment, health service use, and health outcomes. Telehealth systems combined with health coaching have the potential to improve the quality of health care by increasing access to services. Treatment fidelity is particularly important for behavior change studies; however, fidelity protocols are inadequately administered and reported in the literature.ObjectiveThe aim of this study is to outline all the intervention fidelity strategies and procedures of a telecoaching intervention—artificial intelligence for diabetes management (AI4DM)—which is a randomized controlled trial to evaluate the feasibility, acceptability, and preliminary efficacy of a telehealth platform in adults with type 2 diabetes and permanent impaired mobility. AI4DM aims to create a web-based disability-inclusive diabetes self-management program. We selected the National Institutes of Health Behavior Change Consortium (NIH BCC) fidelity framework to describe strategies to ensure intervention fidelity in our research.MethodsWe have developed fidelity strategies based on the five fidelity domains outlined by the NIH BCC—focusing on study design, provider training, treatment delivery, treatment receipt, and enactment of treatment skills. The design of the study is grounded in the social cognitive theory and is intended to ensure that both arms would receive the same amount of attention from the intervention. All providers will receive standardized training to deliver consistent health coaching to the participants. The intervention will be delivered through various controlling and monitoring strategies to reduce differences within and between treatment groups. The content and structure of the study are delivered to ensure comprehension and participation among individuals with low health literacy. By constantly reviewing and monitoring participant progress and protocol adherence, we intend to ensure that participants use cognitive and behavioral skills in real-world settings to engage in health behavior.ResultsEnrollment for AI4DM will begin in October 2021 and end in October 2022. The results of this study will be reported in late 2022.ConclusionsDeveloping and using fidelity protocols in behavior change studies is essential to ensure the internal and external validity of interventions. This study incorporates NIH BCC recommendations into an artificial intelligence embedded telecoaching platform for diabetes management designed for people with physical disabilities. The developed fidelity protocol can provide guidance for other researchers conducting telehealth interventions within behavioral health settings to present more consistent and reproducible research.Trial RegistrationClinicalTrials.gov NCT04927377; http://clinicaltrials.gov/ct2/show/NCT04927377.International Registered Report Identifier (IRRID)PRR1-10.2196/31695

The SAGE study: Global observational analysis of glycaemic control, hypoglycaemia and diabetes management in T1DM.

AimsTo describe glycaemic control and diabetes management in adults with type 1 diabetes (T1DM), in a real‐life global setting.Materials and MethodsStudy of Adults' GlycEmia (SAGE) was a multinational, multicentre, single visit, noninterventional, cross‐sectional study in adult patients with T1DM. Data were collected at a single visit, analysed according to predefined age groups (26–44, 45–64 and ≥65 years) and reported across different regions. The primary endpoint was the proportion of participants achieving HbA1c less than 7.0 % in each age group. Secondary endpoints included incidence of hypoglycaemia, severe hypoglycaemia and severe hyperglycaemia leading to diabetic ketoacidosis (DKA) and therapeutic management of T1DM.ResultsOf 3903 included participants, 3858 (98.8%) were eligible for the study. Overall, 24.3% (95% confidence interval [CI]: 22.9–25.6) of participants achieved the glycaemic target of HbA1c less than 7.0 %, with more participants achieving this target in the 26–44 years group (27.6% [95% CI: 25.5–29.8]). Target achievement was highest in Eastern and Western Europe, and lowest in the Middle East. The incidence of hypoglycaemia and of severe hyperglycaemia leading to DKA tended to decrease with age, and varied across regions. Age and regional differences were observed in therapeutic management, including types of device/insulin usage, frequency of insulin dose adjustment and technology usage.ConclusionsGlycaemic control remains poor in adults with T1DM globally. Several areas of treatment may be optimised to improve outcomes, including supporting patient self‐management of insulin therapy, increasing use of technologies such as CGM, and greater provision of healthcare support.

Psychometric Testing of an Indonesian-Version Diabetes Self-Management Instrument.

ABSTRACTBackgroundSelf-management is one of the vital elements in diabetes management for adults with Type 2 diabetes mellitus (T2DM). Although the number of people with T2DM in Indonesia has risen, clinical understanding of the problems related to practicing diabetes self-management (DSM) is limited because of the lack of a valid measurement instrument. The 35-item Diabetes Self-Management Instrument (DSMI-35) is one instrument widely used in research to assess DSM-related behavior among patients with diabetes.PurposeThis study was designed to translate the psychometric properties of the Indonesian version of the DSMI-35 and evaluate the efficacy of this instrument in a sample of Indonesian adults with T2DM.MethodsForward and backward translation processes were used to translate the DSMI-35 into Indonesian (IDN-DSMI). Then, the translation equivalence, content validity, face validity, construct validity, and internal consistency were assessed using a sample of 222 Indonesian adults with T2DM from eight public health centers. Confirmatory factor analysis was used to test the data.ResultsThe confirmatory factor analysis confirmed that the 35 items all had acceptable goodness of fit. Although the analysis supported removing several of the items, removal of these items was not theoretically justified. The average variance extracted was acceptable, and composite reliability was satisfied. The Cronbach's alpha was .96 for the IDN-DSMI and .84–.93 for the subscales. The significant interitem correlations between some items were consistent with the findings of other previous studies.Conclusions/Implications for PracticeThe IDN-DSMI is a valid and reliable instrument that may be used to measure DSM behavior in Indonesian patients with T2DM in primary healthcare settings.

Experiences of Food Insecurity and Type 2 Diabetes Management in Adults

ABSTRACT The purpose of this qualitative study is to elucidate how food insecurity affects diabetes self-management among adults with type 2 diabetes mellitus (T2DM). Eleven persons with T2DM who screened as food insecure were recruited from a patient pool of a healthcare system in South Carolina. Interview recordings were transcribed, blinded, and imported into NVivo. Participant ages ranged from 36 to 66 years, and included nine women, and seven African American participants. Three major themes emerged: (1) coping with food insecurity; (2) strategies used to manage T2DM within the context of food insecurity; and (3) receiving unrealistic advice from providers.

Impact of Weight Change in Adults with Type 2 Diabetes Mellitus: A Literature Review and Critical Analysis.

ObjectiveWeight reduction is a key component of diabetes management in adults with type 2 diabetes mellitus (T2DM), yet the benefits of weight loss in T2DM patients have been difficult to quantify. We examined the medical literature regarding the relationships between weight change and 1) glycemic control and 2) cost and resource use.MethodsSystematic searches were conducted in the electronic databases Embase, MEDLINE, and the Cochrane Database of Systematic Reviews to identify publications regarding the impact of weight change on T2DM outcomes from 2007 onward. Identified publications were screened for relevance against predefined eligibility criteria, and methodological approaches and results were extracted. Evidence for the impact of weight change on outcomes was evaluated and used to identify strengths, limitations, and gaps in the current literature.ResultsThe number of studies meeting eligibility criteria for each outcome was: glycemic control (n=38) and cost and resource use (n=11). The relationship between weight change and glycemic control was dependent on the interplay of multiple factors, eg, the weight loss interventions employed, the antidiabetic medication classes used, the time horizon, and baseline BMI and glycemic control. With respect to cost and resource use, the review indicated that savings were associated with weight loss, and increased costs were associated with weight gain.ConclusionStudies regarding weight change in T2DM patients demonstrated varying effects on glycemic control and a positive association with costs and resource use, where weight loss was associated with decreased costs and resource use. Future studies may be able to clarify these relationships.

1514-P: Suboptimal Glycemic Control and High Prevalence of Diabetes Complications in Adults with Type 1 Diabetes (T1D) in the SAGE Study

Poor glycemic control is a risk factor for many diabetes-related complications, but global real-world data on diabetes management in adults with T1D is limited. SAGE was a multinational, observational, cross-sectional study to describe glycemic control of participants aged ≥26 years with T1D for ≥1 year. Of 3858 participants from 17 countries, 54.6% were female, with mean (standard deviation [SD]) age 47.4 (14.0) years, T1D duration 20.7 (12.6) years, and age at T1D onset 26.7 (14.4) years. Childhood-onset T1D was most common (48%) in the 26-44 years age group. Mean (SD) HbA1c was 7.95 (1.42) % (63.4 [15.6] mmol/mol), and similar across predefined age groups (Table). Only 20.9% of participants reached their individualized HbA1c target. Prevalence of microvascular complications was 36-63%, increasing with age and duration of diabetes. Incidence of diabetic ketoacidosis was similar in all age groups and consistent with previous reports. SAGE shows that the prevalence of microvascular complications remains high, affecting over half of the study population aged ≥65 years, and is more prevalent in those with a longer duration of diabetes. Disclosure E. Renard: Board Member; Self; Abbott, Insulet Corporation, Novo Nordisk A/S, Roche Diabetes Care. Consultant; Self; Air Liquide, Eli Lilly and Company, Sanofi. Research Support; Self; Dexcom, Inc., Tandem Diabetes Care. Z. Bosnyak: Employee; Self; Sanofi. Stock/Shareholder; Self; Sanofi. F. Lauand: Employee; Self; Sanofi. P. Pozzilli: Advisory Panel; Self; Abbott, AstraZeneca, Eli Lilly and Company. Research Support; Self; Medtronic, Sanofi. H. Ikegami: None. J. Kesavadev: Speaker’s Bureau; Self; Biocon, Novo Nordisk Inc., Sanofi-Aventis. A.G. Vianna: Board Member; Self; Abbott, Medtronic, Novo Nordisk A/S. Research Support; Self; Sanofi. Speaker’s Bureau; Self; Lilly Diabetes. Funding Sanofi

Chronic Care Management Services for Complex Diabetes Management: a Practical Overview.

Formalized chronic care management has the potential to improve the quality and cost-effectiveness of complex diabetes management in adults, but has historically not been sustainably supported by health care systems. This review discusses the application of the chronic care model in the care of complex diabetes and its translation in the current reimbursement structure designed by Centers for Medicare and Medicaid Services (CMS). Following the introduction of Wagner's Chronic Care Model (CCM) in the late 1990s, evidence gathered over the past 2 decades has supported the shift in focus of health care systems from acute to chronic disease management and proactive care. Acknowledging evidence and potential for improved cost-effectiveness, in 2015, Medicare began reimbursing for chronic care management services (CCMS) for patients with multiple chronic conditions. The CCMS billing codes allow a program to be reimbursed for up to 90min per month spent by clinical staff performing interim care within a comprehensive care plan. Recent data from local and global programs support the application of formalized CCM in diabetes management. Although reimbursement models for CCM have been designed for use in primary care, the challenges of the reimbursement model has opened the door for specialty areas focused on multimorbidity care such as diabetes care to explore this approach. With the broader availability of remote glucose monitoring and telemedicine, a strategy that combines goal-oriented care and telehealth solutions appears to be most effective in diabetes CCM care. Despite widespread acceptance of the chronic care model of care, there remain significant barriers to its incorporation into standard practice.

Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS): guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings.

The Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS) for Inpatient Careguidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings are available in full at: www.diabetes.org.uk/joint-british-diabetes-society and https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group. This article summarizes the guidelines and recommendations. Commissioners are urged to ensure that the needs of people with diabetes and severe mental illness are specifically addressed in contracts with providers of inpatient care, and to avoid financial or other barriers to cross-organizational working and to ensure that patient-structured education is commissioned to meets the complex needs of people with diabetes and severe mental illness. Acute trusts are asked to develop joint pathways with mental health providers and facilitate multidisciplinary working and to screen for mental ill health in those admitted with acute complications of diabetes whose aetiology is unclear or not medically explained. Mental health trusts should create a diabetes register, screen for diabetes, particularly in those prescribed second-generation antipsychotics and ensure that staff are trained in managing and avoiding hypoglycaemia, and the safe use of insulin. Finally, clinical teams should ensure that all staff can access training in diabetes and mental health to support them to care for people with both diabetes and severe mental illness, develop local pathways for joint working and ensure best practice tariff criteria are met for diabetic ketoacidosis and hypoglycaemia, and for children and young people with diabetes.

Supporting Diabetes Management—Perspectives on Care Management in a Medicaid Health Home in Alabama

Background: Chronic diseases like diabetes require constant and ongoing self-management. The Health Home model provides a unique platform to facilitate diabetes management and connect patients to community resources that support and promote self-management. However, little is known about specific activities, barriers, and needs that exist in Health Homes particularly in Alabama which suffers disparately high rates of diabetes compared to other regions. To address this knowledge gap, the purpose of this study is to understand how a Medicaid Health Home facilitates diabetes management in Alabama. Methods: Three interviewers conducted semi-structured interviews with six staff at a health home organization. A guide facilitated discussion on patient recruitment, frequency and mode of communication with patients and health care delivery team, and clinical and non-clinical patient-related barriers. Content analysis was performed to identify major themes using an iterative, combined deductive and inductive approach. Results: Six female participants were aged a mean 49 years; majority employed 4 to 5 years in current role. Professional qualifications included a dietician, social worker, and nurses. Five care management domains were identified: health education, medication management, nutrition therapy, and addressing psychosocial issues. Facilitators of staff roles discussed were a high degree of collaboration within their organization and externally with providers and other professionals. For example, staff described the value of reciprocal relationships in which providers interacted with the health home. Barriers to care management included state Medicaid cost-sharing policies, medication limits, timely access to care, and variation in the availability of community resources. Conclusions: These findings suggest that opportunities exist to intervene at the policy and healthcare system level to improve adult diabetes management for a vulnerable population. Disclosure A.A. Agne: None. F. Mondesir: None. J.P. Shelley: None. M. Pisu: None. A. Cherrington: Advisory Panel; Self; AstraZeneca. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc.. Consultant; Self; Novo Nordisk Inc..

Telemedicine in Complex Diabetes Management.

Telehealth has the potential to positively transform the quality and cost-effectiveness of complex diabetes management in adults. This review explores the landscape of telemedicine approaches and evidence for incorporation into general practice. Telemedicine for diabetes care is feasible based on over 100 randomized clinical trials. Evidence shows modest benefits in A1c lowering and other clinical outcomes that are better sustained over time vs. usual care. While telemedicine interventions are likely cost-effective in diabetes care, more research is needed using implementation science approaches. Telehealth platforms have been shown to be both feasible and effective for health care delivery in diabetes, although there are many caveats that require tailoring to the institution, clinician, and patient population. Research in diabetes telehealth should focus next on how to increase access to patients who are known to be marginalized from traditional models of health care.