Improve Diabetes Control Research Articles

Effect of interdisciplinary obesity care on metabolic markers and body weight in people with type 2 diabetes in a rural setting: A randomised controlled trial.

Management of type 2 diabetes includes medications that can unintentionally increase obesity and insulin resistance. This unblinded, single-centre, randomised controlled trial focused on rural Australian adults with type 2 diabetes (aged 18-75 and body mass index [BMI] >30 kg/m2), measuring the effectiveness of a tailored interdisciplinary obesity care approach compared with usual diabetes care. Led by a nurse practitioner with allied health support (dietitian ± psychologist and physiotherapist), the bariatric treatment involved reducing weight-gaining medications, a 500-calories/day deficit, an unsupervised exercise program emphasising movement/strength and psychotherapy, 3-monthly to 24-months with support phone calls at weeks 2, 4, 8 and 10. Outcomes from the 224 (113 intervention/111 control) participants were differences in biomedical and physical markers within- and between-groups estimated using multivariate mixed-effects linear regression between recruitment and 6-monthly follow-ups. Greater change occurred in intervention compared with control groups at 12 and 24 months in mean: body weight (-5.9 kg [95% confidence interval, CI: -8.53, -3.23] and -9.0 kg [95% CI: -13.2, -4.77]); BMI (-2.03 kg/m2 [95% CI: -2.92, -1.15] and -3.51 kg/m2 [95% CI: -4.93, -2.08]); and glycated haemoglobin (-0.26% [95% CI: -0.69%, 0.18%] and -0.63% [95% CI: -1.17%, 0.08%]). The control group showed a significant increase in mean leptin level, resulting in a between-group difference (-27.1 [95% CI: -42.7, -11.5]). Lipids and blood pressure differences were inconclusive, while exploratory analysis showed greater decline in estimated glomerular filtration rate in the control group. The interdisciplinary obesity approach, compared with usual diabetes care, resulted in sustained weight loss and improved diabetes control over 2 years. Trial registration number: ACTRN12622000240741.

Evaluating diabetic foot care knowledge and practices at education level.

Diabetic foot is one of the complications in type 2 diabetes mellitus. Adequate knowledge and practice are an important aspect to control further deteriorating conditions such as ulcers and amputations. Thus, the objective of this cross-sectional study was to investigate the impact of the education levels of diabetic patients on diabetic foot care knowledge and practice. This cross-sectional study with a convenient sampling technique was conducted on 534 patients with diabetes mellitus from public and private care hospitals. The data was collected using a validated, pretested and structured bilingual (Arabic, English) questionnaire. There were 534 patients interviewed, 39.1% of whom were males and 60.9% of whom were females and 61.4% of the patients had had T2DM for over 10 years. There was a significant difference in education levels between the male and female patients (53.8% and 46.2%, P = .001). Furthermore, 83.9% patients were married. The difference in education between the married and the single, divorced, and widowed patients was significant (P = .007). Patients with uncontrolled HbA1c were 2.43 times more likely to have hypertension (RR = 2.43, P = .03), while patients with highly uncontrolled diabetes had 3.1 times more chances of hypertension (RR = 3.1, P = .009). Heart disease prevalence was 3.27 times higher in diabetes patients with uncontrolled HbA1c and 3.37 times higher in patients with highly uncontrolled HbA1c. Patients with diabetes who have been diabetic for more than 10 years have a greater risk of heart disease (RR = 2.1; P = .03). Patients with lower education levels exhibited more diabetic complications compared to patients with higher education levels (P < .05). The present study highlights the importance of education and awareness campaigns targeting diabetic patients, especially those with lower education levels, to improve diabetes control and prevent, or manage, comorbidities. Healthcare providers should also prioritize patient education and medication adherence to improve diabetes management and reduce the risk of complications.

Whom should we target? A brief report on a prospective study to identify predictors of mental health and self-care worsening in patients with diabetes mellitus during the COVID-19 pandemic.

To identify predictors of mental health disorders and self-care worsening in patients with diabetes through 15 months of COVID-19 pandemic. Prospective study following patients with type 1 and type 2 diabetes during the COVID-19 pandemic in Southern Brazil. Participants were evaluated through phone calls in two moments: first three months of the outbreak, and 15 months later. The outcomes were the assessment of worsening in mental health disorders (increase ≥ 10% in the total score of the Self-Report Questionnaire), the assessment of emotional distress related to diabetes (increase ≥ 10% in the total score of the Brazilian version of the Problem Areas in Diabetes), and worsening in self-care parameters (reduction ≥ 3 points in the Self-Care Inventory-Revised). Logistic regression models were used to determine the odds ratio (OR) and their respective confidence intervals. Point-biserial correlation coefficients (rpb) were used to measure the relationship between the variation in scores and patient characteristics. In total, 150 adults were enrolled (54.6 ± 13.9 years old, 58.7% female, 85.9% white), out of which 118 remained during follow up. After 18 months, 34,7% of them (52.2 ± 14.8 years old, 53.7% female, 87.5% white) worsened mental health scores. An increase in mental health disorders was experienced by patients with lower middle-income [OR 4.2 (1.2-15.0)], and those who reported greater difficulty managing diabetes [OR 3.2 (1.4-7.1); rpb 0.32, P < 0.01]. In contrast, those who perceived an improvement in diabetes control showed a reduction in their mental health scores [OR 0.3 (0.1-0.8)]. For self-care, there was a score worsening in patients with longer duration of diabetes [OR 1.1 (1.0-1.1)] and in those using insulin [OR 8.3 (1.7-41.4); rpb 0.23, P = 0.01]. Conversely, those who followed the social distancing guidance had an improvement in self-care [OR 0.4 (0.1-0.9); rpb 0.18, P = 0.05]. Some clinical and socioeconomic characteristics may be suitable for identifying patients at higher risk of mental health and self-care worsening, signaling who needs to be monitored more closely during crisis situations.

Effectiveness of Continuous Glucose Monitoring in Glucose Control and Quality of Life Among Type 1 Diabetic Patients in Madina City: A Cross-Sectional Study.

Diabetes is a growing global health problem, affecting millions of people worldwide and in Saudi Arabia in particular. Continuous glucose monitoring (CGM) offers real-time glucose levels, alerts, and 24/7 coverage, making it an affordable treatment option. The study aimed to assess CGM's effect on diabetes control and quality of life among type 1 adult diabetic patients in Saudi Arabia. This cross-sectional study enrolled Saudi adults diagnosed with type I diabetesand was conducted from 1 April 2024 to 30 May 2024 in Madinah City, Saudi Arabia. Data was collected from patients' medical records and the diabetes quality of life questionnaire (DQoL). This study enrolled 317 participants, mostly male (52.1%) and a mean age of 34.34±12.28 years. After three months, the HbA1c levels significantly decreased (p<0.001). Older participants reported lower overall quality of life and satisfaction with their level of well-being when using CGM. Univariate analysis found that age had a significant negative association with the total score (B=-0.062, P=0.049) and satisfaction (B=-0.109, P=0.011. Marital status significantly affected the impact score (B=0.567, P=0.024). Education level notably affected satisfaction (B=-0.906, P=0.008)and monthly income influenced satisfaction (B=-1.25, P=0.033). However, multivariate analysis showed that age, education level, and monthly income did not significantly (p>0.005) affect the CGM impact, quality of life, and satisfaction. These findings indicate that CGM significantly improved diabetes control, while improved quality of life was not significant. The impact, quality of life, and satisfaction were influenced by age, marital status, education, and income level, though not statistically significant independent predictors. Therefore, we recommend longitudinal studies, controlling for confounders.

Influence of prosthodontic rehabilitation and dietary advice on glycaemic control, nutritional status and oral health-related quality of life of older adults with type 2 diabetes.

This prospective clinical study aimed to determine the influence of oral prosthodontic rehabilitation with partial removable dentures and simplified dietary advice on glycaemic control, nutritional status and oral health-related quality of life (OHRQoL) of older adults with type 2 diabetes. Individuals with tooth loss who did not wear complete or partial dentures are more likely to be at nutritional risk, suggesting that using dental prostheses would benefit the re-establishment of an adequate nutritional status and potentially improve quality of life. Nutritional therapy is essential for diabetes prevention, treatment and management, favouring glycaemic control. The literature provides little evidence on the contribution of partial removable dentures to improving diabetes control, nutritional profile and satisfaction in older adults, especially those with type 2 diabetes. Older individuals diagnosed with type 2 diabetes mellitus, aged 60 years or older and needing oral rehabilitation with partial removable dentures were eligible for this prospective study. The primary outcome measure was glycaemic control, measured by glycated haemoglobin (HbA1c) levels. The Oral Health Impact Profile (OHIP-14) questionnaire and the Mini Nutritional Assessment short-form (MNA-SF) represented secondary outcome measures. These measures were assessed at baseline and 12 months of follow-up after prosthesis delivery, combined with simple dietary advice in pamphlet form. The data were analysed using the Wilcoxon matched-pairs test. Forty-four patients who met the inclusion criteria and required treatment with removable partial dentures were selected for this study, which was carried out for a year. During this period, seven participants declined to participate because they moved to another city. Hence, a final sample of 37 participants (16 men and 21 women, average age of 65.8 years, ranging from 60 to 83 years) were included in the study. No laboratory parameter (HbA1c levels) changed significantly during the investigation. The number of older adults at risk of malnutrition was significantly lower at 12 months than at baseline. Furthermore, nutritional status significantly improved 12 months after prosthodontic treatment combined with dietary advice, and the effect sizes were large. OHRQoL significantly improved after prosthodontic therapy combined with dietary advice. Prosthodontic treatment with partial dentures associated with simple dietary advice did not influence glycaemic control but improved the nutritional status and OHRQoL of older adults with type 2 diabetes.

Exploring the self-efficacy of patients with diabetes: its role as a predictor of diabetes management and well-being.

Self-efficacy is a popular psychological concept that refers to an individual's perception or belief in his ability to perform specific actions. This study aimed to assess the predictive value of self-efficacy, measured using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEM6S) questionnaire, for diabetes management and overall well-being in patients with diabetes. An anonymous online cross-sectional study was conducted to evaluate the self-efficacy of diabetic patients in the Asser region of Saudi Arabia. The participants were requested to upload their most recent glycated hemoglobin A1C (HbA1C) measurements taken in the last three months, which helped in the accurate categorization of their diabetes as either controlled or uncontrolled. We used the valid Arabic version of the SEM6S and WHO-5 well-being questionnaires to assess patient self-efficacy and well-being. A cohort of 342 patients was enrolled in the study, 67.25% were married, their mean age was 43.17 ± 17.61 years, and 52.69% had university-level or higher education. Among the participants, 46.0% exhibited well-being, while 24.9% reported poor well-being, including 9.4% who were identified as experiencing depression. The mean scores of self-efficacy and well-being were significantly higher among those with controlled diabetes versus uncontrolled diabetes (40.86 ± 13.26 vs. 36.48 ± 13.26) and (67.35 ± 21.22 vs. 60.93 ± 25.05), respectively. The predictors of glycemic control were self-efficacy [Odds ratio (OR)=1.03 (95%CI, 1.01-1.06, P=0.002], having other chronic diseases [OR=3.25 (95%CI), P<0.001], having type 1 diabetes [OR=7.16, 95%CI, P=0.005], being Saudi [OR=7.67, (95%CI, P=0.027], working in a public sector [OR=0.15, (95%CI, 0.05-0.44), P=0.005], being unemployed [OR=0.19, (95%CI, 0.06-0.59), P=0.005], being a smoker [OR=0.44, 95%CI, 0.19-0.98, P=0.048], and duration of diabetes between 6-10 years [OR= 0.33, 95%CI, 0.11-0.95), P=0.043] or more than 10 years OR=0.32, 95%CI, 0.12-0.86), P=0.026]. The main determinants of well-being were having self-efficacy [OR=1.07 (95%CI, 1.04-1.09), P = 0.0001], having public health insurance [OR=4.36 (95%CI, P=0.015], and education level (read and write) [OR=0.13 (95%CI,.02-.70), P=0.021]. The study reveals that non-modifiable and modifiable factors, including self-efficacy, play a crucial role in diabetes control. The study recommends providing targeted educational interventions, using different social media platforms, psychosocial support programs, and inclusive healthcare policies to improve diabetes control and mental well-being among diabetic patients.

Assessment of a community pharmacist remote monitoring service in patients using continuous glucose monitors

BackgroundDiabetes is the eighth leading cause of death and has a substantial impact on the U.S. health care system. Recent changes to major insurance formularies allow for increased access to continuous glucose monitors (CGMs). Community pharmacists routinely assist and educate patients about diabetes care, including usage of CGM. ObjectivesThe purpose of this study was to evaluate the clinical impact of a community pharmacist remote CGM monitoring service on patients’ glycemic metrics. Patient completion of comprehensive diabetes standards of care and pharmacist interventions and recommendations were assessed as secondary objectives. MethodsThis study was a prospective, feasibility study conducted at two pharmacies within 1 regional division of a large community pharmacy chain between November 2022 and June 2023. A pharmacist conducted patient enrollment visits and remotely monitored CGM glycemic metrics via cloud-based platforms per the study protocol. CGM glycemic metrics were evaluated for each patient 3 months pre- and post-study enrollment, including time above range (TAR), time in range (TIR), time below range, glucose management indicator, average glucose, CGM utilization rate, and glucose variability. Metrics were evaluated for statistical significance using the Wilcoxon signed-rank test and descriptive statistics. ResultsPharmacists enrolled 36 patients in this study with 20 patients completing the full 3-month study period per protocol. There was a statistically significant improvement in three of eight glycemic metrics (very high TAR, TIR, and average glucose). Specifically, TIR had the largest improvement from 61.8% pre-enrollment to 69.9% (P < 0.006) postenrollment. All other pertinent glycemic metrics displayed improvements but were not statistically significant. ConclusionThe results demonstrate clinically and statistically significant improvements in several glycemic metrics for patients who participated in the community pharmacist-led remote CGM monitoring service, which may result in improved diabetes control and fewer long-term diabetes-related health complications.

Prolonged remission followed by low insulin requirements in a patient with type 1 diabetes on a very low-carbohydrate diet.

The use of a low-carbohydrate diet (LCD) reduces insulin requirements in insulinopenic states such as type 1 diabetes mellitus (T1DM). However, the use of potentially ketogenic diets in this clinical setting is contentious and the mechanisms underlying their impact on glycaemic control are poorly understood. We report a case of a patient with a late-onset classic presentation of T1DM who adopted a very low-carbohydrate diet and completely avoided insulin therapy for 18 months, followed by tight glycaemic control on minimal insulin doses. The observations suggest that adherence to an LCD in T1DM, implemented soon after diagnosis, can facilitate an improved and less variable glycaemic profile in conjunction with temporary remission in some individuals. Importantly, these changes occurred in a manner that did not lead to a significant increase in blood ketone (beta-hydroxybutyrate) concentrations. This case highlights the need for further research in the form of randomised controlled trials to assess the long-term safety and sustainability of carbohydrate-reduced diets in T1DM. This case highlights the potential of low-carbohydrate diets (LCDs) in type 1 diabetes mellitus (T1DM) to mediate improved diabetes control and possible remission soon after diagnosis. Could carbohydrate-reduced diets implemented early in the course of T1DM delay the decline in endogenous insulin production? Adherence to an LCD in T1DM can facilitate an improved and less variable glycaemic profile. This case suggests that LCDs in T1DM may not be associated with a concerning supraphysiological ketonaemia.

Beneficial Effect of Remote Glucose Monitoring and Computerized Insulin Dose Adjustment Algorithms Independent of Insulin Dose Increases in Sizeable Minorities of Patients.

This article describes a program through which interactions every 2-3 weeks between patients and primary care clinicians (PCCs), with recommendations based on analysis of remote glucose monitoring by computerized insulin dose adjustment algorithms, significantly improved diabetes control. Insulin doses increased by 30% in the majority of patients. A sizeable minority (36%) had a decrease or no increase in insulin doses, but still showed an improvement in diabetes control. Frequent interactions allowed PCCs the opportunity to recognize and address medication nonadherence.

Improving Diabetes Control in a Medicaid Managed Care Population With Complex Needs.

People enrolled in Medicaid managed care who struggle with diabetes control often have complex medical, behavioral, and social needs. Here the authors report the results of a program designed to partner with primary care teams to address those needs. A nonprofit organization partnered with a Medicaid managed care plan and a Federally Qualified Health Center in California to enroll people with A1cs >9% in a 12-month program. The program team included a community health worker, certified diabetes care and education specialist/registered dietitian, behavioral health counselor, and registered nurse. They developed patient-led action plans, connected patients to community resources, and supported behavior changes to improve diabetes control. Baseline assessments of behavioral health conditions and social needs were collected. Monthly A1c values were tracked for participants and a comparison group. Of the 51 people enrolled, 83% had at least 1 behavioral health condition. More than 90% reported at least 1 unmet social need. The average monthly A1c among program participants was 0.699 lower than the comparison group post-enrollment (P = .0008), and the disparity in A1c between Hispanic and non-Hispanic White participants at enrollment declined. Participants had high levels of unmet medical, behavioral, and social needs. Addressing these needs resulted in a rapid and sustained improvement in A1c control compared to non-enrollees and a reduction in disparity of control among Hispanic participants. By partnering with a primary care team, a program external to Federally Qualified Health Center primary care can improve clinical outcomes for people with complex needs living with diabetes.

Uptake of diabetes follow-up checks by minority community groups: a rapid review of the evidence for the CYMELL study

BackgroundType 2 diabetes is a public health priority for the UK. A growing body of evidence has indicated ethnic and socioeconomic disparities in rates of diabetes prevalence and complications. Attendance at diabetes follow-up checks is key to ensuring complications are identified and managed at an early stage. The aim of this rapid review was to identify and summarise evidence of ways to improve diabetes management in ethnic minority groups. MethodsIn this rapid review, we searched PubMed, PsycInfo, and CINAHL for studies published in English between Jan 1, 2000, and Jan 31, 2023. Studies were included if the population was from ethnic minority groups and if the intervention was community-based and aimed to improve diabetes self-care. The comparisons were persuasion and behaviour change, and the outcomes were improved diabetes self-management including, glycaemic control, attending eye tests, kidney, and foot screening follow-up checks. This study is registered with PROSPERO 2023, CRD42023399283. FindingsNine studies were included, from Mexico (n=1), USA (n=7), and UK (n=1). Most studies reported on community engagement (n=8), and one focussed on peer support and diabetes self-management. Peer support and diabetes self-management education were found to significantly improve diabetes control in a Mayan community (n=29) in Mexico (p<0·0001) and in the Korean American (n=105), African American (n=107), and Latino American (n=56) communities in the USA. Another study showed that women from the Pakistani community in England also benefitted from a culturally appropriate and socially supportive environment when learning about diabetes self-management. Diabetic eye screening rates could be increased through education but not through incentive payments. InterpretationCulturally competent health-care policies and programmes have been shown to increase diabetes self-management including uptake of diabetes screening for people with diabetes from ethnic minority communities to avoid potential harmful and life limiting conditions. A strength of this review is that robust, recent, and relevant papers regarding self-management of diabetes were included. The main limitations were that none of the nine studies included any cost analyses, and only one UK-based study was included, indicating that further research is required to fill the evidence gap. FundingResearch for Patient and Public Benefit (RfPPB), Health and Care Research Wales.

Technology use and clinical outcomes in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes.

Technology use has been shown to improve diabetes control, but minority youths tend to have low rates of technology use and exhibit suboptimal glycemic control. We examined the impact of continuous glucose monitors (CGM) and continuous subcutaneous insulin infusion (CSII) on glycemic control in a racial-ethnic minority cohort of children and adolescents with type 1 diabetes (T1D). A cross-sectional study was conducted among 140 pediatric T1D patients seen at a multidisciplinary clinic. From January to November 2022, data on demographics and glycated hemoglobin (HbA1c) levels were collected. Patients were categorized as technology (CGM, CSII, or both) or non-technology users (finger stick meter (FS) and multiple daily injections (MDI)). The majority identified as Hispanic (79 %) and had public health insurance (71 %). Sixty-nine percent used technology. Compared with non-technology users, technology users had significantly lower mean HbA1c levels (9.60 vs. 8.40 %, respectively) (p=0.0024), though no group (CGM+CSII, CGM+MDI, FS+CSII, and FS+MDI) achieved a mean HbA1c level of <7.0 %. Regarding minority status, no significant differences in mean HbA1c levels existed between Hispanics and Blacks in the CGM+MDI and FS+CSII groups (p=0.2232 and p=0.9224, respectively). However, there was a significant difference in mean HbA1c levels between Hispanic and Black non-technology users (9.19 vs. 11.26 %, respectively) (p=0.0385). Technology users demonstrated better glycemic control than non-technology users. Further research is needed to investigate factors affecting glycemic control in minority youths with T1D.

A stepped wedge cluster randomized trial to evaluate the effectiveness of a community leader-driven kit-based diabetes self-management education approach in improving diabetes control and care: study protocol for the DElhi Diabetes INTervention Trial (DEDINTT)

IntroductionDiabetes self-management education (DSME) helps patients self-manage their condition and improve outcomes/quality of life. However, access to DSME is limited, particularly in low-income areas. This study aims to develop a DSME training kit (EK-DIN), understand barriers to implementation, and evaluate the effectiveness and sustainability of community leader (CL)-based rollout using a stepped wedge cluster randomized trial format.Methods and analysisThe mixed methods study will begin with a qualitative study to evaluate the facilitators and barriers towards CL-based DSME. The in-depth interview notes will be transcribed for thematic analysis. These results will be utilized for a stakeholder’s workshop to develop the EK-DIN kit, a patient-interfacing app, and an implementation plan. Rollout will be conducted in 30 clusters in Delhi, preselected by the DEDICOM-II survey in 5 steps (6 clusters every 3 months: 2 each from each socio-economic category; randomly selected per sequence). A CL from each cluster will be trained in using the EK-DIN kit/app over 1 month. The trained CL will conduct DSME sessions among the cluster residents using the EK-DIN kits provided fortnightly for 3 months. Compliance and blood parameters data will be collected at baseline, 3 months after the intervention, and every quarter thereafter till completion. Change in HbA1c before and after the intervention will be evaluated as the primary outcome using the swCRTdesign package for R version 4.0.2 and the swSummary function. The sustainability of the effects will be evaluated using the change in quarterly parameters after intervention completion.DiscussionA positive result will set the template for a generalizable public health intervention with proven community effectiveness, sustainability, cost-effectiveness, and positive quality-of-life impact. While a negative result will require the testing of alternative approaches, it would still add substantially to existing knowledge on the subject. Given the diverse socio-cultural setting in which the trial is being proposed and the high power of the study, the results (positive or negative) should be widely applicable and have policy implications.Trial registrationCTRI/2023/07/054963. Date of Registration: 7th July 2023.

THU152 HbA1c Control Of Pediatric Patients With Diabetes In The Urban Community Hospital Representing Underserved, Minority Population: Can The Frequent Encounters With Multi-Disciplinary Diabetes Team Overcome Patient-Related Adverse Variables In Improving Their Glycemic Control?

Abstract Disclosure: S. Velasquez: None. O. Ozcan: None. S. Dave-Sharma: None. Introduction: The American Diabetes association’s established goal for HbA1C across all age groups is as &amp;lt;7%. As the prevalence of diabetes continues to increase, its control in the pediatric population has become more challenging. Studies have shown controlling diabetes is especially challenging in minority ethnic groups of low income neighborhoods. Our hospital, located in the Mott Haven community, serves the minority population of mostly Hispanics and Blacks with an average household income of &amp;lt; $ 20 000 (poverty rate 39%). Objectives: This study aimed to identify different variables among patients with controlled and uncontrolled HbA1c in our unique pediatric population. Our goal was to learn from the group of patients with good diabetes control to improve the control of patients with poor glycemic control by changing the protocols involving our multi-disciplinary care team. Results: We collected data from 86 patients with diabetes (type 1 and 2) from our pediatric endocrinology clinic and divided them into 3 groups based on their HbA1c levels. 1. Good control: HbA1c &amp;lt;7.5 % in 33/86 (38%) patients, 2. Poor control: HbA1C 7.5%-10% with 34/86 (40%), and 3. Very poor control: HbA1C &amp;gt;10% with 19/86 (22%) patients. We studied the data for variables such as gender, age, ethnicity, insurance, type of diabetes, duration of diabetes, BMI, frequency of encounters with the multi-disciplinary team, and more. Of 86 patients, the average age was 15.65 (51% were females, and 49% were males). 43% had type 1 diabetes, and 57% had type 2 diabetes. The type 1 vs. Type 2 diabetes ratio among different groups was 12% Type 1 vs. 88% type 2 in the group with good control, 73.5% Type 1 vs. 26.5% Type 2 in the poor control group, and 42% type 1 vs. 58% type 2 in the group with very poor control. Obesity was found in 50% of our patients; in the good control group, it was 57%. In the poor control group, 38%, and in the very poor control group, 58%. A correlation study run between the HbA1c levels and duration of diabetes found significantly correlated (R 0.38) in the good control group. Other groups were found positively correlated yet found statistically insignificant. Conclusion: We found that Type 2 Diabetes with Obesity was more prevalent than Type 1 in our pediatric population. Patients with poor and very poor diabetes control had a longer duration of diabetes compared to patients with good control. Frequent visits with the diabetes team improved HbA1C in our patients. 84% of patients in the good control group were seen by the diabetes team more frequently (at least every 3-6 months) compared to patients with higher HbA1c. The group with very poor glycemic control patients were more obese with Type 2 Diabetes and were less frequently coming for the scheduled appointments. More efforts must be made to design the protocols to overcome patient-related obstacles to improve diabetes control. Presentation: Thursday, June 15, 2023

Community Health Center 340B Program: A Qualitative Study of the Experiences of Patients with Diabetes.

Background: The 340B Drug Pricing Program provides discounted drug prices to safety-net entities which help stretch scarce resources to expand comprehensive services and treat more vulnerable patients. The program has received criticism questioning whether the original intentions are being accomplished. Objective: This qualitative study aimed to understand lived experiences of patients accessing high-cost injectable diabetes medication(s) through a 340B Prescription Cash Discount Program (PCDP) provided at a community health center. Methods: This qualitative study utilized semi-structured individual interviews. We invited patients ≥18 years old with diabetes for >1year who utilized the 340B PCDP to fill an injectable diabetes medication at least twice between 3/1/2020-3/1/2021 to participate. Trained personnel interviewed ten participants in 11/2021-2/2022 and completed thematic analysis of the transcribed interviews. Results: Themes included 340B feedback, benefits of 340B, consequences of being without 340B, community pharmacy experience, and use of other services. Participants deemed the 340B program as a "lifesaver." Perceived benefits of the program included improved diabetes control and savings that made their prescriptions more affordable. Consequences of being without the program include that medication was too expensive to take as prescribed and rationing/skipping doses. Participants were pleased with the accessibility of the network of contract pharmacies and described benefiting from services supported by 340B savings. Conclusions: Recent criticisms question whether the 340B program accomplishes its original intentions of stretching scarce federal resources to help safety-net entities expand services and treat more patients. This study provides insight into the personal impact of the 340B program on underserved patients with chronic disease accessing high-cost medication(s). Findings highlight crucial strengths of the program from the patient perspective, which policymakers and other stakeholders should consider to provide support for the continuation of these services.

Current Technologies for Managing Type 1 Diabetes Mellitus and Their Impact on Quality of Life-A Narrative Review.

Type 1 diabetes mellitus is a chronic autoimmune disease that affects millions of people and generates high healthcare costs due to frequent complications when inappropriately managed. Our paper aimed to review the latest technologies used in T1DM management for better glycemic control and their impact on daily life for people with diabetes. Continuous glucose monitoring systems provide a better understanding of daily glycemic variations for children and adults and can be easily used. These systems diminish diabetes distress and improve diabetes control by decreasing hypoglycemia. Continuous subcutaneous insulin infusions have proven their benefits in selected patients. There is a tendency to use more complex systems, such as hybrid closed-loop systems that can modulate insulin infusion based on glycemic readings and artificial intelligence-based algorithms. It can help people manage the burdens associated with T1DM management, such as fear of hypoglycemia, exercising, and long-term complications. The future is promising and aims to develop more complex ways of automated control of glycemic levels to diminish the distress of individuals living with diabetes.

Presentation of new onset type 1 diabetes with diabetic ketoacidosis and hyperosmolar hyperglycaemia after a single dose of nivolumab and ipilimumab.

A Caucasian man in his 60s with recent diagnosis of metastatic renal cell carcinoma presented to the emergency department with a 5-day history of severe polyuria, polydipsia and fatigue and 1-day history of confusion, abdominal pain, nausea and vomiting. Investigations revealed an overlap of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS). He had received the first dose of immunotherapy with nivolumab and ipilimumab 3 weeks prior to this attendance. New-onset type 1 diabetes (T1DM) was confirmed based on the clinical features at presentation, seropositivity for glutamic acid decarboxylase antibodies and significant insulin deficiency. He is currently on a multiple daily injections of insulin and uses intermittent-scanned glucose monitoring. Given the irreversible impact on beta-cell function and clinical response with insulin resulting in improved diabetes control, immunotherapy was resumed for his metastatic cancer with good radiological response. Although rare, new-onset T1DM can present with DKA and HSS overlap after a single dose of nivolumab/ipilimumab in individuals without pre-existing history of diabetes. Although rare, new onset of T1DM after immunotherapy can present with DKA and HSS overlap after a single dose of nivolumab/ipilimumab in individuals without pre-existing history of diabetes and normal glycaemic parameters. Due to the irreversible destruction of beta-cells, treatment with steroids is not indicated in contrast to other settings such as immunotherapy-induced hypophysitis. Presence of low c-peptide levels post-acute presentation is indicative of an irreversible impact on beta-cell function and supports resuming immunotherapy given the significant benefits on cancer prognosis. Clinicians must maintain a high index of suspicion in regards to diagnosis and management of new-onset type 1 diabetes and advice patients on reporting symptoms suggestive of diabetes and/or diabetes-related hyperglycaemic emergencies.

906-P: Audit of Technologies Used for Glucose Monitoring and Insulin Delivery in Patients with Type 1 Diabetes at a Single Diabetes Center during 2019–2022—Real-World Data

The new NICE guidelines recommend that all adults with type 1 diabetes (T1D) should have access to either Continuous Glucose Monitoring (CGM) orIntermittently Scanned CGM (isCGM). The latest treatment modality for T1D is represented by the hybrid closed-loop systems (HCL), which consist of an insulin pump (CSII), a CGM and a smart algorithm. The aim of the study was to evaluate the effect of methods used for glucose monitoring and insulin delivery on diabetes control in patients with T1D treated during 2019-2022. We analyzed 2132 patients with T1D (48.9% males, mean age 43, 6 years) registered in our Diabetes Centre, 1165 (54.6 %) with multiple daily injections and 967 (45.4 %) using CSII, including 354 (36.6%) using HCL in 2022. A significant increase in the proportion of patients using CGM or isCGM in comparison to Blood Glucose Monitoring (BGM) during the years 2019-2022 was noted (14%/21%/65% in 2019 vs 43%/30%/27% in 2022; p&amp;lt;0.001). There was a significant improvement in diabetes control in CGM and isCGM users between 2019-2022, but not in the BGM group (CGM: 2019 7.9±1.2 % vs. 2022 7.5±1.1 %; p&amp;lt;0.0001; isCGM: 8.1±1.4 % vs. 7.8±1.3 %; p&amp;lt;0.001; BGM: 7.7±1.5 % vs. 7.6±1.5 %; NS). Patients using CGM had better diabetes control than patients with isCGM in 2022 (p&amp;lt;0.001). HbA1c significantly decreased during the past 2 years in all patients using CSII (2020: 8±1.2 % vs. 2022 7.7±1.1 %, p&amp;lt;0.001). In 2022, patients using HCL reached better glycemic control than only CSII users (HCL 7.5±1.2 % vs. CSII 7.8±1.1 %; p˂0.05). Patients using HCL had a significantly more pronounced decrease of glycated hemoglobin between 2020 to 2022 as compared to CSII users (2022: 7.5±1.2 % vs. 2020: 8±1.3 %; p&amp;lt;0.001). Our study demonstrated that more than 2/3 of patients meet the NICE guidelines for glucose monitoring in 2022, and this ratio is improving every year. CGM, isCGM and CSII treatment, especially with HCL are associated with better diabetes control. Disclosure R.Bem: None. D.Vávra: None. K.Sochorova: Advisory Panel; Ypsomed AG, Consultant; Medtronic. M.Müllerová: None. M.Haluzik: Advisory Panel; Novo Nordisk, Lilly Diabetes, Boehringer-Ingelheim, Research Support; Sanofi, Speaker's Bureau; Abbott, AstraZeneca. Funding National Institute for Research of Metabolic and Cardiovascular Diseases (EXCELES LX22NPO5104)

716-P: Improving Provider–Patient Relationships in Treatment of Young Adult Type 1 Diabetes

Aims: Type 1 diabetes mellitus (T1D) is a chronic illness that requires constant monitoring and management of one's blood glucose levels. This study focuses specifically on young adults aged 18-25 living with T1D in the United States and aims to identify strengths and areas of improvement for provider-patient relationships within young adult T1D care. Methods: An online 15-question Qualtrics survey was distributed across social media over one month, and responses were studied using descriptive, inferential, and causal statistical analysis. Results: Of the 48 responses, 56% strongly agreed that their provider listens to how they like to do things and conveys confidence in their ability to make changes, whereas 29% didn't feel trust and are unable to be open with their provider. Diabetes-specific stressors and diabetes burnout was the most selected topic that participants wanted their provider to address more often. 56.3% of participants have switched diabetes care providers due to dissatisfaction, and 47.9% have felt belittled or called a bad diabetic by a diabetes provider. Discussion: Strong provider-patient relationships that facilitate trust, comfort, and connection were related to lower HbA1C, improved diabetes control, and improved diabetes-related stress. Disclosure C.N.Diaz: None. A.Ong: None. C.Chen: None.

1126-P: Smart Insulin Pens—A Randomized, Crossover Pilot Trial Assessing Glycemic Control and Diabetes-Related Burdens in Adolescents and Emerging Adults with Diabetes

Introduction: Despite advancements in diabetes technology, some adolescents, and emerging adults with type 1 diabetes (T1D) remain on insulin injections. There is a need to reduce the burden of managing T1D in adolescents who use insulin injections. Objective: To determine whether a smart insulin pen (InPen™) alters the glycemic control, glucose variability, burden of diabetes care, and parental experience in adolescents and emerging adults with T1D. Methods: We performed a randomized, cross-over prospective pilot trial in participants 13-21 years with T1D. Participants were randomized to either 90 days of standard multiple daily injection management with continuous glucose monitor (CGM) use or 90 days of InPen™ and CGM use with a cross-over design, switching to the other arm for 90 days. We assessed diabetes control, diabetes distress, transition readiness, and parental experience of illness scales. Results: Fourteen participants were enrolled in the trial, 1 withdrew. At baseline, median HbA1C was 8.1%, (IQR 7.7, 9.1). There was no statistically significant change in HbA1C, average glucose, glucose SD, total insulin dose, or time in range using the InPen™ relative to standard of care. Participants using the InPen™ had declining engagement with time, calculator use was 41.5% (IQR 5.0, 84.0) and 7% (IQR 0.0, 59.0) at 30 and 90 days, respectively. Questionnaire outcomes did not demonstrate statistically significant differences between treatments; diabetes distress did improve but not statistically significant. Conclusion: InPen ™ use was not associated with improved diabetes control but did trend to decreasing diabetes distress. Low InPen™ calculator use could be a potential factor for the lack of improvement in glycemic control. Larger studies are warranted to study the effect of smart insulin pen technology on glycemic metrics and diabetes-related burdens in adolescents and emerging adults with T1D. Disclosure S.Jackson: Research Support; Medtronic. S.Kumar: None. A.Al nofal: None. R.Hentz: None. S.Pittock: None. A.Creo: None.