Persons With Diabetes Research Articles

Correlation of Diabetes self-care adherence with glycemic measures: a cross-sectional health facility-based study in Kathmandu, Nepal

Self-care plays a key role in prevention of complications, and improvement of the quality of life of persons with diabetes (PWDs). This study has assessed adherence to self-care behavior and its correlation with glycemic measures among PWDs attending private health care facilities in Kathmandu, Nepal. A cross-sectional study was carried out using a semi-structured questionnaire. Socio-demographic information and recent fasting (FBG) and 2-hr post-prandial blood glucose (2-hr PBG) levels were recorded. Self-care inventory (SCI) 12-item version was used to assess adherence to diabetes self-care over the preceding four weeks. Self-care practice was measured in five domains: glucose monitoring; diabetes medication; diet; exercise; and preventative care. The overall adherence score was obtained by computing the average of seven items (items 1, 2, 4, 5, 6, 7, 14). Scores more than or equal to median score were considered as higher levels of self-care efficacy. Univariate linear regression analysis of the subscale scores and individual item-wise score with age, duration of diabetes (years), FBG and PPBG levels was carried out. Pearson’s coefficient (r) was reported for normally distributed variables. Among 385 PWDs, mean FBG was 146 mg/dl (±54.7), 2-hr PBG was 210 mg/dl (±82). Median score for overall adherence to diabetes self-care was 25 (IQR:21 to 29). Higher self-care efficacy was seen among 55% (n=212). Overall adherence to self-care was significantly and negatively correlated with age and glycemic measures. Self-care efficacy was mainly driven by adherence to diabetes medication. Adherence to preventative care, exercise and home monitoring of blood glucose was low. FBG was significantly and negatively correlated with glucose regulation (r=-0.16, P=0.001), diabetes medication and food regulation (r=-0.11, P=0.03), preventative care (-0.14, P=0.03) and overall adherence to treatment (-0.15, P=0.004). 2-hr PBG was significantly and negatively associated with all domains of self-care (r -0.14, P=0.04 to -0.21, P<0.0001). Elderly persons, may face difficulty with regular physical exercise, dietary recommendations and overall adherence to self-care. Continuing diabetes education is imperative to motivate PWDs and caregivers regarding importance of self-care efficacy in glycemic regulation and diabetes care.

Predictors of collaborative coping in couples managing type 2 diabetes: Illness factors, relationship factors, and interdependent personality traits

Past work has revealed benefits for both persons with diabetes (PWD) and their partners (e.g., spouses) when engaging in collaborative coping to manage a chronic illness, yet little is known about predictors of this type of dyadic coping. Based on conceptual frameworks on communal and dyadic coping, we sought to examine how illness factors, relationship factors, and interdependent personality traits predicted the frequency of collaborative coping among couples managing type 2 diabetes, and whether role (PWD vs. partner) moderated the associations. Cross-sectional survey data from 296 older adults ( N = 148 different-sex couples) were analyzed. Multilevel models examined both linear and nonlinear associations between each factor and collaborative coping, controlling for race/ethnicity. Linear associations were found for positive relationship quality, and nonlinear associations were found for diagnostic length and relationship length. No significant associations emerged between interdependent personality traits and collaborative coping. Although PWD reported more frequent engagement in collaborative coping than partners, role only moderated the associations between diagnostic length and relationship length with collaborative coping. Findings contribute to an understanding of potential correlates of collaborative coping and may have implications for health promotion and interventions for older couples managing type 2 diabetes.

Well-being outcomes of a family-focused intervention for persons with type 2 diabetes and support persons: Main, mediated, and subgroup effects from the FAMS 2.0 RCT

AimsType 2 diabetes self-management occurs within social contexts. We sought to test the effects of Family/friend Activation to Motivate Self-care (FAMS), a self-care support intervention delivered via mobile phones, on psychosocial outcomes for persons with diabetes (PWDs) and their support persons. MethodsPWDs had the option to enroll with a friend/family member as a support person in a 15-month RCT to evaluate FAMS versus enhanced usual care. FAMS included 9 months of monthly phone coaching and text message support for PWDs, and text message support for enrolled support persons. ResultsPWDs (N = 329) were 52% male and 39% reported minoritized race or ethnicity ; 50% enrolled with elevated diabetes distress. Support persons (N = 294) were 26% male and 33% reported minoritized race or ethnicity. FAMS improved PWDs’ diabetes distress (d = -0.19) and global well-being (d = 0.21) during the intervention, with patterns of larger effects among minoritized groups. Post-intervention (9-month) and sustained (15-month) improvements were driven by changes in PWDs’ self-efficacy, self-care behaviors, and autonomy support. Among support persons, FAMS improved helpful involvement without increasing burden or harmful involvement. ConclusionsFAMS improved PWDs’ psychosocial well-being, with post-intervention and sustained improvements driven by improved self-efficacy, self-care, and autonomy support. Support persons increased helpful involvement without adverse effects.

Healthcare Professional Experiences and Opinions on Depression and Suicide in People With Diabetes.

People with diabetes have an increased risk of depression, intentional self-injury and self-harm (ISI), and suicide compared with the general population. This study aimed to explore experiences and awareness of healthcare professionals (HCPs) regarding depression, ISI, and suicide, and understand resource use and needs among HCPs who care for persons with diabetes (PWD). Healthcare professionals who see children and/or adults with type 1 diabetes or type 2 diabetes anonymously completed an online survey about their experiences, opinions, barriers, and needs surrounding identification and care of PWD with depression, ISI, and suicide. One hundred twenty-nine HCPs participated. The majority were medical doctors (MDs) or advanced practice providers (APPs). Only a quarter of MDs and APPs felt very comfortable asking about ISI or suicidal ideation (SI), whereas 20% felt they had received appropriate training to support those with ISI or SI. The primary needs reported include more training on how to ask, respond, and support those expressing ISI and SI. Healthcare professionals reported wanting better access to resources for PWD. The HCPs tend to underestimate SI in the diabetes population and rates of training were low. Areas to address include providing education and training to HCPs to improve identification and management of ISI and suicide risk. These data can inform the development of mechanisms to improve discussions of depression and suicide and of resources to help HCPs support PWD.

Effect on Glycemic Control of an Early Intensive Dietary Structured Education Program for Newly Diagnosed Children with Type 1 Diabetes in Jordan

Background and Aim. Early diabetes education for persons with type 1 diabetes (T1D) is important to achieve early glycemic control. We had developed a dietary structured education program (SEP) to provide patients with the required skills for optimal diabetes management. Our aim was to study the effect of our program and factors that might affect its outcomes. Methods. This is a retrospective medical chart review study at Jordan University Hospital. The glycemic control of children who were diagnosed with T1D and included in the SEP between June 2017 and December 2019, was compared with those who were exposed to the conventional diabetes education, between January 2014 and December 2016. Various factors were assessed for the possible effects on the SEP outcomes. Results. The average age at diagnosis for the 112 persons with diabetes (PwD) included in the dietary SEP was 8.30 ± 3.87 years. Glycated hemoglobin was lower in children in the SEP group at 6 months ( P value = 0.001) and 12 months ( P = 0.032 ) but not at 24 months ( P = 0.290 ). SEP had better effect on patients older than 5 years. The possible predictors of glycemic control for the SEP group at 12 months included the mother’s educational level and the number of hospital admissions due to DKA and hyperglycemia during the first year after diagnosis. Conclusion. Our dietary SEP was associated with better glycemic control than conventional diabetes education, at 6 and 12 months after diagnosis. It had a positive effect, mainly in PwD patients who are older than 5 years and had higher maternal educational level.

Rationale, design, and recruitment outcomes for the Family/Friend Activation to Motivate Self-care (FAMS) 2.0 randomized controlled trial among adults with type 2 diabetes and their support persons

BackgroundSelf-care behaviors help reduce hemoglobin A1c (HbA1c) and prevent or delay type 2 diabetes (T2D) complications. Individualized interventions that support goal setting and self-monitoring improve self-care and HbA1c in the short-term; engaging family and friends may enhance and/or sustain effects. Family/Friend Activation to Motivate Self-care (FAMS) is a mobile phone-delivered intervention (i.e., phone coaching and text message support) based on Family Systems Theory which was successfully piloted among diverse adults with T2D. MethodsWe made improvements to FAMS and conducted iterative usability testing to finalize FAMS 2.0 before evaluation in a randomized controlled trial (RCT). Adult persons with diabetes (PWDs) who enrolled were asked to invite a support person (friend or family member) to participate alongside them. For the RCT, dyads were randomly assigned to FAMS 2.0 or enhanced treatment as usual (control) for the first 9 months of the 15-month trial. Outcomes include PWDs' HbA1c and psychosocial well-being (including diabetes distress) and support persons' own diabetes distress and support burden. ResultsWe recruited RCT participants from April 2020 through October 2021 (N = 338 PWDs with T2D; 89% [n = 300] with a support person). PWDs were 52% male, 62% non-Hispanic White, aged 56.9 ± 11.0 years with HbA1c 8.7% ± 1.7% at enrollment; 73% cohabitated with their enrolled support person. Data collection is ongoing through January 2023. ConclusionFindings will inform the utility of engaging family/friends in self-care behaviors for both PWD and support person outcomes. Using widely available mobile phone technology, FAMS 2.0, if successful, has potential for scalability.Trial Registration: ClinicalTrials.gov identifier: NCT04347291 posted April 15, 2020.

Professional Competencies for Diabetes Technology Use in the Care Setting.

The integration of diabetes technology into diabetes care and self-management is evolving so rapidly that providing sufficient support has become an obstacle for many health care professionals (HCPs) in practice. Diabetes technology requires HCPs to stay current with treatment goals and practice guidelines. Diabetes care and education specialists (DCESs) are well positioned to take on this challenge by seizing opportunities to apply their skills, knowledge, and experience to contribute to a technology-enabled practice environment. Diabetes technology includes devices, hardware, and software utilized to manage all aspects of diabetes care, including lifestyle management, glucose monitoring, and insulin delivery. The complexities of caring for persons with diabetes (PWD) who utilize diabetes technology is best accomplished in partnership with other members of the care team and support staff to cover all aspects of technology including prior authorizations, onboarding PWD, downloading and interpreting data, and supporting ongoing utilization. The purpose of this article is to introduce a comprehensive set of role-based competencies for HCPs, DCESs, and staff for the selection, implementation, and sustainability of diabetes technology when providing diabetes care, education, and support. The role-based competencies described in this article are intended to support the initiation, continuation, and optimal use of diabetes technology in practice through ongoing education and guidance of care team members. This article describes the diabetes technology competencies essential for all levels of the care team and support staff in various care settings to deliver comprehensive diabetes management and support to PWD utilizing diabetes technology in their self-care regimen.

1293-P: Diabetes Management at the Time of Renal Transplantation

The goal of this retrospective review was to characterize the glycemic status and antihyperglycemic treatments in persons with diabetes (PwD) undergoing renal transplant and to determine whether use of intravenous insulin infusion (IVI) is associated with clinical outcomes. A retrospective review of all adult patients undergoing renal transplantation at a single tertiary referral center from January 1 - December 31, 20 was performed. Results: Of the 292 patients who underwent renal transplantation, 1 (34.6%) had a diagnosis of diabetes. Pre-transplant treatment for diabetes included insulin in 61 (60.4%) , non-insulin medications in (10.9%) , and both insulin and non-insulin medications in 5 PwD (4.9%) . Twenty-four PwD (23.8%) were not taking medications for diabetes. While hospitalized 65 (64.4%) PwD received IVI while the remainder received SC insulin (SCI) . The pooled daily mean point of care (POC) glucose on postoperative day (POD) 0 through POD 3 was not significantly different between IVI vs. SCI (164.5 vs. 165.3mg/dL, p=0.91) . ICU admission occurred in 7 (10.8%) IVI and 8 (22.5%) SCI (OR 0.42, 95% CI 0.14-1.28) . Fourteen (21.5%) IVI and 5 (13.9%) SCI underwent dialysis during hospitalization (OR 1.70, 95%CI 0.56-5.19) . Readmission within 30 days occurred for 17 (26.6%) IVI and 12 (33.3%) SCI (OR 0.53, 95% CI 0.22-1.27) . Discussion: While pre-transplant treatment of diabetes varied, most PwD undergoing renal transplantation were placed on IV insulin for management of hyperglycemia post-transplant. Insulin infusion was not associated with significant differences in pooled daily mean blood glucose. Significant differences in clinical outcomes were not identified between those treated vs. not treated with insulin infusion, but this could be due to the relatively small sample size. More research is needed to understand how diabetes care can be improved in hospitalized PwD undergoing renal transplantation. Disclosure M.Griff: None. S.Crawley: None. A.Rowland: None. S.A.Seggelke: None. R.Hawkins: None. C.C.Low wang: Employee; CPC Clinical Research, Research Support; CellResearch Corporation, Virta Health Corp.

330-OR: Engagement, Satisfaction, and Preliminary Impact of a Personalized Diabetes Chatbot in a Diverse Cohort of Adults with Type 2 Diabetes

Strategies are needed to expand diabetes education and support among persons with diabetes (PWD) . We designed a personalized conversational agent (“chatbot”) to provide diabetes education and monitoring. Feasibility and preliminary efficacy were assessed in a pilot cohort of adults with type 2 diabetes (T2DM) . Primary care patients with T2DM and an A1C of 8.0 - 8.9% were recruited from 4 sites in a regional health care system. Patients received proactive text/email notifications from the web-based chatbot which integrated assessment of self-knowledge and self-reported care behaviors, such as medication taking and checking blood glucose, with video and written educational content. Chat frequency started at once weekly, and content was delivered up to 12 months. Between November 2020 and October 2021, 112 (84%) of 132 invited PWD agreed to enroll. Enrollees were predominantly African American (65%) and female (60%) , with mean age 58.3 +/- 10.6. Account activation was completed by 86 enrollees (77%) . Of those, 85% (76) completed at least one subsequent education chat. Amongst those 76 enrollees, 97% were very satisfied/satisfied with the chats and 84% strongly agreed/agreed that the chats made them feel more confident in managing their health. Participants have completed 914 chats over 12 months with 10,6data points collected. Only 5% disenrolled. There were no changes in self-reported medication adherence. Follow-up A1C was available for 71 participants. Participants who completed at least one educational chat had a 0.34 percentage point decrease in mean A1C vs. a 0.2 percentage point increase for participants who did not complete any educational chats, a difference of 0.54 between the 2 groups (p=0.089) . This pilot study demonstrates patient acceptability and satisfaction and suggests improvement in A1C and self-care confidence in a primary care population. Future research with a larger population will be needed to validate these early findings. Disclosure M.F.Magee: None. C.M.Nassar: None. R.Dunlea: Employee; Conversa Health / American WEll. B.James: None. A.R.Montero: None. P.Sack: None. A.Tweedt: None. D.Vetal: Employee; Conversa Health. N.K.Cobb: None.

Expert Roundtable on Continuous Glucose Monitoring

ObjectiveThe objective of this study was to define an expert opinion on continuous glucose monitoring (CGM) in persons with type 2 diabetes mellitus, including its advantages, barriers, and best clinical practices for initiation, patient-clinician communication, and data management. MethodsA series of virtual discussions was held to recommend improvements to clinical practice and design clinical tools for primary care clinicians. Participants included endocrinologists, primary care physicians, physician assistants, advanced practice nurses, and diabetes care and education specialists. ResultsThe expert panels recommended CGM as a supplement to blood glucose monitoring and hemoglobin A1c for managing diabetes in persons with diabetes (PWDs). CGM can help predict potential pitfalls in glycemic management, including hypo and hyperglycemic excursions, which directly influence lifestyle changes, medication initiation, and dosing decisions. A toolkit was designed with practical guidance on the integration of CGM into clinical practice, interpretation of results, clinical guidelines, a patient action plan, and other useful management tools. ConclusionThis review summarizes the findings from a roundtable discussion with endocrinology and primary care clinicians, a discussion of the advantages and challenges of CGM, and clinical approaches to improving the care of PWDs. CGM offers more detailed tracking of glucose levels than blood glucose monitoring or hemoglobin A1c, and it can detect asymptomatic hypoglycemia. Specialized education of providers, the cost to patients and providers, and data management are barriers to the widespread adoption of CGM for PWDs.

Systematic literature review of insulin dose adjustments when initiating hemodialysis or peritoneal dialysis.

Chronically uncontrolled hyperglycemia is the leading cause of end stage kidney disease (ESKD) necessitating dialysis. During times of transition to hemodialysis (HD) or peritoneal dialysis (PD), considerations must be given to insulin dosing adjustments for persons with diabetes (PWD) in efforts to maintain glycemic control. However, the literature is sparse with few clear and direct practical clinical recommendations for therapeutic insulin dosing adjustments in PWD and ESKD. The objective of this systematic review was to identify and report the evidence and gaps in the literature for adjustments in therapeutic insulin recommendations when initiating HD or PD in patients with ESKD and diabetes mellitus. A literature search using PubMed, CENTRAL, MEDLINE, CINAHL, Google Scholar, and ClinicalTrials.gov revealed 242 results. After removing duplicates and articles not reaching pre-specified criteria, 29 relevant articles remained for further analysis. Following the exclusion of 18 articles after full-text review due to lack of relevance or inappropriate publication type, 11 articles remained and were included in the review. The most common recommendation regarding HD was to reduce the basal insulin dose up to 25% on HD days to prevent hypoglycemia, although a lack of consensus exists on the percent reduction. Little information was found relating to insulin management with continuous ambulatory PD or automated PD. During PD, insulin may be administered subcutaneously, IP, or with the dialysis fluid. Administration of insulin with dialysate may necessitate a dose increase of up to 30% due to a loss to tubing and dilution. Furthermore, the use of dextrose-based dialysate may require additional insulin to mitigate systemic impact of dextrose absorption on BG. Overall, a gap exists in the primary literature regarding recommendations for prophylactically adjusting insulin therapy when initiating HD or PD, or when switching between the two. More research is needed to clarify ideal alterations in insulin dosing, administration techniques, and product selections for PWD and ESKD undergoing dialysis.

Automated Bolus Calculators and Connected Insulin Pens: A Smart Combination for Multiple Daily Injection Insulin Therapy.

Although automated bolus calculators (ABCs) have become a mainstay in insulin pump therapy, they have not achieved similar levels of adoption by persons with diabetes (PWD) using multiple daily injections of insulin (MDI). Only a small number of blood glucose meters (BGMs) have incorporated ABC functionality and the proliferation of unregulated ABC smartphone apps raised safety concerns and eventually led to Food and Drug Administration (FDA)-mandated regulatory oversight for these types of apps. With the recent introduction of smartphone-connected insulin pens, manufacturer-supported companion ABC apps may offer an ideal solution for PWD and health care professionals that reduces errors of mental math when calculating bolus insulin dosing, increases the quality of diabetes data reporting, and improves glycemic outcomes.

Leptin treatment prevents impaired hypoglycemic counterregulation induced by exposure to severe caloric restriction or exposure to recurrent hypoglycemia.

Hypoglycemia-associated autonomic failure (HAAF) is a maladaptive failure in glucose counterregulation in persons with diabetes (PWD) that is caused by recurrent exposure to hypoglycemia. The adipokine leptin is known to regulate glucose homeostasis, and leptin levels fall following exposure to recurrent hypoglycemia. Yet, little is known regarding how reduced leptin levels influence glucose counterregulation, or if low leptin levels are involved in the development of HAAF. The purpose of this study was to determine the effect of hypoleptinemia on the neuroendocrine responses to hypoglycemia. We utilized two separate experimental paradigms known to induce a hypoleptinemic state: 60% caloric restriction (CR) in mice and three days of recurrent hypoglycemia (3dRH) in rats. A sub-set of animals were also treated with leptin (0.5-1.0μg/g) during the CR or 3dRH periods. Neuroendocrine responses to hypoglycemia were assessed 60min following an IP insulin injection on the terminal day of the paradigms. CR mice displayed defects in hypoglycemic counterregulation, indicated by significantly lower glucagon levels relative to controls, 13.5pmol/L (SD 10.7) versus 64.7pmol/L (SD 45) (p=0.002). 3dRH rats displayed reduced epinephrine levels relative to controls, 1900pg/mL (SD 1052) versus 3670pg/mL (SD 780) (p=0.030). Remarkably, leptin treatment during either paradigm completely reversed this effect by normalizing glucagon levels in CR mice, 78.0pmol/L (SD 47.3) (p=0.764), and epinephrine levels in 3dRH rats, 2910pg/mL (SD 1680) (p=0.522). These findings suggest that hypoleptinemia may be a key signaling event driving the development of HAAF and that leptin treatment may prevent the development of HAAF in PWD.

How far persons with diabetes travel for care? Spatial analysis from a tertiary care facility in Southern India

ABSTRACT Accessibility determines health care utilization among individuals with noncommunicable diseases as they need to visit health facilities frequently. Hence, we aimed to assess the road distance and travel time to the diabetes clinic of Persons with Diabetes (PWDs) seeking care at a public tertiary care facility in South India. PWDs house locations were geocoded using ArcGIS World Geocoding Services, and ArcGIS Pro Business Analyst Geoprocessing extension was used to conduct network analysis. A simple median regression analysis was done to compare the association of sociodemographic variables with distance and time. Of the total 2261 PWDs included, the mean (SD) age was 53.7 (11.5) years, and 49.4% were males and about 66.0% of the PWDs resided in rural areas. The median (IQR) travel distance of PWDs from their home to the diabetes clinic was 30.5 (7.6–78.5) km and the median (IQR) time spent in travelling was 77.9 (16.4–194.7) minutes. About 76% travelled more than 5 km to the diabetes clinic. About 85% of PWDs travelled farther than the nearest available public health facility to avail care from the diabetes clinic. Younger age group, male gender, PWDs from rural areas and the state of Tamil Nadu travelled significantly longer distance compared to their counterparts. To conclude, about three-fourth of the PWDs travelled more than 5 km for care at the diabetes clinic. Also, about 9 out of 10 travelled farther than the nearest available public health facility where diabetes care was available.

Persons With Diabetes and General/Family Practitioner Perspectives Related to Therapeutic Inertia in Type 2 Diabetes Mellitus Using Qualitative Focus Groups and the Theoretical Domains Framework: Results From the MOTION Study

ObjectivesTherapeutic inertia in type 2 diabetes (T2DM) is the failure to receive timely treatment intensification as indicated according to T2DM treatment guidelines. Multifactorial causes of therapeutic inertia in T2DM have been documented at the level of persons with diabetes (PwD), health-care providers and health-care systems. MethodsWe developed a 3-part mixed-methods research program, called the Moving to Overcome Therapeutic Inertia Obstacles Now in T2DM (MOTION) study, to inform the development of strategies to address therapeutic inertia in T2DM. We present the results from focus groups with the following objectives: 1) understanding PwD and general practitioner/family practitioner (GPFP) determinants of behaviour related to treatment intensification using the Theoretical Domains Framework (TDF); and 2) identifying the sources of behaviours contributing to therapeutic inertia in T2DM, as proposed by the Behaviour Change Wheel (BCW). Two focus groups with PwD and 4 with GPFPs were conducted. Transcripts from the focus groups were coded independently by 2 investigators to identify themes, then mapped to TDF domains and linked using the BCW. ResultsFor PwD, the most commonly coded TDF domains were intentions, goals, knowledge, beliefs about consequences and social influences. For GPFPs, the most common domains were intentions, environmental context and resources and social/professional role and identity. The BCW identified that PwD interventions should include reflective motivation, psychological capability and social opportunity; GPFP interventions should include physical opportunity, social opportunity and reflective motivation. ConclusionsComprehensive strategies that target both PwD and GPFP barriers would encourage a more collaborative approach toward treatment intensification decisions and reducing therapeutic inertia.

137-OR: Dasiglucagon Ready-to-Use Autoinjector Is More Reliably and Quickly Administered than Glucagon Emergency Kit (GEK)

Dasiglucagon is a novel glucagon analog, stable in aqueous solution and suitable for delivery in a ready-to-use autoinjector (HypoPal®) for the treatment of severe hypoglycemia. This study was performed to assess HypoPal device handling vs. GEK during simulated episodes of severe hypoglycemia. Participants included persons with diabetes (PWD) and their caregivers and untrained bystanders (UB) with no experience with diabetes. Participants had no experience with either device. PWD were trained by staff and subsequently trained caregivers (TC) on the use of devices; UB received no instruction on use prior to simulations. Primary outcome was success of TC to correctly use HypoPal vs. GEK. Secondary outcomes included success of UB, time to successful administration, and assessment of confidence in, ease of use of and preference for each device. The success rate was significantly greater for HypoPal vs. GEK in TC (p These data support that dasiglucagon HypoPal use is easier, more reliable, and faster than the use of GEK and offers the potential to improve the time to recovery from a severe hypoglycemic event. Disclosure N. Bailey: Research Support; Spouse/Partner; Zealand Pharma A/S. J. Dimsits: Employee; Self; Zealand Pharma A/S. R. Tehranchi: Employee; Self; Zealand Pharma A/S. D. M. Kendall: Employee; Self; Zealand Pharma A/S, Employee; Spouse/Partner; Amgen Inc., Stock/Shareholder; Self; Eli Lilly and Company, MannKind Corporation. T. S. Bailey: Consultant; Self; Abbott Diabetes, LifeScan, Novo Nordisk, Sanofi, Research Support; Self; Abbott, Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Dexcom, Inc., Eli Lilly and Company, Kowa Research Institute, Inc., Lexicon Pharmaceuticals, Inc., Livongo, Medtronic, Medtrum Technologies, Novo Nordisk, REMD Biotherapeutics, Sanofi, Sanvita, Viacyte, Inc., vTv Therapeutics, Zealand Pharma A/S, Speaker’s Bureau; Self; BD, Medtronic, Sanofi. Funding Zealand Pharma A/S

551-P: Results from a National Multicenter Study: Health Professionals Report High Feasibility, Acceptability, and Utility of a New Pro Dialogue Tool in Routine Multisectorial Diabetes Care

Aim: To assess health care professionals’ (HCP) perceptions of feasibility, acceptability, and impacts of a new digital patient-reported outcome (PRO) dialogue tool in routine diabetes care. Methods: A single-arm implementation study (MPRODIA) evaluating use of a PRO tool by 33 HCP in routine multi-sector diabetes care. Intervention: Persons with diabetes (PWD) filled out a digital questionnaire about health, well-being and self-care 1-8 days prior to the visit and their HCP used a PRO dialogue dashboard in the visit to facilitate a collaborative, person-centered dialogue. Primary outcome in this sub study was HCP responses to a clinical end-of-study Likert-Scale and Free-Text evaluation survey. Quantitative and explanatory qualitative data analyses were done with SPSS 25.0/Nvivo 12. Results: 33 HCP at 7 unique sites used PRO in 474 diabetes visits and completed the end-of-study survey. 80% were diabetes specialized, 67% saw>10 PWD/week, 33% had <10 years of care experience. HCP confidence in use of PRO improved in pre-post analysis (3,8 (SD=.9) to 4,4 (SD=.7), range 1-5, p<0.05). 97% were confident in their ability to use PRO well (interpret and use PRO insights). 52% became more positive (3% more negative) towards the PRO tool overall over time. 85% reported improved work satisfaction (due to better preparation and dialogue), 0% worse satisfaction. 33% felt visits were less stressful, 21% felt it was somewhat more stressful with PRO (due to time constraints). All HCP indicated the desire to continue PRO use (9,0(SD=1,2), range 1-10) and recommend it to others (9,0(SD=1,4), range 1-10). 64% found it essential that HCP are trained in use of PRO prior to implementation. Conclusions: HCP in both municipality and hospital settings found a new digital PRO diabetes tool to be highly acceptable and value-adding by improving the active participation of PWD and the delivery of quality person-centered care. Disclosure S. E. Skovlund: None. D. M. Hessler: Consultant; Self; Eli Lilly and Company. S. H. Kaplan: None. N. Ejskjaer: None. C. Glümer: None. S. H. Nielsen: None. D. B. Berthelsen: None. H. Perrild: n/a. N. C. Balk-møller: None. L. Nørgaard: None. L. Troelsen: None. A. Pietraszek: None. Funding Danish Health Data Authority

397-P: Insulin Dosing Adjustments in Patients with Diabetes on Peritoneal Dialysis or Hemodialysis: A Systematic Review of the Literature

Chronically uncontrolled hyperglycemia is the leading cause of end-stage renal disease (ESRD) necessitating dialysis. During times of transition to hemodialysis (HD) or peritoneal dialysis (PD), considerations must be given to insulin dosing adjustments for persons with diabetes (PWD) in efforts to maintain glycemic control. However, literature is sparse with few clear and direct practical clinical recommendations for therapeutic adjustments. The objective of this systematic review was to identify and report the evidence and gaps in the literature for adjustments in therapeutic insulin recommendations when initiating HD or PD in patients with ESRD and diabetes mellitus. A literature search using PubMed, CENTRAL, MEDLINE, CINAHL, Google Scholar, and ClinicalTrials.gov revealed 184 results. After removing duplicates and articles not reaching pre-specified criteria, 29 relevant articles remained for further analysis. The most common recommendation regarding HD was to reduce the basal insulin dose up to 25% on HD days to prevent hypoglycemia, although a lack of consensus exists on the percent reduction. Little information was found as to insulin management with continuous ambulatory PD (CAPD) or automated PD (APD). During PD, insulin may be administered subcutaneously, intraperitoneally, or with the dialysis fluid. Administration of insulin with dialysate may necessitate a dose increase of up to 30% due to a loss to tubing and dilution. Furthermore, the use of dextrose-based dialysate may require additional insulin to mitigate systemic impact of dextrose absorption on blood glucose. Overall, a gap exists in the primary literature regarding recommendations for prophylactically adjusting insulin therapy when initiating HD or PD, or when switching between the two. Greater research is needed to clarify ideal alterations in insulin dosing, administration techniques, and product selections for this patient population. Disclosure R. Tumlinson: None. E. Blaine: None. M. Colvin: None. T. G. Haynes: None. H. P. Whitley: None.

Decentralizing diabetes care from tertiary to primary care: how many persons with diabetes can be down-referred to primary care settings?

In a cohort of persons with diabetes (PWDs) seeking care at a tertiary care center, we aimed to determine the proportion of PWDs eligible and willing for down referral to primary health centers (PHCs). We conducted a cross-sectional analytical study among PWDs on treatment for at least 1 year. PWDs with stable blood sugar, no history of cardiovascular events and proliferative retinopathy were considered as 'eligible' for primary care management. Of the total 1002 PWDs, mean (SD) age was 56 (12) years; 62% were male and 81% were from rural areas. About half (49%) of them were on insulin, and 52% had comorbidities. In total, 45.6% (95% CI: 42.3-48.8%) were eligible to be managed at PHCs. Among those who were eligible, 46.6% were willing to go back to PHCs. Males (APR=1.16), people with diabetes for more than 10 years (APR=1.23), and the presence of comorbidities (APR=1.13) were significantly associated with unwillingness. Quality of medicines (46%) and poor facilities (40%) at PHCs were the main reasons for unwillingness. About half of the PWDs availing care at tertiary hospitals can be managed at primary care settings; of those, only half were willing to receive care at PHCs.

Laboratory and Pharmaceutical Data Associated With Hospital Readmission in Persons With Diabetic Foot Ulcers.

Purpose: Diabetic foot ulcers (DFUs) are a leading cause of lower extremity amputations among persons with diabetes (PWD) and a common cause of hospitalizations. This study identified demographic characteristics, lab values, and comorbidities associated with 30-day and 90-day hospital readmission in persons with DFU.Methods: A retrospective chart review at our institution examined 397 patients with type 2 diabetes admitted with DFU between January 2014 and December 2018. Variables were analyzed using descriptive statistics, t-tests, and logistic regressions.Results: None of the studied demographic, laboratory (including Hemoglobin A1c) or comorbid diseases were associated with 30-day readmission in persons with DFU. Risk factors for 90-day readmission included discharge location to home with health care (OR: 2.62, 95% CI: 1.39, 4.95), anticoagulant use (OR: 2.36, 95% CI: 1.27, 4.39), and SQ insulin use (OR: 2.08, 95% CI: 1.20, 3.61).Conclusions: None of the variables examined were associated with 30-day readmission; however, potential predictors for 90-day readmission included anticoagulation or insulin use and discharge home with healthcare services. Future studies should devise interventions to improve transition of care in patients with DFU to further assess the role of medications and home health care as a potential predictor of 90-day hospital readmission.