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Introduction: Sudomotor impairment (SI) is common in people with diabetic peripheral neuropathy (DPN) and could potentially influence the effects of exercise. Exercise is known to improve outcomes such as physical fatigue (PF); however, the impact of SI on PF is not clear. Thus, our objective was to examine the impact of sudomotor function on PF change after 16-weeks of moderate intensity aerobic exercise (AEx). Methods: People with DPN (n=17) who participated in 16-weeks of AEx were included in this secondary analysis. Sudomotor function was evaluated at baseline via a quantitative sudomotor axon reflex test and classified as normal (n=6), mild (n=6), moderate (n=3), or severe (n=2). Self-reported PF was assessed at baseline and post-intervention via a fatigue questionnaire. A Kruskal-Wallis test evaluated the impact of baseline sudomotor function on change in PF after exercise. Dunn’s tests were used to evaluate multiple comparisons. Association between sudomotor function and PF change was evaluated via a Spearman’s correlation. Alpha was set at 0.05. Results: Changes in PF are reported as negative (↓in PF) and positive (↑in PF) values. Median PF changes of -29%, -30%, 0%, and 14% were observed for normal, mild, moderate, and severe groups, respectively with a significant between-group difference (p=0.039). Pairwise comparisons revealed significant differences between normal and moderate (p=0.025), normal and severe (p=0.047), and mild and moderate (p=0.04) groups. A moderate correlation between SI and PF change (r=0.630, p=0.007) was observed. Conclusions: Our results indicate that change in PF following 16-weeks of AEx may be influenced by SI. SI can limit the body’s ability to dissipate heat during exercise, potentially exacerbating PF through disruptions in the thermoregulatory negative feedback loop. This could influence response to exercise, and future research should examine the effects of underlying mechanisms of SI on PF in this population. Disclosure C.M. Gray: None. A. Yahya: None. A.M. Alenazi: None. M. Alshehri: None. J.L. Rucker: None. M. Pasnoor: Advisory Panel; Self; Alexion Pharmaceuticals, Inc., Terumo BCT. Consultant; Self; Momenta Pharmaceuticals. P. Kluding: None. Funding National Center for Advancing Translation Sciences (UL1TR000001); Eunice Kennedy Shriver National Institute of Child Health and Human Development (T32HD057850)

Assigned exercise and other lifestyle modification can alter the natural history of diabetic neuropathy, but adherence to lifestyle change protocols poses a challenge in a clinical trial setting. In particular, the commitment for participants to begin engagement with the assigned intervention is a critical juncture. The Activity for DiAbetic neuroPaThy (ADAPT) trial is an NIDDK sponsored two-center single blinded protocol that randomizes type 2 diabetic neuropathy patients for 18 months to either brief lifestyle counseling or a combination of monitored exercise, diet counseling and actigraphy driven anti-sedentary behavioral modification. 103 participants have consented, screened, and been found eligible for ADAPT. Of these, 20 dropped from the trial during baseline evaluation (n=3), randomization (n=1), or before the first intervention visit or 3-month follow-up (n=16). Of the 83 who have reached 3-month follow-up, only 7 participants have dropped from the study. The pattern of early attrition has differed at the two sites. At one site, early attrition was essentially equal between assigned groups. The second site 9 of those randomized to intervention and one assigned to control dropped before 3 months. At the second site, protocol changes to improve “hand-off” from the assessment to intervention coordinators, and marked reduction in time from randomization to first intervention visit has improved retention. Structured counseling to set expectations, reduce performance anxiety, and address disappointment with assignment to the less intensive arm has improved initial retention at both sites. Once familiar with the intervention process, most participants will continue with behavioral modification. Clinical trials utilizing patient-motivated lifestyle modification protocols should seek to minimize physical barriers to initial engagement, and focus counseling and motivational effort on the critical early trial period during which participants commit internally to the intervention process. Disclosure C. Revere: None. A. Smith: Consultant; Self; Alexion Pharmaceuticals, Inc., Disarm, Regenesis. P. Kluding: None. R.L. Marcus: None. M. Dimachkie: Research Support; Self; Viromed. F. Vivanco: None. S.C. Foster-Palmer: None. P.E. Hauer: None. A.B. Aperghis: None. M. Pasnoor: Advisory Panel; Self; Alexion Pharmaceuticals, Inc., Terumo BCT. Consultant; Self; Momenta Pharmaceuticals. A. Stonebraker: None. A.N. Hawks: None. L. Herbelin: None. J. Singleton: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases; National Center for Advancing Translational Sciences

Background: Deficits in finger proprioception might impact the ability to perform tasks such as picking up pills, monitoring blood sugar and injecting insulin. However, no tests are available for finger proprioception with functional relevance for tasks using pinch between the index finger and thumb. This study investigates the impact of diabetic peripheral neuropathy (DPN) on pinch proprioception in people with type 2 diabetes (T2D). Methods: This study tested pinch proprioception in 8 healthy participants (3 males, 57±5.6 years), 11 participants with T2D without DPN (T2D-only) (5 males, 61±5.9 years), and 13 participants with T2D and DPN (T2D+DPN) (6 males, 59.9±6.4 years). We used a device previously tested for reliability. Following familiarization with a 15° target position of the index finger and thumb, subjects performed 3 trials where they attempted to reproduce the target position without visual feedback. The average of the absolute error matching the 15° target represented accuracy, and the standard deviation from the trials denoted precision. Results: Descriptive statistics presented as Means ± SD. Accuracy: healthy (0.67±0.64), T2D-only (0.94±1.2), and T2D+DPN (3.51±2.24). Precision: healthy (0.59±0.41), T2D-only (0.79±0.53), and T2D+DPN (2.81±2.4). Kruskal-Wallis test was significant for accuracy (p = .003) and precision (p = .001). Pinch proprioception was significantly different between the T2D+DPN group and the T2D-only group (accuracy and precision: p = .003) as well as between the T2D+DPN group and the healthy group (accuracy: p = .006; precision: p = .001). There were no significant differences between the T2D-only group and the healthy group: accuracy (p = .98) and precision (p = .5). Conclusion: Our results showed that pinch proprioception was disrupted in people with DPN, but not in people with T2D without DPN. Detection of pinch proprioceptive deficits will potentially improve the neurological screening and can be used in future studies for other neurological populations. Disclosure A. Yahya: None. P. Kluding: None. M. Pasnoor: None. M. Santos: None.