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Insulin pen devices have been reported to improve patient satisfaction and treatment adherence compared to the traditional vial/syringe. Insulclock® is a small electronic device plugged onto insulin pen to track information via Bluetooth to smart-phone technology on date, time and dosage of injections and with an alarm system to reduce insulin omissions. We performed a randomized, cross-over design study in patients with type 2 diabetes (T2D) on basal insulin to assess the efficacy and satisfaction of Insulclock device. Eighty T2D patients on basal insulin ± oral agents with HbA1c between 7.0% and 12.0% were randomized to a 12-week ’intervention’ phase receiving reminders or to a 12-week ’control’ phase with device without feedback. Basal insulin was titrated every 2 weeks to a target fasting and premeal glucose between 70-130 mg/dl. Study outcomes included differences between groups on glycemic control, treatment adherence and satisfaction (DTSQc survey). Baseline characteristics were similar between groups (56±11 years, HbA1c 9.2%±1.5). HbA1c improved significantly from baseline, with reduction of 0.9 % in the intervention and 0.7% in the control group. Insulclock improved glycemic control with an estimated reduction in average mean daily blood glucose (BG), fasting BG, and pre-meal BG of 6.03 (95% CI: [-3.21, 15.3]), 6.66 (95% CI: [-1.72, 15.04]), and 5.57 (95% CI: [-6.15, 17.31]) mg/dl, respectively. Repeated measures analyses based on linear mixed models suggest significant effects of insulclock on the trajectory of mean daily BG, fasting BG, pre-meal BG (p In conclusion, the use of Insulclock resulted in improved glycemic control and treatment satisfaction in insulin treated patients with T2D. Disclosure C. Ramos: None. R.J. Galindo: Advisory Panel; Self; Lilly Diabetes. Consultant; Self; Valeritas, Inc. Research Support; Self; Novo Nordisk Inc. Other Relationship; Self; UpToDate. M.M. Alam: None. S. Cardona: None. B.S. Albury: None. O. Oladejo: None. F.J. Pasquel: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp & Dohme Corp. Research Support; Self; Dexcom, Inc., Merck Sharp & Dohme Corp., National Institutes of Health. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. M. Fayfman: None. A. Migdal: None. G. Davis: None. J. Haw: None. G.E. Umpierrez: None.

Diabetes is a leading cause of lower limb loss in the United States that disproportionately affects minority groups of lower socioeconomic status. The reasons for these disparities are poorly characterized. We employed qualitative (focus group discussions, FGD) and quantitative (survey) methods among persons with diabetic foot disease. Participants were stratified into two groups: a diabetic foot ulcer (DFU) group and minor amputation (ankle or below) group. The FGDs addressed patient experience with a goal of understanding: (1) foot care knowledge, (2) barriers to care, and (3) preferred foot-related educational methods. 5 sessions were conducted with 6-12 people each. Participants were recruited from clinics at a safety-net hospital in Atlanta that provides care to an inner-city population with a high burden diabetic foot related complications. Forty participants (90% Black) were enrolled. Surveys revealed an adequate knowledge of proper diabetic foot care, with ≥70% of participants correctly answering questions relating to proper self-care. Several dominant themes emerged from the FGDs. Personal barriers to self-care included lack of motivation, difficulty accessing supplies due to cost and/or lack of insurance, and being unable to limit activity for proper offloading. Participants frequently reported systematic barriers, citing difficulty making timely appointments and reaching a provider to arrange care. Participants reported that foot-related knowledge and access to care improved with greater disease severity but that knowledge and interventions seemed to come too late in their disease course. They expressed interest in peer support groups to facilitate learning and sharing information about diabetic foot care. These findings indicate patients with DFU or minor amputations in our institution have adequate footcare-related knowledge, but barriers to care and lack of motivation limit appropriate foot care. Disclosure M. Fayfman: None. M. Schechter: None. C.N. Amobi: None. R.N. Williams: None. J.L. Hillman: None. R. Rajani: None. D.C. Ziemer: None. M.M. Alam: None. R. Kempker: None. G.E. Umpierrez: None.

Objective We explored barriers to proper foot care in this population using a qualitative approach with focus group discussions (FGD). Methods Participants were recruited from clinics at a safety-net hospital in Atlanta, Georgia and stratified into two groups: diabetic foot ulcer (DFU) and minor amputation (below ankle). The FGDs addressed patient experience in receiving care with a goal of understanding: foot care knowledge, barriers to care, and preferred educational methods. Surveys were performed to supplement FGDs. Results Forty participants (90% Black) were enrolled. Dominant themes emerging from FGDs were: 1-Patients reported adequate understanding of recommended foot care practices; 2-Personal barriers to self-care included lack of motivation, high cost, poor insurance coverage of supplies, and difficulty limiting activity for proper offloading; 3-Hospital system barriers included difficulty making timely appointments and reaching a provider to arrange care; 4-Access to footcare-related information and services improved with greater disease severity. Participants stressed that improved access often came too late to alter their course. They expressed interest in developing peer support groups to facilitate learning and sharing information relating to DFU. Conclusion We found that patients with DFU or minor amputations have adequate footcare-related knowledge, but personal and systemic barriers limited appropriate foot care.

Toll-like receptors (TLRs) signal the presence of pathogens and tissue injury, triggering the inflammatory process in macrophages. The goal of inflammation is to resolve the injury and return the body to homeostasis. MicroRNAs are an important group of regulators of TLR signaling and several are induced by TLRs in macrophages. These TLR-induced microRNAs target signaling components in the TLR pathway, thereby producing a negative feedback loop, and they are therefore prime candidates for the initiation of repair. Importantly, their dysregualtion may be important for chronic inflammation, which in turn can lead to autoimmunity and cancer, as discussed in this Viewpoint.