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Objective This study evaluates the impact of peers’ support on the A1C and FBS levels of the patients with type 2 diabetes. Methods In this randomized clinical trial, 60 patients with type 2 diabetes were selected using proportional stratified sampling and divided randomly into two intervention and control groups (each group includes 30 patients). The intervention group was divided into 3 groups. After that, for each intervention group, we held 10 training-supportive face-to-face sessions by trained peers in the diabetes clinic for three months. We collected data at baseline and three months after the intervention. Results 73.3% of the participants were female and 52.34% of them were middle-aged. The participants also had high baseline median A1C (8.8%) and FBS 180 mg/dl. There was no significant difference in the baseline levels of A1C ( p = 0.88) and FBS ( p = 0.29) between the groups. Within-group analyses showed that the intervention group significantly improved from baseline to month 3 in absolute levels of A1C (−1, p = 0.001) and FBS (−35.8, p = 0.002). This indicates that the intervention group exhibited greater improvement (i.e., decreases) across time. There was no significant change in the control group. Conclusions The peers’ support can be effective in managing diabetes.

Objectives: Health literacy is a major factor contributing to the effective control and prevention of diabetes. Diabetes patients with low health literacy have a lower adherence to self-care activities and blood sugar control. The present study was conducted to assess health literacy, knowledge and relevant factors in patients with type 2 diabetes presenting to a diabetes clinic in Zahedan, Iran, in 2014. Methods: The present descriptive, analytical, cross-sectional study was conducted on 182 patients with type 2 diabetes selected through convenience sampling in 2014. A valid and reliable health literacy and knowledge inventory was used. Data were analyzed in SPSS-16 using descriptive statistics and the linear regression analysis. Results: The majority of the participating patients were woman (75.8%), illiterate (38.5%) and married (85.2%). A total of 31.3% of the patients had an adequate health literacy, 61.5% had a marginal and 7.1% an inadequate health literacy, while 58% had a high level of knowledge. A statistically significant relationship was observed between health literacy and the level of education (P0.05). Conclusion: The study revealed the majority of patients with type 2 diabetes to have marginal health literacy, while health literacy was lower in women than in men. Simple training programs are recommended to be designed for improving health literacy, especially among women and people with lower levels of education.

Setting: Tuberculosis (TB) and diabetes mellitus (DM) are prominent public health problems in the Republic of the Marshall Islands, a small island nation with high rates of tuberculosis and diabetes. Objective: Evaluate the rate of active and latent TB in a Pacific Island DM clinic. Design: In one DM clinic on the island of Ebeye, 213 adult patients aged 27â86 years completed tuberculin skin testing and TB work-up between April 2010 and March 2012. Results: Screening for TB led to the diagnosis of 77 patients with TB infection and 11 patients with TB disease. From these data, the prevalence of TB disease among DM patients in the clinic exceeded 5% (95% CI 2.2%â8.1%). All patients who completed TB screening were at high risk of TB disease, and those with DM aged â¤50 years had a higher risk of TB disease than those with DM over age 50 (RR 3.1, C.I. 1.0â9.7, p=â0.05). Conclusion: The experience at the Ebeye Diabetes Clinic demonstrates that screening DM patients for TB can identify significant rates of TB infection and TB disease, and should be considered for other settings with a high background TB incidence. Further assessment of TB risks should explore age, gender, and level of diabetes control. Keywords: Tuberculosis, Diabetes, Pacific Islands, Bi-directional screening

Aims Empower our young people and encourage self-management and advocacy -that remains the overarching principle at our diabetes clinic. A key component of this is to understand the expectations of young people and answer questions they seek answers to. By using their checklist and not our own, we may cover fewer items but are more likely to have a purposeful and eventually fruitful conversation. Our aim was to identify each patient‘ individual goals and tailor discussions accordingly. Methods We distributed questionnaires, in the form of a ‘mind bubble’, to young people over 12 years attending paediatric diabetes clinics in our hospital over a two-month period. A ‘mind bubble’ is a simplified visual questionnaire designed to be user-friendly and engage with young people. Young people were asked ‘What would you like to discuss today at your diabetes clinic?’ and their responses were then addressed at that attendance. Results We received 32 completed ‘mind bubbles’. The most common response was for advice on hyperglycemia and hypoglycaemia management (44%). 7 responses (22%) were regarding practical advice on holidays and exercise, 6 responses (19%) for specific questions regarding insulin pumps and infusion sets, and 3 (9%) regarding the use of associated computer programmes. 3 responses (9%) asked for education on ketones. Feedback from these were very positive specially from parents who felt their young person was empowered to articulate exactly what they wanted from us. Conclusions The ‘mind bubble’ provides a practical way for young people to inform the diabetes team of their expectations for each clinic visit. The wide variety of responses highlights the challenges of engaging with young people with complex, life long conditions, and the need for patient centred care to enable our young people grow in confidence.

BACKGROUND/OBJECTIVE Carbohydrate (CHO) counting is a recommended daily practice to help manage blood glucose levels in type 1 diabetes. Evidence suggests that CHO estimates should be within 10 to 15 g of the actual meal for optimal postprandial blood glucose control. The objective of this study was to assess accuracy of CHO counting in adolescents with type 1 diabetes. METHODS Adolescents (aged 12-18 years) with type 1 diabetes who self-identified as regular CHO counters were recruited from the SickKids Diabetes Clinic, Toronto, Canada. Adolescents completed the PedsCarbQuiz (PCQ) and estimated CHO content of test trays (three meals and three snack trays) that were randomly assigned. Analyses were conducted to identify factors associated with accuracy of counting and CHO counting knowledge (PCQ score). RESULTS A total of 140 adolescents (78 females, mean age 14.7, SD = 1.8) participated. The average PCQ score was 81 ± 10%. Forty-two percent of adolescents were accurate in estimating meal trays (ie, within 10 g of the actual CHO content), 44% estimated inaccurately (within 10-20 g), while 14% were significantly inaccurate counters (>20 g variation). PCQ scores were higher in teens who CHO counted accurately than in those with significant inaccuracy (>20 g) (P

Background Despite the fact that the rate of type 1 diabetes (T1D) is increasing worldwide, there exists a dearth of information on the disease in most sub-Saharan African countries. The goal of this study was to determine the enrolment trend of T1D using data compiled over 28 y from a teaching hospital in Kumasi, Ghana. Methods Information collected included sex, age at diagnosis and date of T1D diagnosis. We identified trends from 1992 to 2018, divided into 3 y intervals. Results From 1992 to 2018, 1717 individuals with T1D were enrolled in the diabetes clinic at the Komfo Anokye Teaching Hospital. The male:female ratio was 1:1.2. The number of individuals diagnosed with T1D decreased among the 10–19 y age group during the 1992–1994 period, followed by a progressive increase within the same age group during the subsequent period (from 35.4% in 1995–1997 to 63.2% in 2016–2018). There was a decline in the proportion of children 0–9 y of age diagnosed during the study period (from 5.1% in 1992–1994 to 3.6% in 2016–2018). Conclusions In our study population, a decreasing trend of T1D enrolments was observed in general while among adolescents an increasing trend was observed.

Background Linking process of care data from general practice (GP) and hospital data may provide more information about the risk of hospital admission and re-admission for people with type-2 diabetes mellitus (T2DM). This study aimed to extract and link data from a hospital, a diabetes clinic (DC). A second aim was to determine whether the data could be used to predict hospital admission for people with T2DM. Methods Data were extracted using the GRHANITE™ extraction and linkage tool. The data from nine GPs and the DC included data from the two years prior to the hospital admission. The date of the first hospital admission for patients with one or more admissions was the index admission. For those patients without an admission, the census date 31/03/2014 was used in all outputs requiring results prior to an admission. Readmission was any admission following the index admission. The data were summarised to provide a comparison between two groups of patients: 1) Patients with a diagnosis of T2DM who had been treated at a GP and had a hospital admission and 2) Patients with a diagnosis of T2DM who had been treated at a GP and did not have a hospital admission. Results Data were extracted for 161,575 patients from the three data sources, 644 patients with T2DM had data linked between the GPs and the hospital. Of these, 170 also had data linked with the DC. Combining the data from the different data sources improved the overall data quality for some attributes particularly those attributes that were recorded consistently in the hospital admission data. The results from the modelling to predict hospital admission were plausible given the issues with data completeness. Conclusion This project has established the methodology (tools and processes) to extract, link, aggregate and analyse data from general practices, hospital admission data and DC data. This study methodology involved the establishment of a comparator/control group from the same sites to compare and contrast the predictors of admission, addressing a limitation of most published risk stratification and admission prediction studies. Data completeness needs to be improved for this to be useful to predict hospital admissions.

Diabetes remains one of the most common chronic conditions seen in primary care clinics. While it remains one of the toughest quality measures to fulfill, it is crucial since we are approaching “Pay for Performance” in healthcare that will determine physician re-imbursement rates. We therefore performed this initiative to target patients within the internal medicine clinic at East Carolina University, who have a hemoglobin A1c (A1c) >9% (as this is suggested as a quality measure by Medicare’s Merit-based Incentive Payment System and the National Committee of Quality Assurance). The 1st phase involved creating a protocol to identify/contact patients with an A1c >9%. The 2nd phase was to establish a diabetes clinic via a diabetes specialist within the primary care setting with the goal of providing individualized diabetes care for high-risk patients. The 3rd phase was to educate the residents on evidence-based diabetes management through yearly didactic sessions. The 4th phase was to establish a Diabetes Fellow clinic within the primary care clinic. We divided our results according to the level of training of the patients’ primary care provider (attending vs. resident). On Mar 9, 2017, the clinic protocol identifying/calling patients with A1c >9% was initiated, the first diabetes clinic was on Sep 8, 2017, and the first diabetes fellow clinic was on July 30, 2018. Our initiative resulted in a reduction in the number of patients with A1c >9% in the resident clinic (30% vs. 22.6% vs. 20.9% in Feb 2017, Nov 2017, and Dec 2018 respectively) and the attending clinic (24% vs. 19.3% vs. 17.9% in Feb 2017, Nov 2017, and Dec 2018 respectively). Our clinic’s overall number of patients with A1c >9.0% improved from 21.6% in Nov 2017 to 20.02% in Dec 2018. Our project has been successful in reducing the percentage of patients with an A1c >9%. Our project also reflects real-time attempts to improve clinic-wide glycemic control while continuously establishing care with new patients in a primary care clinic. Disclosure B.M. Mishriky: None. J.R. Powell: None. C.E. Holoman: None. M.R. Mian: None.

Dyslipidemia is commonly found in T1D adults and increases the risk of CVD. There is no research on dyslipidemia in T1D adults in Spain so far. The aim of the study was to evaluate the prevalence and the pattern of dyslipidemia and its relationship with other risk factors or comorbidities. Methods: A multicentric, cross-sectional study in Spain included 1252 adults with T1D who visited Diabetes Clinic from December 2017 to December 2018. Cut-off points for abnormal lipid levels (total cholesterol (TC) ≥200 mg/dL, LDL ≥130 mg/dL, HDL ≤35 mg/dL, and triglycerides (TG) ≥150 mg/dL) were taken from the Third Report of the National Cholesterol Education Program and the ADA. Dyslipidemia was defined by the presence of one or more abnormal serum lipid concentrations. Results: Among 1252 patients 50,3% were male. Median age 40,5+/-13 years old and the median duration of diabetes was 20+/-13 years. Median A1c 7,96+/-2,49% and BMI 25,7+/-4,6kg/m2 The overall lipid profile was TC 188+/-42 mg/dL, LDL 109+/-36 mg/dL, HDL 59+/-17 mg/dL and TG 96+/-96 mg/dL. The prevalence of dyslipidemia was 43,5%. The most frequent dyslipidemia found wash high TC (34,6%), followed by high LDL (26,6%), high TG (11,3%) and low HDL (1,8%). Comparison between the dyslipidemic (D) group and normolipidemic (No D) group age was significantly higher in the D group P< 0,001). The frequency of dyslipidemia was higher in male, current smokers and hypertension. There were no differences between the D and No D groups in terms of A1c, BMI, family background, hypoglycemic treatment or duration of diabetes. The prevalence of microvascular complications was higher in the D group (p< 0,0001), there were no differences in macrovascular complications. Conclusions: Our study was the first report of lipid data in Spanish T1D adults. We have shown that the overall lipid pattern was comparable to that in nondiabetic individuals. There is high prevalence of dyslipidemia which was associated with age, sex (male), smoking and comorbidities but not with glycemic control. Disclosure M. Rodriguez Carnero: None. D. Bellido Guerrero: None. C. Tejera: None. M. López de la Torre: None. A. Soto González: None. F.J. Escalada: Advisory Panel; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; Esteve, Lilly Diabetes. Speaker's Bureau; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. A. Hernandez-Mijares: None. L. Suarez Gutierrez: None. C. Morales: Other Relationship; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. L. Gutiérrez Carrasqu: None. A. Cadenas: Advisory Panel; Self; Janssen Pharmaceuticals, Inc. O. Díaz Trastoy: None. J. Amigó-Farran: None. I. Gonzalez molero: None. V. Bellido: None. F. Arrieta: None. F. Tinahones: Advisory Panel; Self; Lilly Diabetes, Novo Nordisk A/S, Regeneron Pharmaceuticals, Sanofi-Aventis. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Danone Nutricia Research, Lilly Diabetes, Novo Nordisk A/S, Regenerative Medical Solutions, Sanofi-Aventis.

Background: AA have a higher prevalence of diabetic nephropathy (DN) than Caucasians. However, the prevalence of DN between AA and Caucasians as a function of time is less well understood. Methods: We retrospectively reviewed the medical charts of 1211 adults who consecutively presented to our diabetes clinic from 2001-10. We collected data from their initial clinic visit. We defined DN as microalbuminuria >300 mg/g or GFR Findings: The prevalence of DN among AA and Caucasians was 32% and 19.6%, respectively. The prevalence of DN increased as a function of time for both AA and Caucasians, but was significantly higher among AA >10 years after diabetes diagnosis (Figure). In multivariable logistic regression, having hypertension (OR = 3.0, 95% CI 2.03 - 4.49), diabetes for >10 years (2.64, 1.91 - 3.68), A1c >8% (1.40, 1.01 - 1.96), and being AA (1.88, 1.32 - 2.66) were independently associated with DN. Diabetes subtype, BMI, and gender were not associated with DN. Interpretation: Differences in DN prevalence between AA and Caucasians appear ∼10 after diabetes diagnosis, independent of A1c and hypertension control. AA may benefit from early prevention and aggressive risk factors control. Disclosure A. De Ferrari: None. F. Ovalle: Speaker's Bureau; Self; Janssen Pharmaceuticals, Inc., Novo Nordisk A/S.

Introduction: Cardiovascular disease (CVD) is the major cause of mortality in T1D. Lipid-lowering treatment (LLT) with statins prevent major cardiovascular events and dead in a broad spectrum of patients. However, evidence of CVD risks factors and its management are based on subgroup analyses and extrapolations of effects demonstrates in other populations. Objectives: The aim of the study was to analyze the differences between T1D adults on lipid-lowering treatment (T group) and without treatment (No T group). We pay special attention to CVD risk factors, comorbidities and which factors are associated with receiving lipid-lowering treatment. Research design and Methods: A multicentric, cross-sectional study in Spain included 1252 T1D adults who visited Diabetes Clinic from December 2017 to December 2018. Results: Among 1252 patients 344 were on LLT. In terms of lipid profile LDL (131 vs. 100 mg/dL), HDL (57 vs. 60 mg/dL), total cholesterol (213 vs. 178 mg/dL) and triglycerides (125 vs. 85 mg/dL) levels were statistically significant while compared between T and No T groups. T group was older (48 vs. 37 years old) and the median duration of diabetes was higher (25 vs. 18 years)than No T group (p< 0.000). BMI in T group was 27 kg/m2 higher than no T group (25 kg/m2) (p < 0,0001). There was a trend toward higher prevalence of microvascular (57% vs. 23,8%) and macrovascular complications (13,7% vs. 3,6%) in T group than in No T (p < 0,000). A positive association was found between sex (male), smoking, high blood pressure and to be on treatment. There were no differences between the T group and No T group in terms of A1c (A1c 7,90% vs. 7,99%) or fasting glucose (157 vs.161 mg/dl). Conclusions: This multicentric study shows that starting LLT is associated with LDL > 100 mg/dL, aged, sex (male), duration of diabetes, high BMI, comorbidities, smoking and a high blood pressure. Our results show compliance with the recommendations of 2014 AHA/ADA scientific statement type 1 diabetes mellitus and Cardiovascular Disease. Disclosure M. Rodriguez Carnero: None. D. Bellido Guerrero: None. C. Tejera: None. M. López de la Torre: None. A. Soto González: None. F.J. Escalada: Advisory Panel; Self; Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; Esteve, Lilly Diabetes. Speaker's Bureau; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Janssen Pharmaceuticals, Inc., Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. A. Hernandez-Mijares: None. L. Suarez Gutierrez: None. C. Morales: Other Relationship; Self; AstraZeneca, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi. L. Gutiérrez Carrasqu: None. A. Cadenas: Advisory Panel; Self; Janssen Pharmaceuticals, Inc. O. Díaz Trastoy: None. J. Amigó-Farran: None. I. Gonzalez molero: None. V. Bellido: None. F. Arrieta: None. F. Tinahones: Advisory Panel; Self; Lilly Diabetes, Novo Nordisk A/S, Regeneron Pharmaceuticals, Sanofi-Aventis. Consultant; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Danone Nutricia Research, Lilly Diabetes, Novo Nordisk A/S, Regenerative Medical Solutions, Sanofi-Aventis.

Introduction: Incidence of type 2 diabetes (T2DM) among young adults has been increasing rapidly. We have noticed a significant increase in consultations received for patients with T2DM diagnosed at age Methods: All patients (new and follow-up) with T2DM and age≤ 50 years, at our Diabetes and Endocrinology Centre were included. 95 patients (21% of all patients in our diabetes registry) met the eligibility criteria. Demographic variables. comorbidities, diabetes complications, vitals, lab parameters and medications were reviewed. Results: n=38 (40%) were females. Sixty-eight (71%) were South Asians. Mean age at diagnosis was 34 years(± 7.2). Normal, overweight and obese BMI was seen in 25%, 42% and 33% of South Asians and 12%, 25% and 62% of Caucasians, respectively. South Asians were diagnosed at a younger age with 9%, 16% and 57% diagnosed at age Conclusion: A large proportion of patients in our diabetes registry are young or middle aged. South Asian ethnicity increases risk of diabetes at a younger age and lower BMI. The epidemic of diabetes at a young age is likely related to increased sedentary lifestyle, inadequate sleep, stress and increasing use of technology and screens. Disclosure K. Suntharamoorthy: None. S. Dave: None. U. Muhammad: None. E. Javaid: None. N. Gupta: Consultant; Self; AstraZeneca, Eli Lilly and Company, Novo Nordisk Inc., Sanofi. Speaker's Bureau; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Novo Nordisk Inc., Sanofi.

Background: People with T1DM under 21 are eligible for subsidised continuous glucose monitoring (CGM) products under the Australian National Diabetes Services Scheme. There are few “real world” published studies to evaluate the benefits of CGM in young adults. Aim: To determine whether CGM is associated with improvement in glycaemic markers amongst eligible T1DM patients. Methods: Patients at the Westmead Hospital young adult diabetes clinic aged 16-21 who commenced CGM prior to July 2018 were followed-up for 6 months after CGM commencement. Differences in HbA1c and glucose metrics at baseline and follow-up are compared between those started on CGM and those who were not. Results: There were 115 eligible patients, of which 38% (n=44) commenced CGM. There were no differences in age, gender or baseline HbA1c of those started on CGM vs. those who were not. CGM users were more likely to use CSII than MDI (n=27 vs. 17, P=0.02), and came from post code areas which had higher median household incomes, despite fully subsidised CGM costs. At 6 months follow-up, only 41% (n=18/44) were confirmed to still be using CGM, with common reasons for dropout being discomfort, inconvenience, and disruptive alarms. Of those who continued, there was no change from baseline to 6 months in HbA1c (8.2±1.3% vs. 8.3±1.5%, P=0.7), coefficient of variation of glucose (0.39 vs. 0.38, P=0.5), or % time in range (54% vs. 58%, P=0.3), with average CGM wear time 65% in the 4 weeks prior to follow-up visit. At 6 months there was a weak correlation between percentage use of CGM and HbA1c reduction (R=0.46, P=0.07). Mean hypoglycaemia fear scores (worry scale) was significantly decreased from baseline at 6 months (33 vs. 18, P Conclusion: There are high rates of discontinuation in CGM use amongst T1DM patients aged 16-21. At six months of use there was no significant improvement in glycaemic control, although higher CGM usage was weakly correlated with increased time in range. Worry of hypoglycaemia was significantly decreased amongst those who continued CGM. Disclosure M. Lee: None. J. Holmes-Walker: None. K. Farrell: None.

Strong scientific evidence supports the benefits of ABC control (A1c A diabetes clinic in a Chinese tertiary hospital conducted a pilot quality improvement project from January to November 2018 to enhance ABC outcomes. Doctors and nurses from the clinic participated in biweekly video case conferences with Joslin Diabetes Center clinicians (endocrinologist and a certified diabetes educator). They also received bi-monthly on-site training, each lasting 10 days, from visiting U.S. clinicians. A1c, blood pressure and cholesterol levels collected from patients receiving routine care in the diabetes clinic from the first half of 2018 were compared with those collected in the second half of 2018. There were 1,036 patients who had at least one visit at each of these periods, and 683 patients of them (65.9%) had A1c, BP and LDL measured during these two periods. Paired comparisons were done by paired t-test (continuous variables) or McNemar’s test (dichotomous variables) using SAS version 9.4. The mean age of the patients was 54.7±11.9 years, with 53.8% female, and 95.3% with T2DM. There was a significant increase in the patients who achieved composite A1c, BP and LDL goal from 6.8 to 10.0% (p=0.048). The percentage of patients attaining the BP goal increased from 54.6 to 63.5% (p=0.0016). The systolic pressure decreased from 137.8 ± 20.2 to 133.3 ± 19.4 mmHg (p Interventions through regular case-based video conferences, complemented by live coaching from diabetes specialists, have the potential to improve clinical outcomes for patients with diabetes in China. Disclosure K. Lau: None. L. Yunxia: None. L. Yi: None. C. Li: None. Y. Zhengguo: None. D.M. Pober: None. L. Zhang: None. R.A. Gabbay: Advisory Panel; Self; HealthReveal, Hygieia, Lark, Onduo LLC. Consultant; Self; Sanofi. W.C. Hsu: Consultant; Self; Onduo LLC.

Background: Onduo’s Virtual Diabetes Clinic (VDC) incorporates a continuous glucose monitor (CGM), telemedicine, and a coaching app into the management of patients with type 2 diabetes (T2D). A recent meta-analysis of studies involving CGMs (Vigersky & McMahon 2019) showed HbA1c and time in range (%TIR) are strongly correlated. Methods: All patients in the program with CGM usage in the 45 days prior to a follow-up HbA1c were analyzed. Mean HbA1c and %TIR were added to the previously published meta-analysis plot where each study or cohort is represented by a single dot. Additionally, a regression model was fit on the patient-level data. Results: Patient-level results from the VDC confirm the two metrics are strongly correlated (r=.-78). At the population-level, a mean %TIR of 84% in 194 VDC patients with mean HbA1c of 7.0% is 18% higher than predicted from the meta-analysis regression line. Cohorts associated with the 3 T2D studies in the meta-analysis were the 3 with the highest %TIR versus predicted, and 1 study with mixed type 1/2 was also higher than predicted. Conclusions: Our findings add support to the strong correlation observed between TIR and A1c overall, and suggest potentially distinct calibrations in T1D vs. T2D populations. Additional CGM data in T2D will clarify if separate prediction formulae are necessary. Disclosure R.F. Dixon: Employee; Self; Onduo LLC. D.P. Miller: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. A. Majithia: Consultant; Self; Onduo LLC. A. Armento Lee: Employee; Self; Verily Life Sciences LLC. S. Robertson: Employee; Self; Verily Life Sciences LLC. M. Germanos: None. H. Zisser: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC.

Objective: Despite long-standing participation of youth with T1D in research, clinical trials often fail to meet recruitment goals. The current study examined youth, young adult, and caregiver barriers and facilitators of participation in clinical research. Methods: Participants were recruited online nationally and in-clinic from two diabetes clinics in the U.S. Self-report surveys of research participation, barriers, and interests were obtained; HbA1c was collected via chart review. Results: Young adults (N=83; Mage=22.2±2.1; MA1c=7.6±1.5) and caregivers (N=81; Mage=45.3±7.8) via online surveys; and, adolescents (N=16; Mage=14.8±1.7; MA1c=9.1±2.2), young adults (N=10; Mage=20.9±2.2; MA1c=8.7±2.4), and caregivers (N=26; Mage=43.4±9.2) via routine diabetes clinic visits participated. Barriers to enrollment in included: missing school or work, potential unwanted side effects, location, time, and limited information. Over half of online participants (54%) reported lack of discussion with their physician about clinical trials, while 46.9% of in-clinic participants indicated their provider never or almost never discussed clinical research. Highest-rated research interests included: finding a cure, new technology, and closed-loop research. Among caregivers (online cohort), preference for the youth’s provider to discuss clinical trials during clinic visits was correlated with HbA1c% (r=0.302, p Conclusions: Youth, young adults, and caregivers expressed interest in learning more about research, yet identified logistical barriers to participation. Education and outreach are needed. Tailored multi-modal recruitment strategies (e.g., online for young adults; via events/provider for caregivers) may help overcome barriers to participation. Disclosure S.C. Westen: None. L.M. Anderson: None. S.A. Barry: None. S. Look: None. S. Pinto: None. A. Albanese-O'Neill: None. C.A. Kemp: None. M.J. Haller: Advisory Panel; Self; Pancreum, SAB Biotherapeutics. J.L. Papadakis: None. D. Schatz: None. B.T. Olsen: None. D.M. Janicke: None. J. Weissberg-Benchell: Consultant; Self; Roche Diabetes Care. N. Johnson: None. Funding JDRF

Objectives: A reimbursement model for a multidisciplinary young adult diabetes clinic supporting pediatric to adult transition of care was examined. Method: In approximately one year (Dec 2017-Oct 2018), 31 patients with type 1 diabetes (T1D; ages 17-25; 56% males, Hemoglobin A1C ranged from 6.0 to >14.0 (M=9.44, SD=2.07) were billed for attending a Young Adult Diabetes Clinic. Data were extracted via electronic medical record. Reimbursement rates, as noted by Got Transition and American Academy of Pediatrics for Medicare 2018, were used to assess financial sustainability. Results: Services billed included a 45-minute behavioral health group intervention (96153), emotional/behavioral (96127) and substance use questionnaires (96160). This was followed by a 25 minute diabetes education visit (G0108), a 10 minute warm hand off and a 25 minute medical provider visit (99203). Medical CPT Codes (99213, 99205, and 99204) were reimbursed 76% of the time, producing wRVUs of approximately 50. Behavioral health CPT codes (96150, 96152, and 96127) were reimbursed 46% of the time and produced wRVUs of approximately 14. Approximately $8300 was billed for the half-day clinic over the course of 11 months. Approximately $5700 was returned (68% return rate) and wRVUs were around 70. More than 50% of the patients who agreed to attend the clinic also established ongoing clinical services. The clinic model also supported only 10% of patients being lost to follow-up compared to higher rates previously predicted in the literature. Conclusions: The half-day, once a month, multidisciplinary transition clinic designed to support transition-age youth with T1D yielded additional funds and increased youth engagement. While not highly lucrative, this may be due to antiquated billing infrastructure and a small sample size. Future studies are needed to assess the link between outpatient engagement, billing, and reduced health crises, hospitalizations and related costs. Disclosure F. Joarder: None. H. Nagra: None. L. Andreas: None. L. Rocha: None. K. Kraus: None.

Aim To promote collaboration with young people who have diabetes and to empower them to come up with their own ideas and goals. Method The 3 × 3 Technique is an activity from the ‘Me first Resource Hub’. We adapted it for use in our diabetes clinic. The first round everybody present in the clinic room, health professionals and young person and parents (if present) writes down one idea for something that might help the young person’s diabetes. ‘Blue sky thinking’ and ideas that don’t seem directly related to their diabetes are encouraged. The young person reads these ideas quietly to themselves or aloud, if they feel able to and they are then asked to put a dot on the idea that most appeals to them. This process is repeated two more times. At the end the young person is asked to pick one of the three chosen ideas that they would like to take forward. Results This activity encourages young people to take ownership in clinics by offering more choices and involving them in decisions. Some of the chosen ideas selected, ‘Give insulin before snacks’ and to ‘Join an Art Class’. One young person chose ‘Only give 10 to 15 g of carbohydrate for hypos’ as an idea straight away, verbally adding ‘I am going to do this by wrapping glucose tablets in cling film, in groups of 3’. We are currently collecting formal feedback, but young people have already said they found this ‘fun’, ‘helpful’ and ‘made them smile’ Conclusion Young people with diabetes know their condition well and have many great ideas how to improve it, but it can be difficult to facilitate an environment where young people feel able to express their ideas and generate ones that they really want to take forward. The 3 × 3 Technique helps young people input their ideas in a non-judgemental way and helps to keep a serious and sometimes upsetting aspect of clinics a bit lighter and more fun. At present we have only tried this with teenagers but also plan on adapting it for younger children and to collect more formalised feedback.

Introduction Poorly managed transition could adversely impact upon adjustment to diabetes and potentially result in non-adherence to treatment, loss to follow-up and worsening of health-related outcomes. In our DGH, approximately 20 Young Person (YP) with T1DM get transferred to YP Clinic every year. YP between 17–19 years of age attend a joint clinic before the transfer. The YP Clinic provides a continuity of diabetes care up to the age of 25 years. Aim of the study To evaluate the experiences and satisfaction of YP with current diabetes transitional service at a DGH, identify aspects of the service that could be improved and propose plans to improve the service. Methods A survey was conducted evaluating the experiences and satisfaction of YP transitioned in the years 2014 and 2015. The challenges faced by the current transitional service was evaluated through a survey of paediatric and adult diabetes professionals. The patient and professional survey was conducted using SurveyMonkey. Results 30 out of 40 YP responded to our survey. 22 YP responded that transition was first discussed after 15 years of age. 23 YP reported their involvement in planning their transition care but only 30% reported that their transition care plan (TCP) was specific to their needs. 90% had a key worker at transition. 14 YP reported attending age-specific ‘Teen Diabetes Clinic’ between 14–17 years of age. 80% met with YP diabetes team at the joint/transfer clinic. 86% reported attending their first appointment at the YP Clinic. Majority expressed high rate of satisfaction with the transition support. Provision of peer support, reminders for appointments and an opportunity to familiarise with YP Clinic environment before the transfer were highlighted as most crucial by YP. Clinic capacity and lack of in-house dietitian and psychology support were the major challenges identified with the YP Clinic. Conclusion There was high rate of attendance at the handover as well as first clinic post-handover. Majority respondents reported good satisfaction with the service. Recommendations were made to improve the TCP, assess YP’s transitional readiness using ‘Ready Steady Go’ programme and to address the gaps in post-transfer dietetic and psychology support.

Introduction Clinics increasingly screen patients for food insecurity, but little is known about the efficacy of referring food-insecure patients to community-based food resources. Objective To evaluate the implementation of a tailored community food resource referral program in a safety-net diabetes clinic. Methods We conducted semistructured phone interviews with food-insecure patients participating in a screening and referral program in a diabetes clinic affiliated with a safety-net hospital. In this qualitative study, we describe barriers to and facilitators of successful food resource referrals from the patient's perspective. Results The prevalence of food insecurity was high (60%). Provision of written and verbal information alone about community food resources resulted in low linkage rates (0%-4%), even with individually tailored referrals. Misperceptions about eligibility, fears around government program registration, inaccessibility, lack of information retention, competing priorities, an inability to cook, stigma, and a perceived sense of stability with existing food support were major barriers to use. Personnel-guided, in-clinic enrollment to a food resource facilitated a higher connection rate (31%). Discussion Results of this study suggest that screening for food insecurity followed by a list of food resources for those screening positive may not adequately address patient barriers to using community-based food resources. For food insecurity screening programs in the clinical setting to be effective, systems must not only distribute food resource information but also assist patients in enrollment processes.

BACKGROUND. Diabetes mellitus (DM) and major depressive disorder (MDD) constitute a major burden of disease. A study found that type 2 DM (DM2) is associated with a two-fold increase in risk of developing MDD worldwide - except in Africa. The present study challenges this statement. OBJECTIVES. To determine the prevalence of MDD in a cohort of patients with DM and its effect on glycaemic control. METHODS. A cross-sectional study was performed at a diabetes clinic at Edendale Hospital, Pietermaritzburg, South Africa (1 March -31 May 2017). A total of 176 participants were enrolled. Participants completed the Patient Health Questionnaire-9 (PHQ-9), with a score of > 10 representing a diagnosis of MDD. Higher PHQ-9 scores translate into more severe MDD. A surrogate for glycaemic control, glycated haemoglobin (HbAlc) blood testing, was also performed. RESULTS. The majority of participants were female and suffered from DM2. The mean age was 54.4 years. The prevalence of MDD in the study population was 46.6%. A significantly positive linear relationship was shown between PHQ-9 score and HbAlc (p=0.018253). CONCLUSIONS. MDD appears to constitute a large burden of disease in our population of individuals with DM. A relationship between the severity of the MDD and HbAlc suggests that prompt intervention in both conditions is likely to improve health outcomes.

This is an exciting time in diabetology. Though the epidemic of type 2 diabetes epidemic is gradually converting to an endemic (1), there is unprecedented optimism in the diabetes clinic. Newer drug preparations, formulations, delivery devices, assisted by digital platforms and person-friendly approaches, are now available for management of this syndrome.

Aim The study aimed to assess the prevalence of hypoglycaemia in subjects with type 1 diabetes (T1D) attending a public health tertiary diabetes clinic in Durban, South Africa. Methods Patients with T1D were enrolled at the time of clinic attendance. Data on hypoglycaemia over the previous 12 weeks were obtained from glucose meter downloads as well as diary records. Each patient completed the Hypoglycaemia Fear Survey questionnaire as well as an in-house questionnaire on hypoglycaemic episodes in the previous 12 months. Results A total of 151 subjects (58% female, 54% black African) were enrolled. “Any” hypoglycaemia occurred in 144 (95.4%) in the 12 months prior to clinic attendance. Of these, “severe” hypoglycaemia occurred in 107 (74.3%) and 22 (20.6%) had five or more severe episodes. The most frequent behavioural change in response to hypoglycaemia was insulin dose self-adjustment and the commonest worry was the possibility of becoming emotionally upset during hypoglycaemia. Conclusions In a tertiary diabetes clinic in Durban, South Africa, there was a high frequency of hypoglycaemia in patients with T1D and in the majority, at least one severe episode occurred in the 12 months prior to clinic attendance. The results indicate a need for further study and strategies to reduce the frequency and severity of hypoglycaemia.

Aims: The aim of the study is comparing the psychiatric symptom in Type1 DM, Type 2 DM and controls. Methods: The study was designed as case control study and conducted between September 2011 and April 2012 to the Diabetes Clinic. Age, gender and education level matched 70 type 1 diabetics, 68 type 2 diabetics and 70 controls included to the study. SCL-90-R [Symptom Check List-90 (Revised)] test is used for determining the psychiatric symptom rates. Results: It was found that the rate of somatization, interpersonal sensitivity, anger-hostility and additional scales were significantly different in type 1, type 2 diabetics and controls ((p = 0.023, p = 0.008, p = 0.018 and p = 0.039, respectively). Compared to control group, being a patient with type 1 or type 2 Diabetes found as a risk factor for somatization, depression, anger-hostility and additional scales. Moreover being a patient with type 1 DM was found as a risk factor for having OBS symptoms (p = 0.039) and type 1 DM was protective against having interpersonal sensitivity symptoms (p = 0.006). Conclusion: In diabetic patient groups, an increase in the rate of psychiatric symptoms was observed. Therefore a careful psychiatric examination is required in DM. © 2019 Diabetes India

Despite adequate treatment for diabetes, it is estimated that 15%- 20% of people with diabetes are struggling with a moderate to severe form of depression daily. Little is known about depression in diabetes in East Africa, particularly in Tanzania. The study is aimed at determining the prevalence of depression and associated factors among patients with diabetes. A descriptive cross-sectional study was carried out at the diabetes clinic of Muhimbili National Hospital. The 9-item Patient Health Questionnaire (PHQ 9) scale was used to assess presence of depressive symptoms among diabetes patients at the clinic. In addition, patient’s sociodemographic and clinical characteristics were obtained and analysed for their association with depression. A total of 353 participants were recruited, of whom 229 (64.9%) patients were female and 156 (44.2%) were aged between 41 and 60 years. The overall prevalence of depression among diabetes patients at the diabetes clinic was 87%. Most (56.7%) had minimal depression, 22.1% had mild depression, and 8.2% had moderate depression. None had severe depression. Factors independently associated with a diagnosis of mild to moderate depression were being on insulin therapy and being a current smoker. There was a high prevalence of depression in this diabetic population. Majority of patients had minimal depression but about 30% had either mild or moderate depression. A holistic approach that focuses on the identification and management of depression among patients with diabetes is recommended.

Objective: To determine the glycemic control and cardio-metabolic complications of children and adolescents with type 1 diabetes mellitus (T1DM) attending a tertiary care diabetes clinic in Saudi Arabia. Methods: We conducted a retrospective cross-sectional study of children and adolescents with T1DM attending King Abdulaziz Medical City-Jeddah from 2010 to 2013. We assessed their glycemic control and diabetes management. Vitamin D status was compared with glycemic control and gender differences. Results: We identified 301 subjects (53.5% females); mean age was 13.9 ± 3.8 years. The mean duration of diabetes was 7.7 ± 3.7 years, body mass index (BMI) was 21.1 ± 4.5 kg/m2, and hemoglobin A1c (HbA1c) was 9.6% ± 1.9% in both genders. There were modest gender-specific differences in Saudi patients with T1DM, with males having more symptoms than females. Mean age at diagnosis of T1DM was slightly younger in males (6.01 ± 3.65 years) than in females (6.33 ± 3.45 years). Education was the most common reason for admission in males (32.9%), whereas diabetic ketoacidosis (DKA) was the most common reason in females (38.8%). Frequency of symptomatic hypoglycemic attacks was relatively higher in males (47.1%) than in females (42.9%). The majority of our patients (83%) were on intensive insulin regimen, having 4 injections or more per day. The remaining (17%) were on conventional insulin therapy. Only 26.2% had satisfactory HbA1c (⩽8%). The mean level of 25-hydroxyvitamin D was 35.15 ± 15.9 nmol/L and cholesterol was 4.75 ± 1.1 nmol/L. Vitamin D deficiency (25-hydroxyvitamin D ⩽ 37.5 nmol/L) was detected in 63.6% males and 67.7% females. No significant correlation between HbA1c and vitamin D deficiency was observed. Conclusions: Metabolic control among Saudi children with T1DM is less satisfactory compared with other countries. The high prevalence of vitamin D deficiency in this population supports the recommendation of vitamin D supplementation in T1DM subjects. Further studies in a larger cohort are needed to confirm our findings.

Background Sub-Saharan Africa continues to face the highest rate of mortality from diabetes in the world due to limited access to quality diabetes care. We assessed the quality of diabetes care in a rural diabetes clinic in western Kenya. Methods To provide a comprehensive assessment, a set of clinical outcomes, process, and structure metrics were evaluated to assess the quality of diabetes care provided in the outpatient clinic at Webuye District Hospital. The primary clinical outcome measures were the change in HbA1c and point of care blood glucose. In assessing process metrics, the primary measure was the percentage of patients who were lost to follow up. The structure metrics were assessed by evaluating different facets of the operation of the clinic and their accordance with the International Diabetes Federation (IDF) guidelines. Results A total of 524 patients were enrolled into the diabetes clinic during the predefined period of evaluation. The overall clinic population demonstrated a statistically significant reduction in HbA1c and point of care blood glucose at all time points of evaluation after baseline. Patients had a mean baseline HbA1C of 10.2% which decreased to 8.4% amongst the patients who remained in care after 18 months. In terms of process measures, 38 patients (7.3%) were characterized as being lost to follow up as they missed clinic visits for more than 6 months. Through the assessment of structural metrics, the clinic met at least the minimal standards of care for 14 out of the 19 domains recommended by the IDF. Conclusion This analysis illustrates the gains made in various elements of diabetes care quality which can be used by other programs to guide diabetes care scale up across the region. Electronic supplementary material The online version of this article (10.1186/s12902-018-0324-5) contains supplementary material, which is available to authorized users.

Diabetes is a chronic disease that affects nearly 463 million people globally and involves multiple co-morbid conditions that require effective treatment and continuous management. These include lifestyle and behavioral modifications, compliance to diabetes medications and close patient monitoring, all of which can be efficiently conducted via telehealth. Integrating digital technology of telehealth and mobile health into diabetes care may improve diabetes management and increase its efficiency. In this review, we examine recent advances in healthcare technology of diabetes. Moreover, we present an example of a comprehensive virtual diabetes clinic, the “Joslin HOME,” as an innovative digital ecosystem for future application in diabetes care. This model utilizes digital health technology and comprises frequent short visits with easy two-way scheduling, focused documentation and simple billing methods. In this new model, a multidisciplinary team is connected with their patients using telehealth and mobile health to overcome the barriers of distance and location. It may possibly extend quality diabetes care to remote, underserved or rural areas.

Introduction. Physical activity is an important factor in reducing morbidity from type 2 diabetes mellitus and maintaining quality of life. There is no available data on physical activity among Filipino patients with type 2 diabetes mellitus. Objectives. The objectives are to assess the physical activity level of patients with type 2 diabetes mellitus at the UP-PGH Diabetes Clinic using Global Physical Activity Questionnaire and to determine the relationship between physical activity, health profiles and socio-demographic characteristics. Methodology. A cross-sectional study was conducted to assess the physical activity levels of 151 patients with type 2 diabetes mellitus (46 men and 105 women) using GPAQ. Anthropometric measurements, socio-demographic profiles and HbA1c were also taken. Results. Majority of subjects had moderate to high physical activity (68.9%) and most of the patients had poor glycemic control based on HbA1c of ≥7% (68.2%). Subjects aged 60 years and above (68.1%; p=0.022) and with poor glycemic control (89.4%; p=

To examine characteristics and outcomes of type 2 diabetes (T2DM) patients prescribed canagliflozin (CANA) and managed in the real-world setting of a diabetes clinic. Primary outcome was change in A1c, and secondary outcomes were change in weight and blood pressure.Study was an electronic health record (EHR) review of CANA prescribed at the diabetes clinic from June 2013 to June 2015. Patients were included in the study if they were adults with T2DM, received routine follow-up diabetes care at the diabetes clinic, received an initial prescription for CANA from a diabetes clinic prescriber, and returned for at least one follow-up office visit (OV) after initial CANA prescribing. Paired t-tests were performed on the primary and secondary outcomes, and p .05 was considered statistically significant. Descriptive statistics were used to characterize the population and other outcomes.A total of 462 patients met study inclusion criteria. Mean baseline values were: age 55.32 years, BMI 38.23 kg/mANA was associated with a statistically and clinically significant reduction in A1c, weight, and blood pressure when added to multiple diabetes medication regimens by prescribers in a diabetes clinic.

OBJECTIVE: To compare hemoglobin A1c (HbA1c) levels and ankle brachial index(ABI) in older adults with type 2 diabetes mellitus (T2DM) between the experimentalgroup and the control group two months after receiving the foot reflexology program, andto compare HbA1c levels and ABI in older adults with T2DM in the experimental groupbefore and two months after receiving the foot reflexology program. MATERIALS AND METHODS: A randomized experimental design with a randomizedcontrolled two-group pretest-posttest design. The purpose of the study was toinvestigate the effects of foot reflexology integrated with medication use on HbA1cand ABI in older adults with T2DM who sought treatment at the diabetes clinic ofManorom Hospital, Manorom District, Chai Nat Province. The study sample consistedof 40 older adults with T2DM who sought treatment at the diabetes clinic who metthe inclusion criteria. The subjects were recruited through random sampling, with 20assigned into the experimental group and the other 20 into the control group. The subjectsin the experimental group received foot reflexology every day for a period of twomonths, while those in the control group did not receive such treatment. All of thesubjects in both groups received pharmacological treatment of diabetes with eitheroral medication or insulin injection as prescribed in the treatment plan based on theirmeasurements with HbA1c used the ARRAY High Performance Liquid Chromatography(HPLC), and ABI level use the doppler ultrasound with handheld doppler probe.Data were analyzed using inferential statistics, Independent t-test and Paired t-test. RESULTS: The results revealed that after receiving foot reflexology, the HbA1c of theexperimental subjects was lower than that of the control subjects (t = 2.76, p = 0.009,SD = 1.37). In addition, their ABI levels in the right leg and left leg were higher thanthose of the control subjects (t = 5.921, p < 0.001, SD = 0.044 and t = 9.155, p =

Introduction: Diabetes mellitus is one of the most common health problems. Self-care behaviors are very important for managing diabetes and significantly affected by patient's health literacy. The aim of this study was designed to determine the associated factors with health literacy and self-care behaviors among Iranian diabetic patients.Methods: In this descriptive-analytic study, the total of 131 diabetic patients who referred to the Tuyserkan diabetes clinic (in the west of Iran) was recruited by census sampling method in 2014. The data were collected using self-care scale of Toobert and Glasgow and health literacy questionnaire of adults function. To investigate demographic and the underlying information of patients, pre-designed check-lists based on forms of patients’ care records were used. After collection, data analysis was performed using the software SPSS 16.Results: Self-care and education level, employment status, type of treatment, and body mass index were significantly correlated, t...

Objective The Federal Bureau of Prisons (BOP) currently has over 13,000 patients with diabetes and has placed an emphasis on preventing and delaying the onset or progression of diabetes-related complications. In an ongoing effort to improve patient outcomes, BOP has implemented a nationwide, dynamic system of pharmacist-delivered patient care services via pharmacist clinicians working under the auspices of a physician-pharmacist collaborative practice agreement (CPA). Setting The BOP Clinical Pharmacy Workgroup targets improved patient outcomes via oversight and support of institution pharmacist clinicians and physicians in establishing and maintaining physician-pharmacist CPAs. A primary emphasis is diabetes and the pharmacist-run clinic clinical outcomes data are presented. Practice innovation Seventy (nearly one-half) of eligible BOP pharmacists at 37 institutions offer pharmacist-delivered patient care services via an approved CPA. In total, BOP has 111 active physician-pharmacist CPAs. Main outcome measures Pharmacist-run diabetes clinic outcomes from 5 institutions have been reported to date. A total of 126 patients were enrolled. Patient's hemoglobin A1C, blood pressure, and LDL cholesterol level are measured before (i.e., when accepted in the diabetes clinic) and after pharmacist-delivered care has been provided. The pharmacist-run diabetes clinics reported an average baseline A1C of 10.6% and produced an average outcome decrease in A1C of 2.3% from baseline. Results Specific pharmacist clinic interventions found to have the greatest impact are: 1) timely medication adjustment when indicated to help patients meet outcome goals; and 2) timely follow-up after a change in therapy is made (often within 1-2 weeks) with continued medication adjustment when indicated until outcome goal is achieved. Conclusion BOP pharmacists have become respected and trusted clinicians within the team medicine model. As demonstrated by the pharmacist-run diabetes clinic outcomes, pharmacist clinicians are a valued link to the improvement of patient outcomes in BOP.

Background: Quality of life (QOL) is an essential part of health outcomes for diabetes patients . Methods: This cross-sectional study aimed to evaluate the quality of life among 100 Iranian type 2 diabetes patients aged 37 to 66 years, attending the outpatient diabetes clinic at Golestan Hospital, Ahvaz, Iran, from August to October 2013. Diabetes quality of life (DQoL) questionnaire was used to determine quality of life of diabetes patients. Body weight, height, waist circumference, clinical parameters, including glycated hemoglobin A1c level (HbA1c) were also measured. Results: The mean age of men and women was 56±6.1 and 53.4± 6.7 years respectively. Sixty one present of patients were female and 39 % were male with 4.05 ± 1.4 mean years duration of diabetes. The mean total DQOL was 54.6± 2.4, a moderate quality of life and was associated with diabetes care and treatment adherence. The mean for diabetes-related worry was 77.5 ±7.05. Conclusions: Male diabetic patients in comparison with female diabetic patients, non-insulin-treated patients compared with insulin-treated patients had better quality of life. HbA1c higher than 7%, was associated with higher probabilities of worse quality of life among patients. More studies are needed to include larger study populations among Iranian type 2 diabetes patients in order to help health care providers develop proper health care programs for diabetic patients in Iran.

Epidemiological studies performed during last decades in many European countries and in the world proved increasing incidence rate of diabetes, especially diabetes type 1 in children (DMT1). In Europe there is one of the highest diabetes incidence rate. The aim of the study was to estimate the incidence rate of diabetes type 1 in children aged 0-14 years in North-East Poland during 2005-2012 years and to analyse this rates in relation to age, gender and season of the diabetes onset.The study was performed among patients staying under care of outpatient diabetes clinic of the Department of Pediatric, Endocrinologym Diabetology with Cardilogy Division, medical University of Białystok, Poland. The DMT1 incidence rate was calculated as the number of all newly diagnosed cases per 100 000 persons 0-14 aged matched.During the studied 8-years- period DMT1 was diagnosed in 306 children aged 0-14 years, 159 boys and 147 girls, in Podlasie Province. The highest number of new cases was found in 2011: 49, and 2012: 47, with the lowest number in 2005 and 2009: 32 each year. The average incidence rate in the studied period was 20,84/100 000 population, aged matched. The lowest incidence rate was found in 0-4 yrs old group: 14,59 /100 000, in 5-9 years old group was: 22,04/100 000, and was highest in 10-14 years old group: 24,94/100 000. The highest increase in incidence rate was noted in the youngest group: from 9,14/100 000 in 2005, to 23,45/100 000 in 2012. The greatest number of new recognisions was found in from November to March, and the lowest number from June to August.1. The DMT1 incidence rate among children aged 0-14 years, in Podlasie Province, during 2005-2012 years was 20,84/100 000. 2. Increase in incidence rate was observed in the studied period from 15,23/100 000 in 2005 to 26,71/100 000 in 2012. The highest increase in incidence rate, 2,5 times, was fund in the youngest group, aged 0-4 years. 3. The seasonal incidence of New onset was observed with the greater number in autumn-winter months.Wstęp. Przeprowadzone na przełomie ostatnich kilku dekad w wielu krajach Europy i na świecie badania epidemiologiczne wskazują na tendencję wzrostową zapadalności na cukrzycę, w tym cukrzycę typu 1 (CT1) u dzieci. Europa ma jeden z najwyższych współczynników zapadalności na cukrzycę. Celem pracy była ocena zapadalności na cukrzycę typu 1 u dzieci i młodzieży w Polsce północ­no-wschodniej w latach 2005–2012 oraz analiza współczynników zachorowalności w zależności od wieku, płci i pory roku, w której wystąpiła choroba. Materiał i metody. Badaniami objęto pacjentów Poradni Diabetologicznej przy Klinice Pediatrii, Endokrynologii, Diabetologii z Pododdziałem Kardiologii UM w Białymstoku. Zapadalność na cukrzycę wyrażono za pomocą współczynnika zapadalności, stanowiącego liczbę nowo zdiagnozowanych przypadków CT1 w czasie roku na sto tysięcy populacji odpowiednio dobranej wiekowo. Wyniki. W czasie ośmioletniej obserwacji wśród dzieci i młodzieży w wieku 0–14 lat z makroregionu podlaskiego cukrzyca typu 1 wystąpiła w 306 przypadkach, w tym u 159 chłopców i 147 dziewcząt . Najwięcej zachorowań w naszym regionie stwierdzono w 2011 r.: 49 i w 2012 r.: 47 nowych zachorowań, a najmniej w latach 2009 i 2005: po 32 zachorowania. Średnia zapadalność na cukrzycę typu 1 wynosiła w badanym okresie 20,84/100 tysięcy populacji zgodnej wiekowo, najmniejszy średni współczynnik zachorowalności stwierdzono w grupie 0–4 lat: 14,59 /100 tys. populacji, w grupie 5–9 lat wynosił on: 22,04/100 tys. populacji, a w grupie 10–14 lat był najwyższy: 24,94/100 tys. populacji. Największy wzrost zachorowalności zanotowano w najmłodszej grupie wiekowej (0–4 lata): od 9,14/100 tys. w roku 2005 do 23,45/100 tys. w roku 2012. Wykazano, że najczęściej cukrzyca typu 1 ujawnia się od listopada do marca, najmniej zachorowań obserwowano w okresie czerwiec-sierpień. Wnioski. 1. Wskaźnik zapadalności na cukrzycę typu 1 wśród dzieci w wieku 0–14 lat, w makroregionie podlaskim w latach 2005-2012 wynosił 20,84/100 tys. 2. Obserwowano wzrost zapadalności na cukrzycę typu 1 od 15,83/100 tys. w 2005 r. do 26,71/100 tys. mieszkańców w 2012 r., w tym największy wzrost zapadalności, 2,5 krotny, zanotowano w najmłodszej grupie wiekowej 0–4 lata. 3. Obserwowano sezonowość zachorowań na cukrzycę typu 1 z przewagą w miesiącach jesienno-zimowych.

Background: Diabetic patients are extremely recommended to control their blood glucose levels below the standard targets. This study was aimed to evaluate the association between obesity status and poor glycemic control in these patients. Methods: Type 2 diabetic outpatients (n=157) from a diabetes clinic in Ahvaz were recruited for the study. Patients who had insulin therapy were excluded from participants. Weight, height and BMI were recorded for each participant. Obesity status was defined by BMI. Glycosylated hemoglobin (HbA1c) was measured in fasting blood samples to estimate glycaemia status. Results: Mean age of participants was 54.47±9.39 years and mean BMI was 29.26±5.04 kg/m 2 . Poor glycemic control (HbA1c≥7%) was observed in 63.7% of participants. The rate of poor glycemic control in obese group was 60.3% and there was no correlation between obesity and poor HbA1c control using logistic regression we found no association between obesity and poor glycemic control (OR=0.796; p=0.504). Obese patients had lower education level than non-obese patients (p=0.035). Females had higher poor glycemic control than males; however, it was not significant (62% vs. 50% in obese and 68.5% vs. 62.2% in non-obese groups). Conclusions: More than half of participants had poor glycemic control. Obese patients had similar rate of hyperglycemia to non-obese ones. Lower educational level was contributed to obesity. Underlying risk factors for poor glycemic control status in diabetic patients are still unclear.

Background: Peripheral arterial disease (PAD) is a cause of foot disease in type 2 diabetes mellitus (T2DM) patients. Data on associated predictors of PAD in Nigerian T2DM patients are scanty, especially from Southeastern Nigeria. Objectives: The objective was to evaluate the prevalence and predictors of PAD in T2DM patients in Southeastern Nigeria. Materials and Methods: This is a cross-sectional study involving consenting T2DM patients at the Diabetes Clinic of the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeastern Nigeria. History was obtained and physical examination was done on the study participants. Doppler ultrasound of the peripheral vessels was done using the Imex PD II Doppler device. Records of fasting plasma glucose on the day of Doppler assessment, glycated hemoglobin, fasting lipid profile, and electrocardiogram, done within the preceding 3 months, were obtained from the patients' clinic folders. PAD was defined as ankle–brachial pressure index 1.3. Data collection was done using researcher-administered study pro forma and analyzed using the Statistical Package for the Social Sciences version 20.P

The patterns of emergency department (ED) visits in patients with diabetes are not well understood. The Emergency Department Diabetes Rapid-referral Program (EDRP) allows direct booking of ED patients presenting with urgent diabetes needs into a diabetes specialty clinic within 1 day of ED discharge. The objective of this secondary analysis was to examine characteristics of patients with diabetes who have frequent ED visits and determine reasons for revisits.A single-center analysis was conducted comparing patients referred to the EDRP (n = 420) to historical unexposed controls (n = 791). The primary outcome was the proportion of patients in each frequency group of ED revisits (none, 1 to 3 [infrequent], 4 to 10 [frequent], or10 [superfrequent]) in the year after the ED index visit. Secondary outcomes were hospitalization rates and International Classification of Diseases-Ninth Revision (ICD-9) diagnoses at ED revisits.Superfrequent users, responsible for20% of total ED visits, made up small but not significantly different proportions of EDRP and control populations, 3.6% and 5.2%, respectively. Superfrequent groups had lower hospital admission rates at ED revisits compared to frequent groups. Mental health disorders (including substance abuse) were the primary, secondary, or tertiary ICD-9 codes in 30.6% (95% confidence interval [CI], 27.7% to 33.5%) and 6.6% (95% CI, 5.1% to 8.2%) in the superfrequent and infrequent groups, respectively.Direct access to diabetes specialty care from the ED is effective in reducing ED recidivism but not amongst a small subgroup of superfrequent ED users. This group was more likely to have mental health disorders recorded at ED revisits, suggesting that more comprehensive approaches are needed for this population.EDRP = Emergency Department Diabetes Rapid-referral Program; ED = emergency department; HbA1c = hemoglobin A1c; ICD-9 = International Classification of Diseases-Ninth Revision.

Background and Objectives: Type II diabetes is one of the most common chronic diseases with irreparable complications for patients if it is not managed properly. This research aimed to investigate the effectiveness of self-compassion training on glycemic control in patients with type II diabetes, presenting to Taleghani Diabetes Clinic in Kermanshah. Methods: This quasi-experimental research with a pretest-posttest design and a control group recruited patients with type II diabetes presenting to Taleghani Diabetes Clinic in Kermanshah during 2016. Twenty patients were selected through convenience sampling method and were randomly assigned into experimental group (n = 10) and control group (n = 10). The experimental group was offered group self-compassion training in 8 sessions (90 minutes each) and the control group did not receive any training. The groups recorded their blood glucose levels three times a day in a form (3 hours after breakfast, 3 hours after lunch and 2 hours after dinner). Data were analyzed using ANOVA and t-test in SPSS version 21 software. Results: The findings showed that after the intervention, the mean scores of the experimental group were significantly lower than those in the control group (P < 0.001). Conclusions: Self-compassion training is effective in glycemic control in patients with diabetes. Therefore, it is suggested that therapists and psychologists use this method to control blood glucose level of patients with diabetes.

Background: Patients with LADA benefit from different interventions than those with T2D. However, distinguishing one entity from the other may be challenging in individual patients. We hypothesized that LADA is being underdiagnosed by PCPs. Methods: We retrospectively reviewed the medical charts of 1257 patients that consecutively presented to our diabetes clinic from 2001-10. Inclusion criteria were: age >18 years, having diabetes, and having been assessed by one of our investigators upon presentation. We collected demographic, clinical, and laboratorial data from their first visit to our clinic. Findings: Of 1257 only 6 (0.5%) were referred to our clinic with a diagnosis of LADA. In contrast, we identified a total of 133 individuals with LADA (10.6%). There was good correlation between PCPs and an endocrinologist in the diagnosis of common diabetes subtypes like T1D and T2D, but it was poor for less common diabetes subtypes including LADA (Table). Most of the patients with LADA were originally classified as T2D (n=105). Seven percent of patients with LADA in our population had a history of DKA. Interpretation: LADA is currently being underdiagnosed by PCPs. Strategies to raise awareness of the existence of this patient population as well as cost-effective strategies to identify them are largely needed. Prevalence of diabetes subtypes in 1257 patients as diagnosed by PCPs and an endocrinologistPrevalence according to PCPsPrevalence according to an endocrinologistPearson’s correlationCystic-fibrosis related diabetes, % (n)0.8 (10)1.0 (12)0.91Type 1 diabetes, % (n)22.3 (280)24.3 (305)0.78Type 2 diabetes, % (n)70.5 (886)49.6 (624)0.62LADA, % (n)0.5 (6)10.6 (133)0.16Other subtypes, % (n)5.9 (75)14.5 (183)0.32 Disclosure A. De Ferrari: None. F. Ovalle: Consultant; Self; Bayer AG, Novo Nordisk Inc.. Research Support; Self; Novo Nordisk Inc.. Consultant; Self; Janssen Pharmaceuticals, Inc.. Research Support; Self; Janssen Pharmaceuticals, Inc.. Consultant; Self; Eli Lilly and Company. Research Support; Self; AstraZeneca. Consultant; Self; Sanofi. Research Support; Self; Sanofi.

Clinical care of youth with type 1 diabetes (T1D) involves a multidisciplinary team including diabetes provider, registered dietitian (RD), certified diabetes educator (CDE), and social worker (SW) or psychologist. There is limited evidence to guide the ADA recommendations for visit frequency, so this study sought to evaluate the association between visit frequency and glycemic control. A cross-sectional analysis of demographic, clinical, and visit frequency data was performed from 1,995 T1D youth with diabetes duration ≥ 1 year, and ≥ 1 diabetes clinic visit during a 1-year period at a pediatric diabetes center. Patient demographics included 50.6% female, age 13.9±4.2 years, T1D duration 6.3±4 years, HbA1c 8.6±1.8%, and race/ethnicity: 52.4% white, 23.4% Hispanic, 16.7% black, and 7.7% other. The cohort averaged 2.9±1.3 annual provider visits. Patients with 3 or 4 annual provider visits had statistically lower mean HbA1c than those with 1, 2, or ≥ 5 visits (Figure 1). In total, 43.6% attended ≥1 CDE, 50.5% RD, and 71.8% SW/psychology visit. Seeing a CDE, RD, or SW/psychologist was not associated with lower HbA1c among the overall cohort, but was associated with lower HbA1c among privately insured patients. These findings reflect the complex, multidimensional nature of T1D management. Further investigation into clinical, psychosocial, and patient-reported outcomes beyond glycemic control is warranted. Disclosure K. Travis: None. A. Jones: None. S. Lyons: None. D.J. DeSalvo: Consultant; Self; Dexcom, Inc.. Speaker's Bureau; Self; Insulet Corporation.

Diabetes mellitus is a chronic and progressive disease which requires ongoing medical care as well as patient's self-care skills to prevent acute complications. The purpose of this study is to determine the effect of the PRECEDE-PROCEED model combined with self-management theory on self-care behaviors in type 2 diabetic patients.In this semi-experimental study, 86 type 2 diabetic patients referred to the diabetes clinic of Ardabil were randomly selected and divided into two groups (n = 43). Patients in group 1 received educations based on PRECEDE-PROCEED model combined with self-management theory while patients in group 2 received only educations based on PRECEDE-PROCEED model. The self-made questionnaire was used to measure demographic information and PRECEDE-PROCEED model variables at baseline and one month after the intervention.The mean scores of knowledge, attitude, self-efficacy (p = 0.001), self-care (p = 0.001), enabling factors, and reinforcing factors had significant differences in both groups before and after the intervention (p 0.05). In addition, one month after the intervention, the mean scores of attitude, self-efficacy, self-care, and reinforcing factors were significantly higher in group 1 compared to group 2.The results indicate the effectiveness of an educational intervention based on PRECEDE-PROCEED model combined with self-management theory to improve self-care behaviors in patients with type 2 diabetes.

Skin integrity and diabetes device placement are ongoing concerns for people with diabetes who utilize continuous glucose monitors (CGMs) and continuous subcutaneous insulin infusion pumps. This is especially significant for individuals with skin sensitivities, pediatric patients, and those who use devices chronically. Dermatological complications are often cited as a barrier to device use and a reason for device discontinuation. Furthermore, it is a frequent topic of discussion in diabetes follow-up visits, although little evidence-based literature exists to guide providers in managing skin integrity issues. The purpose of this article is to review current literature related to the prevalence of dermatological issues with insulin pumps and CGM, discuss published solutions to skin irritation, and to share the consolidated experience of our large academic diabetes clinic to address placement, prophylactic skin care, adhesives, removal, and skin healing with diabetes device use. Recommendations for targeted studies, increased surveillance, and development of new adhesive compounds are suggested to reduce the burden of device wear for management of diabetes.

Background Type 2 diabetes affects an increasing number of Ghanaians. The timing of the onset of diabetes is linked to several other co-morbid conditions, yet no study has examined the timing of the onset of type 2 diabetes in Ghana. Methods To fill this gap in the literature, this study applied logit models to data extracted from the medical records at the Diabetes Clinic of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Gender-specific models were also estimated. Results The results show that obesity was a significant predictor of the timing of the first onset of diabetes among both males and females. Women with high school education compared with no formal education, and female employees compared with the unemployed were more likely to experience an early onset of type 2 diabetes. Conclusion Policymakers must educate Ghanaians about behaviors that will reduce their risk of obesity and diabetes.

Objective The epidemiological explosion of diabetes is a challenge for Health Systems and the identification of the most appropriate models of care are warranted. The inclusion of primary care physicians in the models is unquestioned whereas the role played by secondary and tertiary care (Diabetes Clinic) is often debated. However, studies focusing on hard endpoints and comparing Diabetes Clinic attendance vs. no attendance are scant. Research design and methods A meta-analysis was performed including all observational cohort studies performed in Italy, reporting crude and/or adjusted estimates of all-cause mortality in patients with diabetes attending or not attending Diabetes Clinics. Attendance was defined by prescriptions and reimbursement of specialist visits by the National Health System. Results Three studies enrolling 191,847 subjects with diabetes were included in the analysis, and about half of them had at least one visit in the Diabetes Clinic per year. During the follow-up, ranging 1–11 years, 9653 subjects died. Mortality was remarkably lower in subjects attending Diabetes Clinic (MH–OR 0.70, 95% CI 0.55–0.88, p = 0.002). Results were confirmed after adjusting for confounders (MH–OR 0.81, 95% CI 0.69–0.95, p = 0.009). Conclusions The results of the present study suggest that attending Diabetes Clinics is associated with a lower all-cause mortality. This finding might be instrumental to implement the best models of care for persons with diabetes.