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Integrated Care (IC) is a perfect fit for people with diabetes. Fundus examination (FE) is a disease marker for diabetologists and identifies potentially blinding complications (Diabetic Retinopathy, DR). In our Diabetes Clinic (DC) in Pescara, Italy, FE is possibly provided with telemedicine in same day as other exams, avoiding it to be a standalone clinical one; images taken with a retinal digital camera are graded by a remote ophthalmologist within a shared Electronic Health Record (EHR), immediately readable by other stakeholders; a dedicated care path to the Eye Clinic, University of Chieti-Pescara is provided for urgent cases. Personnel’s worktime shortening allows gaining time for ophthalmologists’ eye examinations in outpatient settings and other stakeholders’ work in the DC. The need for a DR digital screening system is growing worldwide: our experience confirms the ease of implementation, and the advantage of sharing clinical data with all stakeholders when working within an EHR, aiming to optimize an IC effective system.

The purpose of this study is to investigate the effectiveness of a genetics educational module created to improve understanding about the genetics of diabetes, assess motivation to engage in healthy lifestyle behaviors, and gauge interest in genetic testing for diabetes.Participants were recruited from the Multidisciplinary Comprehensive Diabetes Clinic at the University of Alabama at Birmingham. Participants completed a pre-survey to assess three domains: (1) knowledge about diabetes etiology and testing, (2) healthy lifestyle behaviors, and (3) interest in genetic testing. Participants viewed a short, recorded educational module, then completed a post-survey to re-assess the domains.Participants increased knowledge about genetics of diabetes (p0.0001) and genetic testing (p = 0.0184), demonstrated motivation to adopt healthy behaviors (p0.0001), and decreased interest in genetic testing (p = 0.0833) after viewing the module.The educational module increased understanding of diabetes and increased motivation to adopt healthy behaviors. The need for patient-friendly educational modules explaining the genetics of diabetes will likely increase with continued discoveries of how genetics contributes to diabetes risk and outcomes. This short, educational module has the potential to provide genetic information in an effective way that is easily adapted in a routine clinic setting.

Background: Hypertension and diabetes are associated with an increased risk of cardiovascular diseases. Effective interventions are therefore relevant in reducing the morbidity and mortality associated with hypertension and diabetes. We set out to determine the effect of aerobic exercise on type-2 diabetic-hypertensive clients at a diabetes clinic in Accra.Method: Twenty-one participants were recruited from the National Diabetes Management and Research Center in Korle-Bu in Accra.Participants undertook 30 minutes of aerobic exercise comprising, warm up, ergonomic cycling and cool down, three times a week for a period of eight weeks. Fasting blood glucose and blood pressure levels were measured and changes with respect to exercise were analysed. The mixed model ANOVA was used to test for the differences in the weekly blood pressure and blood glucose levels while the paired t-test was used to compare the baseline and final readings of blood pressure and blood glucose levels. Pearson’s correlation test was used to determine the relationship between age and change in blood pressure and blood glucose levels after eight weeks of exercise.Results: Mean systolic blood pressure reduced from 142mmHg to 135mmHg while the mean diastolic blood pressure also reduced from 89mmHg to 84mmHg post exercises. The baseline and eighth week post exercise average blood glucose level were 8.0 mmol/L and 5.2 mmol/L respectively. There were significant differences in baseline and week eight systolic (p = 0.0017), and diastolic (p = 0.006) blood pressure as well as blood glucose (p=0.0027) levels. There was also a significant positive correlation between age and change in blood glucose level (p = 0.036).Conclusion: Aerobic exercise reduces the fasting blood glucose level and blood pressure in type-2 diabetic-hypertensives. Diabetic-hypertensives should therefore be encouraged to participate in aerobic exercises.

The year 2020 will undoubtedly be marked by the coronavirus disease 2019 (covid-19) pandemic, caused by the novel coronavirus SARS-CoV-2. It has been shown that in diabetes patients, covid-19 occurs in a more severe form, with these patients being more prone to the need for mechanical ventilation and having higher mortality rates than non-diabetic patients. In the present article, we describe possible pathophysiological mechanisms that could explain a more severe course of covid-19 in diabetes patients. We also describe the recommendations for use and discontinuation of anti-diabetic drugs during infection, and continue by explaining how to adjust the management of this chronic disease during an epidemic. In conclusion, our own experience in organizing outpatient diabetes clinic during the covid-19 epidemic at the University Medical Centre Ljubljana is described. Covid-19 still carries many unknowns, so it will not surprise us, if we soon realize that the findings described so far, are outdated. Nonetheless, the present recommendations for the treatment of diabetes patients during the epidemic will remain in force and will hopefully help to improve and optimize the treatment of our patients, even after the pandemic.

Migbnesh Weledegebriel,1 Afework Mulugeta,2 Abraha Hailu1 1Department of Internal Medicine, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia; 2Department of Public Health, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, EthiopiaCorrespondence: Migbnesh Weledegebriel Tel +251914126128Email migbey12@gmail.comBackground: Self-care activities in patients with diabetes mellitus are behaviors undertaken by people with or at risk of diabetes in order to successfully manage the disease on their own. Even though self-care practice plays a critical role in preventing as well as delaying diabetes-related complications, there is poor self-care practice by patients with diabetes mellitus. In Ethiopia, especially in Tigray, there are few studies assessing self-care practice of patients with diabetes mellitus and thus this study will have an input in this area.Objective: To evaluate self-care practice and its associated factors in adult patients with diabetes mellitus having follow-up in Ayder Comprehensive Specialized Hospital, Diabetes Clinic.Methods: A hospital-based cross-sectional analysis was made from March to May, 2015. A total of 410 patients with diabetes mellitus were included. The study participants were selected by a systematic random sampling method. Characteristics of study participants were analyzed using descriptive statistics, while bivariate and multivariable logistic regression was used to identify the association between dependent and independent variables.Results: Two hundred and eighty-eight (70.2%) study participants were above 30 years of age and 254 (62.9%) study participants were males. More than half (52.9%) of the study participants were type-2 diabetes patients. This study showed 207 (50.5%) had poor diabetes self-care practice. In multivariate logistic regression, low income (AOR = 0.518, 95% CI: 0.288– 0.929) and poor knowledge about diabetes (AOR = 5.026, 95% CI: 2.893– 8.734) were found to be significantly associated with poor self-care practice.Conclusion: The proportion of poor self-care practice was high, implying the need for regular follow-up as an integral component of the long-term management of diabetes mellitus.Keywords: self-care practice, diabetes mellitus

Background: Insulin injection education is important in diabetes mellitus patients’ treatment in order to control blood glucose levels. Objective: To present a new innovative teaching method for insulin injection. Methods: Samples included diabetes patients, who were taught the first insulin injection at the diabetes clinic, Ramathibodi Hospital. They were divided into 2 groups (35 patients in each group): the experimental group was taught by the abdomen model for injections, and the control group was instructed by a traditional lecture style. Three evaluation forms were used: 1) injection observation sheet; 2) self-evaluation sheet of understanding and injection skill of the diabetes patients; and 3) evaluate efficiency form of teaching insulin injection model. Results: The study revealed that the experimental group understood injection methods both in terms of injection skills and confidence in self-injection at more than 97% except for fear. The study found that trypanophobia decreased 70.2% and fear of pain reduced 82.8%. The abdomen model teaching method yielded effective results to increase injection skills, knowledge, and understanding of self-injection. Conclusions: This abdomen model is now used to teach insulin injection as a commercial product sold at the Center of Excellent Innovation, Faculty of Medicine, Ramathibodi Hospital, Mahidol University. This model is currently used as one of the medical tools for teaching insulin injection at the diabetes mellitus clinic of the medical outpatient unit of Ramathibodi Hospital.

Objective: Academic health services play an important role in the prevention and control of diabetes mellitus (DM) in Iran. This study aimed at determining the prevalence of DM-related complications and the associated risk factors among patients with DM in a university-affiliated outpatient diabetes clinic of a referral hospital in Southeast of Iran, Zahedan. Materials and Methods: This cross-sectional study was conducted from January to April 2019 in an academic diabetes clinic. A total of 334 patients with DM, whose characteristics (age, sex, family history of DM, and substance abuse), as well as laboratory and clinical information, were recorded in the baseline forms, were included. The relationship between variables were assessed by Pearson’s correlation coefficient at P-value< 0.05 and using SPSS version 20.0. Results: The mean age of the participants was 54.27 (±11.57) years. In these patients, DM type 2 was estimated at 99.1%, and the mean duration of the disease was 8.98 (±6.93) years. The findings showed that 77.2% of the patients had poor glycemic control. Also, 85.4% of the patients had fasting blood sugar (FBS) level >126 mg/dL. There was a significant relationship between insulin-dependent therapy and drug abuse (P-value

OBJECTIVE In response to the coronavirus disease 2019 (COVID-19) pandemic and social distancing guidelines, our pediatric diabetes team rapidly changed the format of conducting diabetes clinic from in person to telehealth. We compared the actual number and rate of completed, canceled, and no-show visits between an 8-week period in 2019, when we exclusively conducted visits in person and the same 8-week period in 2020, during the COVID-19 quarantine, when we exclusively conducted visits via telehealth. METHODS We used electronic health record data for all patients, as well as Dexcom continuous glucose monitoring data collected for a subset of youths during the COVID-19 quarantine and the immediate pre–COVID-19 period. RESULTS Although there was a difference in the absolute number of in-person versus telehealth visits canceled during these two time periods, there was no difference in the rates of completed, canceled, and no-show visits completed in person or via telehealth. This finding suggests that, despite a rapid shift to a completely new health care delivery model, our providers completed a similar rate of patient care via telehealth during the COVID-19 quarantine and that telehealth may be a feasible method for providing diabetes care. However, our results also suggested that youths’ glucose management was less optimal during the quarantine period. CONCLUSION COVID-19 presented an opportunity to adopt and test the feasibility of using a telehealth delivery model for routine diabetes care. Yet, to make telehealth a viable treatment delivery alternative will likely involve the uptake of new clinic procedures, investment in institutional infrastructure, and team-based flexibility.

The increasing prevalence of diabetes, combined with a growing global shortage of health care professionals (HCP), necessitates the need to develop new approaches to diabetes care delivery to expand access to care, lessen the burden on people with diabetes, improve efficiencies, and reduce the unsustainable financial liability on health systems and payers. Use of digital diabetes technologies and telehealth protocols within a digital/virtual diabetes clinic has the potential to address these challenges. However, several issues must be resolved to move forward. In February 2020, organizers of the Advanced Technologies & Treatments for Diabetes Annual Conference convened an international panel of HCP, researchers, patient advocates, and industry representatives to review the status of digital diabetes technologies, characterize deficits in current technologies, and identify issues for consideration. Since that meeting, the importance of using telehealth and digital diabetes technologies has been demonstrated amid the global coronavirus disease (COVID-19) pandemic. This article summarizes the panel's discussion of the opportunities, obstacles, and requisites for advancing the use of these technologies as a standard of care for the management of diabetes.

The Onduo Virtual Diabetes Clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists. Adults with T2D (n = 594) who were evaluated by a VDC endocrinologist, remotely prescribed and mailed a real-time continuous glucose monitoring (rtCGM) device and used ≥1 sensor completed a CGM satisfaction questionnaire. The CGM satisfaction score was 4.5 ± 0.8 out of 5. Most respondents (94.7%) agreed/strongly agreed that they were comfortable inserting the sensor remotely and that rtCGM use improved understanding of the impact of eating (97.0%), increased diabetes knowledge (95.7%), and helped improve diabetes control when not wearing the sensor (79.4%). HbA1c (n = 372) decreased from 7.7% ± 1.6% to 7.1% ± 1.2% (P

Background: To make outpatient visits for adolescents with diabetes successful, it is important for health care professionals to meet the adolescents’ needs and wishes. Aims: The aim is to investigate adolescents’ expectations of an outpatient diabetes clinic visit in comparison to what was deemed to be delivered and contrast this outcome in adolescents with self-reported high- and low-diabetes distress respectively. Methods: All adolescents in Sweden with type 1 diabetes, aged 15 to 18 years, were identified via The National Pediatric Diabetes Registry (SWEDIABKIDS) and asked to complete an online questionnaire regarding their expectations and the support received during the outpatient diabetes clinic visit. Results: 453 adolescents completed the survey. Boys’ expectations of discussion topics were mainly met while girls, especially those with diabetes distress, felt their discussion needs were not met regarding quality-of-life aspects. Conclusions: Although adolescents’ expectations are in general met during the diabetes outpatient clinic visit, aspects related to living with diabetes are not being met especially among female adolescents who reported diabetes distress. This study shows a gender difference both regarding expected discussion topics and what was deemed covered. Practice Implications: A multi-professional, individual person-centred care approach is needed at the diabetes outpatient clinic. This paper proposes that agenda setting performed by the adolescent, and agreed by the physician, prior to the outpatient clinic visit could facilitate individualized care and better meet the adolescents’ needs in a shared decision-making process.

Aims To describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged > 25 years attending a public outpatient diabetes service. Methods Retrospective cohort study of people with T1D aged > 25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines. Results Among the 111 people with T1D (mean age 41 ± 13 years, 55% men, mean body mass index 27.1 ± 5.6 kg/m2), mean HbA1c was 8.1 ± 1.9% (66 ± 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of Conclusions A high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a “wait for acute event” rather than “complication prevention” model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.

The purposes of this study were to: (a) determine the insulin adherence rate and reasons for non-adherence among patients with T2DM, (b) determine the relationship between the Health Belief Model (HBM) construct and insulin adherence, (c) assess the patient’s characteristics that influence the Health Belief Model (HBM) construct, and (d) identify the predictors of insulin non-adherence among patients with T2DM. An analytical cross-sectional survey was carried out on 360 T2DM outpatients at the Diabetes Clinic in Hospital Queen Elizabeth II (HQE II), Sabah. Insulin adherence was measured using a validated Medication Compliance Questionnaire (MCQ). A total of 360 patients took part in this study. Majority were female (60.6%) with an age range from 28 to 87 years (54.07 ± 13.62 years). The overall prevalence of insulin adherence was 60.3%. Forgetfulness was the most common factor for insulin non-adherence (66.9%). The majority of the respondents showed positive perceptions and beliefs of their insulin treatments, with a mean 71.11 (SD = 9.59). There was a significant correlation between insulin adherence and all the HBM constructs. Overall, the HBM constructs predicted 40.9% of the variance in insulin adherence. The strongest predictor of insulin adherence was perceived benefits followed by self-efficacy. The current study suggests an acceptable level of insulin adherence among the T2DM outpatients in HQE II. It is recommended that the high-risk group of non-adherence should be identified, the insulin regimen adjusted, and an individual intensive health education designed in order to increase insulin adherence.

Objective To explore the outcomes of monthly video consultations for children with diabetes. Methods The Virtual Outpatient Diabetes Clinic for Children and Youth (VIDIKI) was a 6-month multicenter controlled clinical trial followed by an extension phase. The 240 participants (1-16 years), all using a CGM, were quasi-randomized by residence location to the intervention group (IG) or the waitlist-control group (WG). The IG started immediately after enrollment with monthly video consultations as an add-on to regular care, while the WG received regular care for 6 months before starting the intervention. The extension phase lasted between 12 months and 2 years, depending on the enrollment date. Linear regression was applied to model the primary outcome of HbA1c after 6 months and other metabolic and psychosocial outcomes. Results After covariate adjustments, the HbA1c at 6 months-corresponding to the controlled treatment phase-was 0.11% lower in the IG than that in the WG (95% CI -0.31 to 0.09, p = 0.277). For the total study sample, a significant HbA1c improvement was found after 12 months of video consultations, which increased further until month 15. The diabetes burden of the main caregivers was lower, and parental treatment satisfaction was significantly higher in the IG than that in the WG. Conclusions The VIDIKI study found no significant HbA1c difference between IG and WG after 6 months in the controlled phase, but there was a decreased diabetes burden and increased treatment satisfaction for the parents. In the longitudinal perspective, a significant HbA1c improvement was found after 12 and 15 months. This article is protected by copyright. All rights reserved.

Objectives While the benefits of diabetes camp programs are well established, minority youth are underrepresented in camp attendance. No research to date has explored barriers to camp attendance or potential disparities in those barriers. Further, little is known about sources families prioritize in seeking diabetes information and support. Methods This was a prospective survey of families of children with type 1 diabetes (T1D) using convenience sampling during normally-scheduled clinic visits. Thirty-nine children and their caregivers completed the survey. Results were analyzed for prevalence and mean number of reported barriers, benefits, and diabetes information networks. Results Age range was 5–15 years and mean duration of diabetes was 2.9 years (0.4–9y). The most prevalent barriers were location, cost, and concern about sending children to overnight camp. Caregivers had high level of knowledge of camp benefits. Participants reported engaging with the diabetes community through interactions with their diabetes team, Facebook groups, and the JDRF. Conclusion Increasing awareness, transportation assistance, and scholarship funding all may increase accessibility of diabetes camps. Diabetes clinic and online or social media groups are both acceptable means of disseminating information about diabetes camp. Further research is indicated to verify if these results are applicable to the larger diabetes community.

The Onduo Virtual Diabetes Clinic is a telehealth program for people with type 2 diabetes that combines mobile app technology, remote personalized lifestyle coaching, connected blood glucose meters, real-time continuous glucose monitoring (rtCGM) devices, and clinical support from board-certified endocrinologists. This analysis evaluated change in diabetes distress among 228 program participants who reported moderate distress (score 2.0–2.9) or high distress (score ≥3.0) on the 17-item Diabetes Distress Scale (DDS17) at enrollment. Participants reported significant reductions in overall distress from 3.0 ± 0.8 at baseline to 2.5 ± 0.9 (P

Background: Knowledge and attitude are the main indicators of awareness about the use of artificial sweeteners. Objectives: This study aimed to evaluate the knowledge, attitude, and practices (KAPs) of patients with type 2 diabetes mellitus (T2DM) in relation to the consumption of low-calorie artificial sweeteners. Methods: In this descriptive-analytical study, 400 diabetic patients admitted to the diabetes clinic of Bu-Ali hospital in Zahedan were selected by the census method. After recording the demographic characteristics, we assessed participants’ knowledge and attitude through a researcher-made questionnaire. Also, the subjects’ practices were evaluated based on their nutritional behaviors. The answers were marked as good, moderate, and poor. Results: The knowledge and attitude of the study population were 39% and 34.8%, respectively at the ‘poor’ level, 58% and 58.3% at the ‘moderate’ level, and 3% and 7% at the ‘good’ level. There was a significant relationship between patients’ knowledge, attitude and their demographic indicators (p

The proportion of patients with type 2 diabetes who achieve their glycemic goals remains low. We examined medical records and A1C results from patient visits to our referral diabetes center between 21 March to 20 July 2018. After stratifying patients into four groups—monotherapy, dual therapy, triple therapy, or insulin therapy—we found that the target A1C of ≤7.0% was achieved by 86% of patients and that A1C was uniformly low across the treatment categories. Our individualized approach, which included high use of glucagon-like peptide-1 receptor agonists and low use of sulfonylureas, may have contributed to these results.

Introduction In late February 2020, due to the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the Italian Government closed down all educational and sport activities. In March, it introduced further measures to stop the spread of coronavirus disease (COVID-19), placing the country in a state of almost complete lockdown. We report the impact of these restrictions on glucose control among people with type 1 diabetes (T1D). Methods Data were collected on 33 individuals with T1D who were monitoring their glucose levels using a flash glucose monitoring device and remotely connected to the diabetes clinic on a cloud platform. We retrieved information on average glucose, standard deviation and percentage time in hypoglycaemia ( 180 mg/dl). We compared glycaemic measures collected during lockdown to those collected before the SARS-CoV-2 epidemic and to the periods immediately before lockdown. Results In 20 patients who had stopped working and were at home as a result of the lockdown, overall glycaemic control improved during the first 7 days of the lockdown as compared to the weeks before the spread of SARS-CoV-2. Average glucose declined from 177 ± 45 mg/dl (week before lockdown) to 160 ± 40 mg/dl (lockdown; p = 0.005) and the standard deviation improved significantly. Time in range increased from 54.4 to 65.2% (p = 0.010), and time in hyperglycaemia decreased from 42.3 to 31.6% (p = 0.016). The number of scans per day remained unchanged. In 13 patients who continued working, none of the measures of glycaemic control changed during lockdown. Conclusion Despite the limited possibility to exercise and the incumbent psychologic stress, glycaemic control improved in patients with T1D who stopped working during the lockdown, suggesting that slowing down routine daily activities can have beneficial effects on T1D management, at least in the short term.

Aim: To assess control and morbidity in patients with type 1 diabetes mellitus (T1 attending a tertiary adult diabetes clinic in Durban, South Africa. Methods: A retrospective chart review of all p...

Objective This study was carried out in type 2 diabetes mellitus (T2DM) patients to assess their knowledge, attitude and practice about fasting during Ramadan and to identify the sociodemographic determinants of the knowledge, attitude and practice. Methods A total of 107 T2DM patients were interviewed at a diabetes clinic in the Eastern Saudi Arabia. A questionnaire containing knowledge, attitude and practice questions about fasting during Ramadan was used to collect data. Data about age, gender, city of residence, nationality, level of education, and history of diabetes in family were also collected. Descriptive and inferential statistics were carried out using IBM-SPSS Version 21. Results The mean total score for knowledge, attitude and practice was 16.5 ±3.72 (out of 27). The individual scores for knowledge, attitude and practice were: 9.67±2.53 (out of 16), 4.10±1.28 (out of 6), and 2.77±1.08 (out of 5), respectively. Gender (OR: 4.08, 95% CI: 1.05,15.79 and p

Background: The number of older adults with diabetes mellitus (DM) is increasing. Falling during walking and the fear of it are prevalent in older adults with DM. Objective: This study aimed to examine the association between fear of falling (FoF) and functional tests in older adults with DM and to determine other factors affecting functional tests in these people. Methods: A cross-sectional study was conducted on 134 older adults with DM who had referred to the diabetes clinic of Matini Hospital in Kashan, Iran. The participants were selected through sequential sampling and then were categorized into two groups of “with” and “without FoF.” In addition to responding to a demographic questionnaire, the participants were assessed by the Mini-Mental State Examination, Diabetic Neuropathy Symptom Score, and Falls Efficacy Scale-International version. Walking performance of the participants was also measured using the Timed Up-and-Go, 5-Sit-to-Stand, and 50-Foot Timed Walk tests. Data were analyzed using the Chi-square, t-, and Mann–Whitney U-tests and linear regressions analysis. Results: Significant associations were found between FoF and education level, body mass index, waist-to-hip ratio, and having neuropathy (P < 0.05). In addition to FoF, a number of demographic, anthropometric, and clinical variables affected the patients' performance in all functional tests; however, gender was the variable that affected the results of all three tests (P < 0.05). Conclusion: FoF is associated with the performance of older adults with DM in functional tests. Thus, the FoF should be assessed in older adults with DM in order to provide better health care for them.

Aim: During COVID-19 restrictions, the paediatric clinic only accepted essential outpatient visits, schools closed, sports activities and social life were limited. Most employees worked at home. This quasi-experiment evaluates how this affected glycaemic control and use of health services among children with diabetes. Methods: Paired t-tests were used to compare HbA1c-values before, during and after lockdown. Sub-analyses were stratified by pre-lockdown HbA1c-values. Results: Overall mean HbA1c decreased from 58.3 to 56.9 mmol/mol (p = 0.025) from pre- to post-lockdown, a decrease also seen during the same season the previous year. HbA1c decreased by −4.2 mmol/mol (p = 0.002) for patients with pre-lockdown HbA1c > 59 mmol/mol, but increased slightly by 0.8 mmol/mol (p = 0.176) for patients with HbA1c 59 mmol/mol experienced an improvement. Less stress and more contact with parents may contribute to the last-mentioned finding. The lockdown enforced more virtual contacts between patients and the clinic.

Background: The COVID-19 pandemic has brought to light both challenges and unique opportunities regarding type 1 diabetes (T1D) management, including the usage of telemedicine platforms. Methods: This study was conducted in a tertiary hospital diabetes clinic. All consecutive T1D patients during March and June 2021 were asked to fill out a structured anonymous questionnaire that aimed to determine their preference regarding continuous use of a virtual platform. Results: In total, 126 T1D patients answered the questionnaire, of whom 51% were under the age of 40, half were men, half used insulin pumps, and 69% used continuous glucose monitoring. During the pandemic, the exposure of patients to virtual visits has grown about twofold, from 29% to 53%. Of the respondents, 49% expressed an interest in future usage of a virtual platform, but most of them preferred use in a hybrid manner. We found an association between preference to use telemedicine in the future and younger age, previous virtual platform experience, and confidence in being able to download data. Conclusions: Our data demonstrate that the COVID-19 experience has led to a growing interest of T1D patients in using the hybrid format of telemedicine. However, we still need to better understand who will benefit most from this platform and assess its cost-effectiveness and organization.

The article's abstract is not available.

The prevalence of diabetes mellitus has become a global public health issue. Natural herbal treatments for type 2 diabetes mellitus have been widely used in traditional societies but has recently become popular among western societies as well. The aim of this study was to explore the experience of type 2 patients with diabetes mellitus who are currently on natural herbal treatment. A qualitative, phenomenological design has been used. Twelve participants from both males and females, aged between 25 and 75 years, who were on medical treatment, were selected for sampling. In-depth interviews were conducted at the diabetes clinic in a selected hospital in southern Sri Lanka. The athematic analysis was conducted, and 6 themes were derived. The majority of participants (75%) were motivated to use natural herbal treatments other than oral glycemic therapy. Experiences have been identified as the most influential factors in the use of natural herbal treatments. The need for educational interventions on natural herbal treatments and to propose the integration of herbal medicine into current medical systems is recommended.

Background: Various teaching methods could be used to reduce complications in diabetic patients. Objectives: The present study aimed to assess the effect of nutrition training based on the health belief model (HBM) and electronic methods on the awareness of patients with type II diabetes in Kermanshah, Iran in 2012. Methods: This quasi-experimental study was conducted at a diabetes clinic in Kermanshah City. In total, 60 patients were selected via convenience sampling and divided into three groups of 20, including SMS, blog, and collaborative blog. Data were collected before, immediately after, and three months after the educational intervention using a standard questionnaire. Data analysis was performed in SPSS version 16 using the Kruskal-Wallis test, Friedman’s test, and analysis of variance (ANOVA) at the significance level of 0.05. Results: The mean score of awareness was considered significant (P < 0.01). In addition, significant differences were observed in the perceived sensitivity and barriers, cue to action, and self-efficacy in the blog group (P < 0.05) before and three months after the intervention. In the collaborative blog group, a significant difference was denoted in the perceived severity and cue to action before and three months after the intervention (P < 0.05). Cue to action also differed significantly in the SMS group, and the self-efficacy score significantly changed only in the blog group after the intervention (P = 0.006). Conclusions: According to the results, using blogs, group/collaborative blogs, and SMS could effectively increase the awareness of the diabetic patients. Therefore, virtual training could enhance the structures of the HBM, with the exception of the perceived sensitivity domain.

Purpose To evaluate the impact of hiring nonclinical support staff on pharmacist productivity and diabetes control outcomes in internal medicine clinics of an integrated healthcare system. Methods A retrospective, longitudinal cohort study was conducted. Patients were included if they were contacted by telephone for a diabetes consultation with a clinical pharmacist from July 1, 2015, through June 30, 2017. Nonclinical support staff were hired in July 2016 to schedule patient appointments with the clinical pharmacists. The primary outcome was the average rate of completed telephone encounters per month before and after hiring of nonclinical support staff. The secondary outcome was the mean change in glycated hemoglobin (HbA1c) level in patients who had a laboratory assay completed within 90 days of clinical pharmacist outreach. The tertiary outcome was the call completion rate for scheduled appointments vs unscheduled calls. Results In total, 6,709 patients were included; their average age was 55 years. After the intervention, the mean (SD) rate of completed telephone encounters increased from 61% (3.8%) to 77% (3.5%) (P < 0.001). Small improvements were noted in glycemic control, as measured by the mean (SD) percentage of patients with an HbA1c concentration of Conclusion Hiring nonclinical support staff led to greater efficiency among the clinical pharmacist team, yielding a higher volume of telephone interactions, a modest overall decrease in HbA1c values, and an increased likelihood of reaching patients by phone.

During the transition from multiple daily injections to an insulin pump, diabetic patients need to engage in an intense period of learning to operate their pumps successfully. Inpatient endocrinology consultants note that some new users of insulin pumps fail to manage hyperglycemia correctly and present to the hospital in diabetic ketoacidosis. We found these patients often did not know when to use manual injections instead of their pumps or did not have backup insulin pens or syringes at home. To better understand this issue, a baseline survey of diabetic patients on insulin pumps was conducted from February to September 2020. The survey was administered to 52 subjects identified though appointments scheduled with the diabetes clinic. The questionnaire asked: 1) How would you respond if your sugar remained elevated an hour after administering a correction bolus through the pump? 2) Do you have insulin syringes or pens at home? The first question reflects events that would occur in the setting of an insulin pump failure. Any response that did not include a manual injection was considered incorrect. Our data showed that 85% of respondents had backup insulin supplies. 33% of patients overall responded appropriately to the pump failure scenario. Of the subjects who had insulin supplies, 39% responded correctly. Further analyses revealed that there is a significant relationship between having supplies and responding appropriately to hyperglycemia in pump failure. There was no relationship between patients’ answers and gender or age. Results of this survey will be used to modify the electronic template for diabetes clinic visits in order to help ensure that patients have appropriate supplies and training in identifying pump malfunctions and handling hyperglycemia. As part of this quality improvement project, patients will be surveyed again after implementation of the new template to assess whether the rates of possessing backup insulin supplies and of appropriate responses to hyperglycemia increased. Disclosure A. Yuen: None. V. Tabatabaie: None.

The Onduo Virtual Diabetes Clinic (VDC) for people with T2D combines a mobile app, remote lifestyle coaching and video consultations with endocrinologists for medication management and prescription of RT-CGM devices for intermittent use in high risk participants. This analysis examined change in A1c at 1-yr in VDC participants with and without CGM use. Subgroup analysis was performed for participants with 6-mo and 1-yr data. Of the cohort (n=772), 45.9% (n=354) used CGM and 54.1% (n=418) did not use CGM. At baseline the CGM group was significantly younger (mean±SD): 53.3±8.6 vs. 55.1±9.4 yr, had higher A1c: 7.9%±1.8 vs. 7.6%±1.7, and greater insulin use: 36.2% vs. 28.5%. Change in A1c at 1-yr is presented in the Table. The increase in participants meeting the HEDIS target of A1c 8.0% (p In conclusion, participation in the Onduo VDC was associated with a significant reduction in A1c at 1-yr in those not meeting treatment targets, with approximately 2-fold greater improvement with CGM use. These results suggest that improvement in A1c observed at 6-mo was maintained at 1-yr. Disclosure J. E. Layne: Employee; Self; Onduo LLC. R. M. Bergenstal: Advisory Panel; Self; Abbott Diabetes, Eli Lilly and Company, Novo Nordisk, Onduo LLC., Roche , Sanofi, United Healthcare , Consultant; Self; Abbott Diabetes, Ascensia , Dexcom, Inc., Eli Lilly and Company, Hygieia, Johnson & Johnson, Medtronic, Novo Nordisk, Onduo LLC., Roche, Sanofi, United Healthcare, Other Relationship; Self; HealthPartners Institute, Research Support; Self; Abbott Diabetes, Dexcom, Inc., Eli Lilly and Company, Helmsley Charitable Trust, Hygieia, Johnson & Johnson, Medtronic, NIDDK, Novo Nordisk, Onduo LLC., Roche, Sanofi, United Healthcare. N. A. Barleen: Employee; Self; Onduo LLC. R. F. Dixon: None. H. Zisser: Employee; Self; Verily Life Sciences, Stock/Shareholder; Self; Verily Life Sciences.

COVID-19 pandemic has triggered the widespread adoption of Telemedicine (TM). As physical distancing measures were established, we rapidly shifted our outpatient appointments to TM. Here we show findings regarding patient TM perception and attendance. Patient demographics and attendance to in person and TM outpatient encounters from January to July 2020 were reviewed. A survey evaluating TM perceptions was distributed to patients and their families following an encounter between March and July 2020. Our diabetes clinic currently cares for 1504 unique patients with type 1 diabetes (T1D) with 46% being publicly insured. A total of 1,653 encounters including in person and TM were included in the analysis. TM visits became available in March 2020, with a total of 571 encounters by July 2020. There was a significantly lower number of completed TM encounters by publicly insured patients when compared with privately insured (p value=0.03523) and a threefold increase in no-shows and same day cancelations by the publicly insured group. Perception of TM was addressed with a survey completed by 40 patients. TM perception was positive with 86% of patients being very satisfied with the visit. TM encounter was thought to be the same as in person encounter by 60% and better than in person visit by 37% of patients. Reported benefits associated with TM included: overall time saved, no missed school day for the patient or workday for the parent, decreased childcare and transportation costs. In conclusion, although TM is perceived as positive by patients with T1D, low-income families showed lower TM visit attendance rate when compared to privately insured families. The COVID-19 pandemic has highlighted disparities related to access to and use of technology to improve diabetes care. More research is needed to identify the specific causes for the disparities. Patient centered approach to increase education and help navigate the processes required for utilizing TM technology may help decrease the health equity gaps. Disclosure C. Demeterco-berggren: None. M. Gottschalk: None.

Background: It is well established that diabetes serves as a risk factor for morbidity and mortality of Influenza infections in the US. The AAP recommends Influenza vaccinations in all children over 6 months of age with a noted emphasis on ensuring that children in high risk groups are vaccinated. We sought to better understand patient and family attitudes towards Influenza vaccination in our diabetes clinic as the first step in trying to improve vaccination rates in our clinics. Methods: 64 patients, ages 2 to 20 years, of a NYC diabetes clinics were surveyed between 12/2019 and 3/2020. If responses indicated they had refused a vaccine, patients were asked why they had refused. Regardless of their vaccination status, all patients were asked if they would obtain vaccination if one were available at their diabetes clinic appointment. Results: Overall, 57% of our patients responded that they had received an influenza vaccine in the 2019-2020 season. Further, 13% of patients indicated that they would be receiving a vaccination while 27% of them responded that they did not wish to receive a vaccination. When viewed by age, the 10-15 year old age group had the highest vaccination rate at 70%. While attitudes varied from family to family, the most the most common reasons for refusal included patient preference (31%), disbelief in efficacy (21%), concerns for side effects of vaccination (21%) and ’too busy’ (10.5%). 70% of all patients surveyed expressed that if a vaccination was offered in their diabetes clinic, they would be interested in receiving it. Conclusions: Focus should be placed on educating our youngest and oldest patients with diabetes to obtain an annual Influenza vaccine. Understanding the most common hesitations among our patients will allow us to improve communication about the vaccine and access to care. Disclosure J. Apsan: None. E. Coppedge: None. Z. Antal: None.

Background and aims We examined HbA1c and cardiovascular risk factors with a median follow-up of 44 months therapy with dapagliflozin. Methods We undertook a clinical practice evaluation of 101 patients attending our clinic. Results Dapagliflozin resulted in a significant reduction in HbA1c 82.6 ± 15.7 v 68.7 ± 17.8 mmol/mol. Conclusion Dapagliflozin maintains glycaemic control along with sustained improvements in weight and no decline in renal function.

We sought to estimate the exact causes of death, mortality rate and life expectancy of diabetes patients by analyzing death records in a diabetes specialist clinic in Japan. Of the 6,140 participants included in our analysis, the average age was 58.1 years and 77% were men. A total of 261 deaths were recorded during the total follow‐up period of 24,079 total person‐years. The leading causes of death were cancer, heart diseases and cerebrovascular diseases. Using a life table prepared from the mortality rates estimated with the exponential distribution model, a life expectancy at 40 years was 39.2 years (95% confidence interval 37.9–40.2 years) for men and 43.6 years (95% confidence interval 41.8–45.3 years) for women. Although the present results must be interpreted with caution, compared with populations with diabetes surveyed during similar periods by the Japan Diabetes Society, our diabetes patients had similar ranking of the causes of death., Among 6,140 patients in a diabetes specialist clinic in Japan, the leading causes of death were cancer, heart diseases and cerebrovascular diseases. A life expectancy at 40 years was 39.2 (95% confidence interval 37.9–40.2) in men and 43.6 (95% confidence interval 41.8–45.3) in women. Although our results must be interpreted with caution, because a healthy survivor bias might exist, compared with populations with diabetes surveyed during similar periods by the Japan Diabetes Society, our diabetes patients had similar ranking of the causes of death.

We examined the relationship between two malleable risk factors, depressive symptoms and fear of hypoglycemia, in children and adolescents with Type 1 diabetes and their relationship to two important outcomes, adherence behaviors and metabolic control. To assess this relationship, we used a multidimensional measure of adherence, assessing frequency of both blood glucose monitoring and healthy behaviors including diet and exercise. We predicted that higher levels of depressive symptoms and higher levels of fear of hypoglycemia would be associated with worse metabolic control as mediated by poor adherence. Eighty-three children and adolescents ages 8 to 20 (M = 13.87, SD 3.21) were recruited from March 2014 to October 2014 at an outpatient diabetes clinic in a moderately sized Southeastern city within the USA. Nested models were evaluated using structural equation modeling. Adherence significantly mediated the relationship between depressive symptoms and metabolic control with more depressive symptoms leading to worse metabolic control. Adherence marginally mediated the relationship between fear of hypoglycemia and metabolic control; however, less fear of hypoglycemia was associated with worse metabolic control. In a combined model, adherence continued to significantly mediate the relationship between depressive symptoms and metabolic control, while also independently significantly mediating the relationship between fear of hypoglycemia and metabolic control. This finding was also contrary to the predicted relationship with less fear of hypoglycemia leading to worse metabolic control. The results indicate that youth with fewer depressive symptoms and more fear of hypoglycemia had better adherence to their treatment regimen, which was associated with better metabolic control. The results of this study highlight the importance of screening for depression and fear of hypoglycemia during routine clinic visits to optimize adherence and metabolic control.

Children and young people with diabetes are at high risk of developing lipohypertrophy (LH) as a result of daily injections of insulin. LH is characterised by dense nodules that are palpable beneath the skin's surface. A retrospective audit investigated the frequency of injection site assessment in children and young people attending a diabetes clinic over one year. The audit was conducted using the medical records of 76 eligible patients with type 1 diabetes, all treated with multiple daily injections or continuous subcutaneous insulin infusions for a minimum of six months from the audit start date. None of the participants had their injection sites assessed at every clinic visit. Just under one third ( n =23, 30%) received at least one injection site assessment within the audit year. Of these, 11 had LH detected. HbA 1c and average blood glucose levels were higher in those with LH, which was deemed significant. There was a slight increase in glucose variation in those with LH compared with those without LH. However, this result was not statistically significant. The frequency of injection site assessment is low in children and young people but the prevalence of LH is high. This means it is essential to improve healthcare professionals' injection technique education and assessment skills to minimise the risk of patients developing LH.