ADCES 2022 Research Abstracts

Abstract

Background/Purpose: Hispanic individuals are disproportionately affected by diabetes and the associated morbidity and mortality. Peers are a major source of diabetes information and support within the Hispanic community. Ongoing peer support that reinforces diabetes education is highly desired by Hispanics living with diabetes. This study had the following goals: (1) to describe the training experiences of Hispanic peer facilitators (PFs) and (2) to understand PFs’ perspectives on their role in an online peer support community that facilitates continuous glucose monitoring (CGM) use. Methods: Peer Facilitators completed The Association of Diabetes Care & Education Specialists (ADCES) paraprofessional and study-specific training for a 12-week online peer support intervention using CGM for Hispanics living with diabetes. An exit interview was conducted at the conclusion of the pilot study, titled “Combining CGM and an Online Peer Support Community for Hispanic Adults With T2DM.” A qualitative descriptive analysis was conducted using a triangulated approach and thematic analysis. The PFs developed 7 web-based training videos to augment the ADCES paraprofessional training for a larger CGM and Online Peer Support Intervention study Results: Five PFs Background/Purpose: The semiautomated insulin delivery systems currently available require individualized insulin regimens to start therapy and meal doses based on carbohydrate counting for routine operation. In contrast, the bionic pancreas (BP), initialized only with body weight, makes all dosing decisions and delivers insulin autonomously. The BP uses a Meal Announcement that does not require carbohydrate counting, using instead a qualitative estimate of carbohydrate content relative to the user’s typical meal. This 13-week trial was designed to test the hypothesis that in persons living with type 1 diabetes (T1DM), the BP would reduce A1C compared to standard of care (any insulin delivery method with continuous glucose monitoring [CGM]) without increasing hypoglycemia. Methods: A total of 326 persons 6 to 79 years old with T1DM (baseline A1C 5.5%-13.1%) were randomly assigned 2:1 to BP treatment with insulin aspart or lispro (n = 219) or standard of care (any insulin delivery method with CGM, n = 107). The primary outcome was A1C level at 13 weeks. The key secondary outcome was the percentage of time CGM glucose was < 54 mg/dl (3.0 mmol/l). Results: Participants’ race and ethnicity were 74% non-Hispanic White, 10% non-Hispanic Black, 10% Hispanic or Latino, and 3% more than 1 race. Participants’ education level was 33% less than a bachelor’s degree, 35% bachelor’s degree, and 29% master’s degree or above. A1C levels decreased from 7.9% to 7.3% in the BP group and did not change (7.7% to 7.7%) in the standard-of-care group (mean adjusted difference at 13 weeks −0.5 percentage points, 95% confidence interval [CI] −0.6 to −0.3; P Background/Purpose: Only 14% of emerging adults, aged 18 to 25 years, living with type 1 diabetes (T1DM) have optimal A1C, and high financial stress and low health insurance literacy are significant contributors. Developmentally tailored financial and health insurance resources are lacking, yet they are crucial to being able to independently navigate health care needs. Therefore, this study aimed to evaluate the preliminary efficacy of a financial and health insurance literacy education toolkit for emerging adults living with T1DM. The following were the objectives of the study: (1) to determine the difference in the primary outcomes (ie, financial stress, health insurance literacy, diabetes-specific quality of life [QoL], and health care navigation readiness) by study group (intervention vs control) and (2) to determine if the differences between groups in the primary outcomes (ie, financial stress, health insurance literacy, diabetes-specific QoL, and health care navigation readiness) change over time. Methods: The preliminary effects of a randomized controlled pilot trial with assignment to the intervention group (T1 Financial Toolkit; n = 20) or the control group (common online resources administered in clinical practice; n = 19) on financial stress, health insurance literacy, health care navigation readiness, and diabetes-specific QoL were evaluated over 3 months. The completion of the resource review was confirmed via Qualtrics analytics. Results: Two-way analysis of variance of primary outcomes by the study group over time revealed that primary outcomes did not differ by study group, but all primary outcomes in both groups improved over time, Greenhouse-Geiser F = 7.068 (df = 1.636), P = .003 (financial stress); Greenhouse-Geisser Background/Purpose: Real-time continuous glucose monitoring (rtCGM) has been helpful in optimizing glucose management for people with diabetes. Previous studies found that there was a significant benefit for those with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) treated with bolus insulin. Recent studies suggest that nonintensive insulin users also benefit from rtCGM. Because insulin dosing is not a factor with them, the rtCGM data must be influencing diabetes-related behaviors. For this study, data were reviewed from individuals living with T2DM enrolled in a program that provided a Dexcom G6 system and Welldoc’s BlueStar platform. We previously reported that participants achieved improvements in glycemia. The goal of this study was to understand how engaging with the combined solution influenced the Association of Diabetes Care & Education Specialists’ ADCES7 Self-Care Behaviors TM (ADCES7 behaviors). Methods: Participant engagement with the digital health solution was examined. The data were deidentified for analysis. Cohort 1 (n = 37) used continuous rtCGM for 24 weeks. Cohort 2 (n = 55) used intermittent rtCGM. Counts of specific feature use of the digital health solution that supports ADCES7 behaviors, such as food, medication tracking, activity, sleep, blood pressure, and weight, were tabulated. Results: Fifty-six percent of rtCGM users were male; 44% were aged 40 to 54 years, and 36% were aged 55 to 64 years. The mean baseline A1C was 9.5%. The average engagement frequency per user per week reflects that Cohort 1 interacted with the digital health solution at a higher weekly engagement frequency than Cohort 2. In the first 12 weeks, Cohort 1 had a significantly higher total average weekly engagement than Cohort 2 ( P = .00005). Conclusions: The rtCGM use coupled with a digital health solution can help individuals with T2DM (who are not prescribed insulin) improve ADCES7 behaviors. Engagement with the digital health solution was greater in the continuous use cohort. These data suggest that clinicians should consider how rtCGM wear time influences self-care behaviors to coach and treat individuals with diabetes. Background/Purpose: The prevalence of diabetes is increasing among youth. The unique physiologic and social dynamics of childhood and adolescence complicate diabetes self-management. The National Quality Forum emphasizes quality of life (QoL) as a critical humanistic outcome of health care delivery, including diabetes self-management education (DSME). The goal of this study was to describe the state of the science on the effects of DSME on self-reported QoL in youth with diabetes. The primary objective of this modified Cochrane method systematic review was to explore and report evidence and gaps in the literature examining the effects of DSME as described in randomized controlled trials (RCTs) on self-reported QoL in youth with type 1 diabetes and type 2 diabetes (T2DM). Methods: Following structured searches in relevant databases, 2 reviewers independently conducted 3-tiered article reviews using the following inclusion criteria: (1) RCTs, (2) > 1 ADCES7 Self-Care Behaviors TM (ADCES7 behaviors) interventions directed at youth participants, (3) established QoL measure, and (4) published in English between January 2007 and March 2020. Retain and Background/Purpose: Diabetes is more common in Deaf or hard-of-hearing (DHH) populations than in hearing populations, most likely due to an information disparity. Information disparities can be caused by a lack of language access. Language access ensures that people with diabetes (PWD) who are deaf or hard-of-hearing (DHH-PWD) receive information, such as diabetes education, in their native language (American Sign Language [ASL]). DHH-PWD often do not have access to an ASL interpreter during medical appointments. The goal of this study was to use a community-based participatory approach to understand (1) the barriers and facilitators DHH-PWD experience when receiving diabetes education and (2) the critical components to best provide diabetes education to DHH-PWD. Methods: Two virtual meetings were held with a national community advisory board of DHH-PWD. Open-ended questions focused on diabetes information seeking, barriers to obtaining diabetes education, and what DHH-PWD want to see in their diabetes education. The meetings were recorded and translated/transcribed, and field notes were taken by 2 members of the research team. Field notes were then assessed for common themes. Results: Eight diverse DHH-PWD (50% female; 50% type 2 diabetes; age range 36-67 years) participated. The overarching theme was the urgent need for culturally tailored diabetes education that provides language access. Barrier subthemes include lack of ASL interpreters who can effectively translate medical information, content delivered for hearing populations does not fit the needs of the DHH culture, and concerns with the credibility of online diabetes information. Facilitator subthemes , Background/Purpose: Most type 1 diabetes (T1DM) research focuses on 1 member with T1DM and excludes participants if other family members are living with diabetes. Relatives of someone living with T1DM are 15 times more likely to develop T1DM than the general population. Having a family membe