Objective: Assess whether participation in a well-established tele-education mentorship program, ECHO (Extension for Community Healthcare Outcomes) , improves preclinical providers’ self-efficacy, ...confidence, and knowledge in managing complex diabetes (DM) .
Methods: Over 3 cycles of ECHO sessions from 2018-2021, we engaged 42 physician assistant students (PAS) in efforts to increase knowledge prior to clinical practice. Using didactics and case-based learning via videoconferencing, the ECHO model allowed participants to receive tele-mentoring from an endocrinologist, a diabetes educator, and rotating specialists. Over 14-16 bimonthly sessions, PAS (n=42) received an evidence-based curriculum on complex DM management. Pre and post course surveys measured self-efficacy (13 questions) , confidence in management (6) , factual knowledge (12) and prescribing practices (11) .
Results: Twenty-three PAS completed at least 50% of sessions; 18 completed both evaluations. On a 7-point Likert scale, self-efficacy increased from 3.18 (slightly competent) pre-intervention to 4.78 (competent) post (p<.0001) . PAS’ belief in their competence to be an endocrinology resource in the community increased from 1.94 to 4. (p<.0001) . Confidence increased from 3.32 (neutral) to 5.33 (somewhat confident) (p<.0001) . PAS answered correctly on 3.78 of 12 knowledge questions before the intervention, increasing to 5.76 after (p<0.01) . Students’ anticipated frequency of prescribing diabetes medication increased from 1.73 (rarely) to 3. (sometimes) (p<.001) and of technology from 1.46 to 2.79 (p<.001) on a 4-point scale.
Conclusion: Our ECHO model is the first to evaluate healthcare trainees. PAS showed improved self-efficacy, knowledge, and confidence in DM management and increased comfort in prescribing. However, overall participation in live sessions was low. Further research is assessing incorporation of pre-recorded ECHO sessions into the PA curriculum.
Disclosure
M.Phelps: None. A.Aldous: None. N.M.Ehrhardt: Advisory Panel; Dexcom, Inc., Novo Nordisk, Research Support; Dexcom, Inc., Merck & Co., Inc., Novo Nordisk.
Funding
Merck Foundation, Merck and Novo Nordisk
Gestational diabetes mellitus (GDM) is common, with 14% of women developing GDM. Although real-time continuous glucose monitoring (RT-CGM) has been shown to support behavioral/lifestyle modifications ...in patients living with type 1 and type 2 diabetes, no studies to date have assessed RT-CGM as a behavior modification tool for patients with GDM.
Participants diagnosed with GDM prior to gestational age 24 weeks (early) or between 24-30 weeks (typical) were randomized to use RT-CGM or continue self-monitoring of blood glucose (SMBG) using finger-sticks and wore 3 serial blinded CGM over the remainder of the pregnancy. Both groups continued their routine obstetric care. After delivery, RT-CGM participants completed a 44-question survey adapted from the Joslin Diabetes Center CGM questionnaire plus our published 8-question survey on behavior modification and CGM use.
To date, 70 participants have enrolled; 31 were randomized to RT-CGM. Twenty-four (4 early and 20 typical) have completed the post-delivery surveys. Demographics: 42% were Caucasian, 63% reported annual incomes of >$50,000, and 79% had achieved at least a bachelor’s degree. From RT-CGM use: 71% excluded or limited sugared beverages (29% never drank sugared beverages), 78% excluded or limited white rice (13% never ate white rice), 67% started reading labels for fiber content (17% of participants already read labels for fiber content), and 92% would walk or increase activity after a meal if they saw their glucose rising. Overall, 92% of participants felt like RT-CGM contributed to a healthier lifestyle during pregnancy. Sixty-three percent wanted to continue using RT-CGM.
Our study suggests that women with GDM perceive that RT-CGM supports improved lifestyle choices during pregnancy. Studies are ongoing to assess whether RT-CGM improves maternal and/or fetal outcomes, but advocacy is needed now to improve accessibility of RT-CGM in GDM.
Disclosure
B.Cedeno: None. E.Fay: None. N.M.Ehrhardt: Advisory Panel; Novo Nordisk, Dexcom, Inc., Consultant; Nestlé Health Science. S.J.Fonda: Research Support; Dexcom, Inc.
Funding
Dexcom, Inc. (IIS-2019-101)
Background: Real-time continuous glucose monitoring (RT-CGM) provides glucose readings to patients with diabetes, potentially supporting self-care. Preliminary data suggests efficacy of these devices ...influencing behavior change but data are limited on the sustainability of this change following short term use.
Methods: Following completion of a 14 week intervention involving use of RT-CGM as a behavior modification tool, a 6 month follow up survey was conducted. The survey included ten questions evaluating the impact of the subject's participation in the study on their continued lifestyle and health. The final question of the survey inquired if the subject had a significant other available to answer questions regarding their awareness of the subject's participation and impact on their own lifestyle choices.
Results: Twenty-two participants with diabetes participated in the initial intervention, of which sixteen responded to the survey. In the six months since their participation, 100% of respondents reported that CGM continues to contribute to a healthier lifestyle. 75% reported that they have excluded or limited certain foods as a result of participating and participation has motivated them to increase activity level. If available, 88% reported that they would you like to wear a CGM device on a regular basis. 68.8 % reported subjective weight loss since participating in the study with 7 (63.7%) of those participants reporting a weight loss of 10lbs or greater. Of the 16 participants, 3 subjects had a significant other that lived with the subject throughout the study and was able to be contacted. Of these three, 1 reported feeling healthier and changing their food choices as a result of their partner wearing a CGM.
Conclusion: In patients with diabetes, RT-CGM creates a sustainable lifestyle impact 6 months following use and is a desired tool for self care. However, longer prospective studies need to be completed. Further evaluation of RT-CGM contribution to the “health” of the household is also needed.
Disclosure
M. W. Porter: None. L. Needleman: None. S. Ramhmdani: None. N. M. Ehrhardt: Advisory Panel; Self; Novo Nordisk, Research Support; Self; Dexcom, Inc., Merck & Co., Inc., Novo Nordisk.
OBJECTIVE: To determine whether short-time, real-time continuous glucose monitoring (RT-CGM) has long-term salutary glycemic effects in patients with type 2 diabetes who are not on prandial insulin. ...RESEARCH DESIGN AND METHODS: This was a randomized controlled trial of 100 adults with type 2 diabetes who were not on prandial insulin. This study compared the effects of 12 weeks of intermittent RT-CGM with self-monitoring of blood glucose (SMBG) on glycemic control over a 40-week follow-up period. Subjects received diabetes care from their regular provider without therapeutic intervention from the study team. RESULTS: There was a significant difference in A1C at the end of the 3-month active intervention that was sustained during the follow-up period. The mean, unadjusted A1C decreased by 1.0, 1.2, 0.8, and 0.8% in the RT-CGM group vs. 0.5, 0.5, 0.5, and 0.2% in the SMBG group at 12, 24, 38, and 52 weeks, respectively (P = 0.04). There was a significantly greater decline in A1C over the course of the study for the RT-CGM group than for the SMBG group, after adjusting for covariates (P < 0.0001). The subjects who used RT-CGM per protocol (≥48 days) improved the most (P < 0.0001). The improvement in the RT-CGM group occurred without a greater intensification of medication compared with those in the SMBG group. CONCLUSIONS: Subjects with type 2 diabetes not on prandial insulin who used RT-CGM intermittently for 12 weeks significantly improved glycemic control at 12 weeks and sustained the improvement without RT-CGM during the 40-week follow-up period, compared with those who used only SMBG.
Background
Cancer‐related worry (CRW) is common among cancer survivors; however, little is known about factors associated with CRW or its impact on health behaviors in adult survivors of childhood ...cancer.
Methods
Survivors in the St. Jude Lifetime Cohort Study (n = 3211; 51% male; mean age, 31.2 years SD, 8.4 years; mean time after diagnosis, 22.8 years SD, 8.3 years) underwent medical evaluations and completed ratings of CRW, psychological symptoms, and health behaviors. Multivariable modified Poisson regression models examined associations between CRW and treatment exposures, chronic health conditions, psychological symptoms, and health behaviors.
Results
Sixty‐four percent of survivors (95% confidence interval CI, 62.6‐65.9) reported worry about subsequent malignancy, 45% (95% CI, 43.5‐46.9) reported worry about physical problems related to cancer, and 33% (95% CI, 31.2‐34.4) reported worry about relapse. Multiple psychological symptoms, treatment exposures, and chronic conditions significantly increased the risk of CRW. Survivors reporting CRW were at increased risk for substance use, inadequate physical activity, and increased health care utilization after adjustments for chronic conditions. For example, with adjustments for chronic conditions, those who endorsed CRW were more likely to have ≥5 cancer‐related physician visits, ≥5 physician visits related to cancer, and ≥5 calls to a physician's office in the previous 2 years in comparison with survivors who were not worried. CRW was also associated with an increased risk of current tobacco use, past marijuana use, and current marijuana use.
Conclusions
A substantial proportion of adult survivors of childhood cancer reported CRW associated with increased health care utilization. CRW may serve as an intervention target to promote well‐being and adaptive health behaviors.
Cancer‐related worry is common among long‐term survivors of childhood cancer. It is associated with treatment exposures, chronic medical conditions, psychological and somatic symptoms, and maladaptive health behaviors. Cancer‐related worry is a modifiable construct that can be targeted via psychosocial interventions.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background: The Achieving Health in Emerging Adults with Diabetes (AHEAD) Program is designed to meet the health care transition and psychosocial needs of emerging adults (EA) with type 1 diabetes ...(T1D).
Objective: To evaluate the impact of the AHEAD Program on diabetes distress (DD) in EA with T1D.
Methods: DD was evaluated using the Problem Areas in Diabetes-Teen survey (PAID-T). Mixed-effects linear regression with a random effect for individual to account for repeated measures was used to evaluate change in DD over time. Models were adjusted for age, race, ethnicity, technology use, and insurance. We assessed whether improvement varied by age, technology use, insurance, or baseline (BL) elevated DD (PAID-T≥44).
Results: Sample included 489 EA with T1D (BL visit: mean age 20.3 years, 52% male, 75% Non-Hispanic White, 26% public insurance, 59% continuous glucose monitor use, 58% insulin pump use, 19% elevated DD). Overall mean PAID-T scores decreased from 31.4 at BL (95% CI: 30.1, 32.8) by 4.6 points (95% CI: -7.4, -1.7; p=0.001) at 2 years (Figure). By 2 years, mean PAID-T scores for patients with elevated DD at BL decreased by 16.2 points (95% CI: -22.9, -9.5; p<0.001) compared to a 3.3 point (95% CI: -6.2, -0.5; p=0.02) decrease in those without elevated DD at BL. PAID-T improvement did not vary by age, technology use, or insurance (all p>0.05).
Conclusion: The AHEAD Program offers a promising approach to reduce DD in EA with T1D.
Disclosure
F.Malik: None. N.M.Ehrhardt: Advisory Panel; Novo Nordisk, Dexcom, Inc., Consultant; Nestlé Health Science. K.Hoch: None. K.Weaver: None. I.B.Hirsch: Consultant; Abbott Diabetes, Lifecare, Inc., Hagar, Research Support; Beta Bionics, Inc., Insulet Corporation, Dexcom, Inc. C.Pihoker: None. A.J.Roberts: None. C.Taplin: Stock/Shareholder; Quest Diagnostics. S.J.Lowry: None. J.P.Yi-frazier: None. A.Moss: Other Relationship; American Diabetes Association. A.Huang: None.
Funding
Forest Foundation; Sequoia Foundation
Background
Although survivors of childhood cancer are at risk of chronic pain, the impact of pain on daily functioning is not well understood.
Methods
A total of 2836 survivors (mean age, 32.2 years ...SD, 8.5 years; mean time since diagnosis, 23.7 years SD, 8.2 years) and 343 noncancer community controls (mean age, 35.5 years SD, 10.2 years) underwent comprehensive medical, neurocognitive, and physical performance assessments, and completed measures of pain, health‐related quality of life (HRQOL), and social functioning. Multinomial logistic regression models, using odds ratios and 95% confidence intervals (95% CIs), examined associations between diagnosis, treatment exposures, chronic health conditions, and pain. Relative risks (RRs) between pain and neurocognition, physical performance, social functioning, and HRQOL were examined using modified Poisson regression.
Results
Approximately 18% of survivors (95% CI, 16.1%‐18.9%) versus 8% of controls (95% CI, 5.0%‐10.9%) reported moderate to very severe pain with moderate to extreme daily interference (P < .001). Severe and life‐threatening chronic health conditions were associated with an increased likelihood of pain with interference (odds ratio, 2.03; 95% CI, 1.62‐2.54). Pain with daily interference was found to be associated with an increased risk of impaired neurocognition (attention: RR, 1.88 95% CI, 1.46‐2.41; and memory: RR, 1.65 95% CI, 1.25‐2.17), physical functioning (aerobic capacity: RR, 2.29 95% CI, 1.84‐2.84; and mobility: RR, 1.71 95% CI, 1.42‐2.06), social functioning (inability to hold a job and/or attend school: RR, 4.46 95% CI, 3.45‐5.76; and assistance with routine and/or personal care needs: RR, 5.64 95% CI, 3.92‐8.10), and HRQOL (physical: RR, 6.34 95% CI, 5.04‐7.98; and emotional: RR, 2.83 95% CI, 2.28‐3.50).
Conclusions
Survivors of childhood cancer are at risk of pain and associated functional impairments. Survivors should be screened routinely for pain and interventions targeting pain interference are needed.
Adult survivors of childhood cancer are at an increased risk of moderate to very severe pain compared with community controls. In long‐term survivors, pain significantly interferes with multiple aspects of daily functioning.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
Background
There is limited understanding of associations between a combination of health behaviors (physical activity, sedentary/screen‐time, diet) and cardiometabolic health risk factors, physical ...performance, and emotional health among young (<18) childhood cancer survivors (CCS). The aims of this research were to address this gap by 1) deriving health behavior adherence profiles among CCS, and 2) examining associations among demographic, diagnosis and/or treatment exposures, cardiometabolic, physical performance, and emotional functioning with health behavior profile membership.
Methods
Participants included 397 CCS (≥5 years post‐diagnosis; 10–17 years old) enrolled in the St. Jude Lifetime Cohort Study who completed physical health evaluations and questionnaires assessing health behaviors and psychological functioning. Latent profile analysis was used to derive profiles of health behavior adherence. Logistic regression and t‐tests were used to examine mean‐level differences and associations between profile membership with demographic, diagnosis, treatment exposures, cardiometabolic health, psychological functioning, and physical performance.
Results
Two profiles emerged: inactive‐unhealthy‐diet (“IU”) and active‐sedentary‐unhealthy‐diet (“ASU”) to guidelines. More participants in IU demonstrated higher resting heart rate (mean M, 76.54; SD = 12.00) and lower motor proficiency scores (M = 34.73; SD = 29.15) compared to ASU (resting heart rate, M = 71.95, SD = 10.74; motor proficiency, M = 50.40, SD = 31.02).
Conclusions
CCS exhibited low adherence to multiple health behavior guidelines, with adherence patterns differentially associated with cardiometabolic health (i.e., resting heart rate) and physical performance. However, robust protection against all health variables was not observed. Findings suggest interventions designed to improve health outcomes should target multiple health behaviors simultaneously.
Plain Language Summary
Pediatric cancer survivors are at‐risk for detrimental health outcomes associated with cancer and treatment.
Engagement in healthy lifestyle behaviors serves to reduce health vulnerabilities among adult survivors but less is known about associations with lifestyle behaviors on young survivors.
This study documents patterns of lifestyle behaviors among survivors of pediatric cancer, factors that increase susceptibility to nonadherence, and associations among lifestyle behaviors and health indicators.
Young (<18 years of age) survivors of pediatric cancer exhibit poor adherence to diet and physical activity guidelines. Adherence is associated with clinical health outcomes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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