diabetes education category...a623 for author disclosure information, see page a810. category...

A623

For author disclosure information, see page A810.

CATEGORY

ADA-Funded Research

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DIABETES EDUCATION

mean duration of diabetes was higher in patients with infected foot ulcers (12.3±9.4 years) than in patients without (9.6±8.3; p=0.018). Gender, type of diabetes, body mass index and glycemic control (level of HbA1c) did not cor-relate with the presence of infected foot ulcers.

The univariate analysis of the risk factors for developing an infected foot ulcer in diabetic patients identifi ed a signifi cant infl uence for PAD (adjusted odds ratio [OR]=12.24 [95% CI 6.84-21.92]; p<0.001), peripheral sensory neuropathy (OR=2.92 [1.37-6.21]; p=0.004), chronic kidney disease (OR=2.35 [1.27-4.37]; p=0.005) and diabetic retinopathy (OR=1.71 [0.99-2.93]; p=0.049). When multivariate logistic regression was applied, PAD (OR=6.14; p<0.001), coronary artery disease (OR=3.38; p=0.042) and duration of diabe-tes (OR=1.06; p=0.028) were signifi cant risk factors for infected diabetic foot ulcers. Strategies to control these risk factors could reduce the incidence of infected foot ulcers in diabetic patients.

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DIABETES EDUCATION

2462-POCreating and Pilot Testing an Integrative Chinese Medicine Diet for Chinese Americans with Type 2 DiabetesEVELYN Y. HO, GENEVIEVE LEUNG, SONYA PRITZKER, HAN-LIN CHI, ELAINE HSIEH, DONALD CHAN, ISABELLE TING, YUQI CHEN, SIYUAN HUANG, QIAO NAN RUAN, HILARY K. SELIGMAN, San Francisco, CA, Los Angeles, CA, West Hartford, CT

Chinese Americans (CAs) get type 2 diabetes mellitus (T2DM) at lower BMI than White Americans and many use Chinese medicinal food principles without disclosing to biomedical providers. We created and pilot-tested a Chinese language diet for T2DM consistent with both the principles of an ADA-recommended diabetes diet and a Chinese medicinal diet. Because Chi-nese medicinal food is not standardized in the U.S. we interviewed licensed and lay Chinese medicine experts, biomedical providers and focus-group tested the diet with CA patients with T2DM.

The diet guide was pilot tested with nine Cantonese CAs with T2DM (7 women, 1 man, 1 undisclosed, ages 41-70; 6 born in Mainland China, 2 in Hong Kong, 1 in Vietnam, 8 taking diabetes medication) who have used some form of Chinese medicine in the last year. Participants met with a licensed acupuncturist for a standard Chinese medicine diagnosis. Participants were given their diagnosis at a 2-hour diet class taught by a registered dietitian and interviewed 4 weeks later.

The integrative diet is culturally sensitive due to its printing in Chinese and English and inclusion of regularly available Chinese foods. Additionally, it is culturally appropriate on a deeper level with its inclusion of Chinese me-dicinal food principles (e.g. hot/cold properties of foods), a “bowl” method as well as “plate” method, and its section on common myths about diabetes and diet (e.g. is bitter melon good for diabetes?).

Participants believed in the importance of using Chinese medicine prin-ciples in their diabetes self-management by using an integrative worldview (e.g. they held strong beliefs in Western medicine and Chinese medicine). One of the greatest barriers to diabetes self-care was a preference for eat-ing “the foods they grew up with,” and therefore, participants appreciated the familiar pictures/suggestions. However, not all participants used their Chinese medicine diagnosis. The integrative Chinese medicine diet shows promise as a diabetes education tool.

Supported By: University of California, San Francisco Asian Health Institute

2463-POPhysician Practices and Attitudes on Insulin Use in the Hospital: A Two-Year Follow-up StudyJESSICA ABRAMOWITZ, TRACY BREEN, RIFKA SCHULMAN, Great Neck, NY, New York, NY

Insulin therapy is recommended for control of inpatient hyperglycemia. Insulin is a high-risk medication and requires safe prescribing to avoid hypo-glycemia.

A 13 question survey was administered to internal medicine houses-taff and attendings in 2012 and again in 2014, at a tertiary care academic medical center. The survey was designed to assess physicians’ practices and attitudes regarding insulin prescribing, and knowledge of basic insulin pharmacodynamics. Our aim was to determine whether there had been a change in these measures following quality improvement initiatives, includ-ing removal of most oral hypoglycemic agents from the hospital formulary, educational programming for providers, and development of a hospital wide hypoglycemia protocol.

In 2014, 17% of attendings and 4% of housestaff reported continuing oral hypoglycemic agents upon hospital admission compared to 61% and 36% in 2012, respectively. In 2012, 92% of attendings were “somewhat” or “very con-cerned” about hypoglycemia, compared to 84% of housestaff who were “con-cerned” or “neutral.” In 2014, 67% of attendings were “somewhat concerned” or “neutral,” while 95% of trainees shared the same level of concern. In 2014, nearly all providers indicated they are “very comfortable” prescribing insulin and “confi dent” in their knowledge, while in 2012 the housestaff comprised the majority of physicians both very comfortable and confi dent. When asked to identify the correct pharmacodynamic profi les of regular, aspart and glargine insulin most physicians answered incorrectly on both surveys.

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DIABETES EDUCATION

This study illustrates that several practices regarding insulin use have improved since our initial assessment in 2012. There has been a decrease in the use of oral hypoglycemic agents but senior physicians have become slightly less concerned about hypoglycemia. The majority of physicians are still unable to correctly identify insulin pharmacodynamic profi les but remain both comfortable using them and confi dent in their knowledge.

2464-POSelf-Reported Information Sources among Chinese-Americans with Diabetes and PrediabetesSOPHIA H. HU, SHAN LIU, MEI FU, Taipei, Taiwan, Garden City, NY, New York, NY

Chinese-Americans face challenges of DM and pre-DM management. Aims of this study were to: 1). Explore sources of DM management info; 2). Compare differences of DM management info sources between DM and pre-DM; and 3). Investigate factors associated with DM management info. This cross-sectional study used both survey and chart review. One hundred and six participants were enrolled in Queens, New York City. Inclusion crite-ria were self-identifi ed Chinese-Americans over age 21; a history and lab val-ues showed DM or pre-DM; and able to communicate in English, Mandarin, or Cantonese. Individuals who were unable to communicate or immobilized were excluded. Demographics (e.g., age, gender, primary language, educa-tion years, years lived in the U.S., marital status, residence, employment, and income), language profi ciency, and self-reported knowledge and info sources of DM were collected. Descriptive statistics, regression analysis, and Chi-Squared test were used. Pre-DM (59, 55.7%) was slightly more than DM (47, 44.3%). Demographics were no statistical differences. The average age was 61.81 (SD=15.22), education years were 22.04 (SD=12.83), years lived in the U.S. were 11.92 (SD=4.6); and primary language was Mandarin (n=54, 55.9%). 82 (77.4%) participants had knowledge of DM. Family doctor (n=56, 26%), newspaper (n=36, 17%), friend (n=31, 15%), and family (n=26,12%) were sources of DM info. More DM (n=34, 36%) got DM management info from family doctors than pre-DM (n=22, 19%, p=.00). More pre-DM (n=22, 19%) got DM info from friends than DM (n=9, 9%, p=.03). Only education years (p=.007) and learning from healthcare professionals (p=.006) were associated with DM management knowledge. DM management info is needed, especially for Chinese-Americans with pre-DM. Healthcare profes-sionals should early address, provide education, and evaluate the accuracy of DM management knowledge. Teaching approaches and tools should be both adapted to literacy levels and be accessible in healthcare clinics.

Supported By: Pless Center for Nursing Research; Association of Chinese American Physicians

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2466-POEffect of a Family-based Educational Intervention on Glucose Con-trol in Type 2 Diabetes in the Marshallese Population in ArkansasPETER A. GOULDEN, PEARL MCELFISH, JONELL HUDSON, MELISSA BRIDGES, PETER KOHLER, Little Rock, AR, Fayetteville, AR

The Arkansas Marshallese population form one of the largest groups of Mar-shallese Pacifi c islanders in the U.S. estimated at over 14,000. Age-adjusted prevalence of diabetes in effected adults, aged thirty or more is 27%. This popu-lation experience HbA1c levels signifi cantly greater than expected those of the non-Marshallese diabetes population. This is due to a set of unique challenges faced by this group resulting in barriers to achieving good glycemic control.

This pilot project was designed to assess the impact of a family based educational intervention on diabetes outcomes over a two month period.

Five subjects with diabetes along with their family members were enrolled totaling 27 subjects. Biometric data collected included glucose, glycosylated hemoglobin, weight, height and body mass index. All subjects received a total of 10 hours of diabetes education over the eight weeks of the study. Educational sessions were provided in the participants’ home or a location of their choice. Sessions were provided by a certifi ed diabetes educator (RN or PharmD). All participants spoke English, and a Marshallese community health worker was at each session to help translate any words or concepts. At each visit the educator included time to discuss blood glucose measure-ments from the preceding week.

The pilot yielded helpful information on the barriers faced by the Arkansas Marshallese population in achieving appropriate diabetes education. There was a mean fall in A1c across the 5 subjects with diabetes (NS). Of the 13 par-ticipants who reported that they had never been diagnosed with diabetes, 8 had pre-diabetes, and 2 had diabetes highlighting an unmet need. Feedback highlighted that the family model of DSME would require multiple adapta-tions from the standard curriculum to be meaningful to this population. The family based approach yielded insights into how a larger scale project would need to be developed to best serve this high risk population group.

Supported By: Sturgis Area Community Foundation

2467-POThe Importance of Educating Patients on Diabetes Management Using Real Time CGM (RT-CGM) Data—Going Beyond Product TrainingKERI J. LEONE, DAVID A. PRICE, San Diego, CA

Many studies have shown use of RT-CGM has led to improved glycemic con-trol; the glycemic benefi ts are based on the patients’ near-daily wear of RT-CGM. A recent quality of life study showed patients opt to wear RT-CGM more consis-tently when they know how to use the data in their daily diabetes management. However throughout the literature, the link between the appropriate use of RT-CGM data in daily life and glycemic improvement has yet to be determined.

Accordingly, we reviewed 14 manuscripts of CGM outcome studies published between 2005 and 2012 for their descriptions of education provided about how to translate RT-CGM data into daily diabetes management decisions. 12 of the studies were randomized controlled studies, 2 were prospective observational studies. 57% of the manuscripts provided no mention of whether and how subjects were educated on the use of RT-CGM data. 29% of the manuscripts mentioned education was provided but it was either limited, such as no written instructions provided, or did not provide details of the type of education – prod-uct education only or using RT-CGM data to better manage their daily diabetes management or both. 14% of the studies provided detailed education for use of retrospective CGM data to inform dosing decisions in the future. Only 14% of these studies describedthe instructions provided to subjects on translating RT-CGM data to diabetes management decisions in daily life.

Conclusion: The majority of published clinical studies have not described the extent of RT-CGM education that was provided to subjects. Often in clinical practice, the focus of RT-CGM education is on the device, not on how to use CGM data to improve glycemic control. More extensive RT-CGM education and its impact in diabetes management decisions may be a missing gap in the additional positive impact RT-CGM can provide in clinical outcome studies.

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EXERCISE

EXERCISE

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2470-POExercise and HbA1c in Adults with Type 1 Diabetes: A Secondary Data Analysis Using Data from the T1D ExchangeMARGARET M. MCCARTHY, ROBIN WHITTEMORE, GEORICA GHOLSON, MAR-GARET GREY, Orange, CT, New Haven, CT

It is unclear if exercise alone in type 1 diabetes (T1D) improves HbA1c, but it provides other benefi ts, including protection against cardiovascular disease. Yet little is known about exercise patterns in adults with T1D, in-cluding how many achieve the recommended 30 minutes, 5 days/week. The purpose of this study was to analyze exercise frequency (# days/week x 30 minutes) and its association with HbA1c.

Adults ≥ 18 years in the T1D Exchange clinic registry (70 U.S.-based pediatric and adult endocrinology practices) who had exercise self-report data (n=7574) were included. Analyses included descriptive statistics and multivariate regression. Controlling for demographic and clinical factors, participants who (1) met exercise recommendations (5-7 days/week), or (2) exercised but did not meet recommendations (1-4 days/week), were com-pared to (3) those who did not exercise.

The sample was 54% women and 89% White; mean age was 37.12 ± 17 years. Mean HbA1c was 7.9 ± 1.5% (63mmol/mol); 45% were overweight or obese. The majority (55%) exercised 1-4 days per week; 33% exercised 5-7 days; and 12% did none. Compared to no exercise, exercising 1-4 days per week was associated with a lower HbA1c (-0.11%; p=.04), but there was no difference in those who exercised 5-7 days (p=.07). Factors also associ-ated with lower HbA1c include: male gender (-0.14%; p<.0001); the number of daily blood glucose checks (-0.12 for each additional check; p<.0001); and a graduate degree [vs. less than high school diploma] (-1.01%; p<.0001). Fac-tors associated with a higher HbA1c include: Black race (+ 0.49%; p<.0001); Hispanic ethnicity (+ 0.33%; p<.0001); being single (+ 0.41; p<.0001) or di-vorced (+ 0.34; p<.0001) vs. married; and the presence of depressive symp-toms (+ 0.48%; p<.0001).

Few adults with T1D exercised at recommended levels, but lower HbA1c levels were seen with 1-4 days/week. Awareness of other factors associ-ated with poor glycemic control (e.g., depressive symptoms) may guide care to improve outcomes.

2471-POMetabolic Effects of Recreational Soccer Training in Brazilian Pa-tients with Type 2 DiabetesMAYSA V. SOUSA, ROSA FUKUI, MARIA ELIZABETH ROSSI DA SILVA, São Paulo, Brazil

Caloric restriction and exercise improve metabolic control. However, little is known about the effects of soccer in the treatment of type 2 diabetes. Therefore, we compared acute and chronic soccer training with caloric-restricted diet versus diet alone on metabolic profi le, insulin resistance, and GH/IGF1 axis in patients with type 2 diabetes (T2D). Fifty-one T2D patients (61.1±6.4 years, 29F:22M) were randomly allocated to the soccer+diet group (SDG; n=22) or to the diet group (DG; n=29). Over 12 weeks, SDG performed 40 min of supervised recreational soccer training three times a week. After 40 min of the fi rst soccer session, there was an increase (P<0.05) in blood ammonia (from 32.7±1.8 to 65.1±5.3 µmol/L), GH (from 0.4±0.1 to 3.2±0.7 ng/mL) and glucagon levels (from 112.2±6.2 to 142.9±8.0 pg/mL), whereas glucose levels remained unchanged. Furthermore, SDG showed suppressed postprandial insulin levels, lower HOMA-IR, and higher ammonia, free fatty acids and GH levels than DG (p<0.05). At 48 h of recovery, a decrease was observed in IGF-1/IGFBP-3 ratio (p<0.05) only in the SDG. After 12 weeks, a similar decrease in body weight by ~4.0 kg was observed in both groups. Signifi cant reductions in fasting glucose, HOMA-IR and IGFPB-3 levels were observed in SDG (p<0.05), whereas IGF-1/IGFBP-3 ratio increased in both groups (p<0.05). After the last training session, an increase in IGF-1/IGFBP-3 ratio (36.6±2.4 vs. 44.1±3.1; p<0.05) and a trend towards lower was observed in ammonia levels (65.1±5.3 vs. 51.8±5.3 µmol/l; p=0.05) suggestive of lower muscle protein catabolism. Chronic soccer training improved metabolic con-trol in T2D patients attested by a decrease on fasting glucose, IGFBP-3 levels and HOMA-IR. Moreover, some of these improvements were observed after the fi rst acute session and a lower catabolic stress was evident after the last training session. Our fi ndings suggest that popular national sports may be co-opted by clinicians as possible interventions for control of diabetes.

Supported By: Fundação de Amparo à Pesquisa do Estado de São Paulo (2012/01400-0)

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EXERCISE

2473-POModerate Intensity Exercise Training Rapidly Increases Insulin-stimulated Intestinal Glucose Uptake in Sedentary IndividualsKUMAIL K. MOTIANI, ANNA SAVOLAINEN, JOONAS J. ESKELINEN, KIRSI A. VIRTANEN, RIITTA PARKKOLA, JUHANI KNUUTI, PIRJO NUUTILA, KARI K. KAL-LIOKOSKI, JARNA C. HANNUKAINEN, Turku, Finland

Recently it has been shown that insulin is a potent stimulator of glucose up-take (GU) in intestine and that intestinal insulin resistance manifests in obesity and type 2 diabetes. Exercise training improves whole body glycaemia and in-sulin stimulated skeletal muscle GU. Thus, we aimed to study the tissue specifi c effects of exercise training on insulin-stimulated intestinal GU.

Materials and Methods: Healthy individuals (n=26, aged=48 [SD 5] yrs, BMI=26.1 [SD 2.4] kg·m-2, VO2peak=34.2 [SD 4.1] ml·kg-1·min-1) and pa-tients with IFG/IGT/T2D (n=20, aged=49 [SD 4] yrs, BMI=30.1[SD 2.7] kg·m-2, VO2peak=28.3[SD 4.6] ml·kg-1·min-1) were randomized into high intensity in-terval training (HIT) and moderate intensity training (MIT) groups. The groups were studied before and after two weeks and six sessions of HIT (4-6x30 s all out sprints on cycle ergometer with 4 minutes of recovery) or MIT training (40-60 min cycling with ergometer at 60 % of VO2max). Intestinal GU was measured during euglycemic hyperinsulinemic clamp using positron emis-sion tomography and 18F-FDG.

Results: In healthy individuals, VO2peak and whole body insulin sensitiv-ity improved and visceral fat decreased similarly in both groups (all p<0.05), following intervention. Training increased GU in colon and tended to increase in small intestine in MIT group, whereas opposite was observed in HIT group [colon: MIT 30%, HIT - 2% (p=0.02) and small intestine: MIT 10%, HIT - 9% (p=0.08), respectively]. The GU in the small intestine correlated positively with the VO2peak [Pre: r= 0.46 p=0.03; Post: r=0.45 p= 0.03] and negatively with visceral fat mass [Pre: r=-0.42 p=0.05; Post: r=-0.45 p=0.03]. The results for IFG/IGT/T2D group are under analysis and will be presented in the congress.

Conclusion: This study shows that MIT rapidly enhances insulin-stimulat-ed intestinal GU already after two weeks of training in sedentary individuals, while HIT seems to be ineffective in respect to this.

2474-POHeart Rate Ratio Method Might Underestimate VO2max in Type 1 DiabetesALI EMAMI, CORINNE SUPPERE, LAURENT LEGAULT, AHMAD HAIDAR, REMI RA-BASA-LHORET, NADINE TALEB, JEAN-LOUISE CHIASSON, Montreal, QC, Canada

The maximal rate of oxygen consumption (VO2max) is an important determi-nant of a subject’s overall health and endurance capacity during prolonged, sub-maximal exercise. Direct measurement of VO2max involves a physical ef-fort suffi cient to fully expend the aerobic energy system, which can be both expensive and practically diffi cult. Accordingly, numerous methods have been developed to indirectly estimate VO2max from the heart rate response (HR) to sub-maximal exercise tasks. The Heart Rate Ratio Method is a popu-lar approach that relates VO2max with the maximal heart rate (HRmax) and resting heart rate (HRrest) using the relation: VO2max = C(HRmax/HRrest) where C denotes the conversion factor and is approximated as 15 ml · (min-1kg-1). However, the Heart Rate Ratio Method has not yet been validated in pa-tients with type 1 diabetes (T1D). In the present study, we experimentally ex-amined whether this method predicts accurately VO2max in a sample of 14 T1D adult subjects during an ergocycle exercise protocol (8 females, 6 males; age 39.25 (15.4) years, T1D duration 24.5 (12.3) years, and BMI 25.7 (4.5) Kg/m2). VO2max and VO2rest were directly measured using a mixing chamber connected to a Moxus system gas analyzer. The VO2max was assessed using a graded exercise test on a stationary bike until subjects reached voluntary exhaus-tion. The average measured VO2max was 32.24 (7.36) mlO2/kg·min, VO2rest was 3.76 (0.91) mlO2/kg·min, HRmax was 168 (20) beats/min, and HRrest was 68 (15) beats/min. The estimated VO2max via the Heart Rate Ratio Method, using HRmax and HRrest, yielded a mean estimate of 25.83 (4.24) mlO2/kg·min. This underestimation was present for both male and female subjects. The stan-dard error of estimate between the measured and predicted VO2max was 5.58

mlO2/kg·min (17.3%), p=0.044. The results suggest that the Heart Rate Ratio Method might underestimate VO2max when applied to individuals with type 1 diabetes and a correction factor might need to be applied.

Supported By: Société Francophone du Diabète and Diabète Québec

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NUTRITION—CLINICAL

2476-POClinical Effect of Real-Time Pulse Rate Monitoring with Portable Pulsimeter on Physical Exercise Therapy for Patients with Type 2 DiabetesYOSHIKAZU SUMITANI, TOSHIO HOSAKA, YUKA SUSAKI, YUHKI FUJISAWA, KINUYO KURIYAMA, YOSHIE TSUKADA, YOSHIHIKO YOKOYAMA, JUNKO HASE-GAWA, JUN TAKEUCHI, JUNETSU OGASAWARA, SUSUMU NISHIDA, TAKUMA KONDO, KOUICHI INUKAI, YASUTOMO OKAJIMA, HIDEKI OHNO, HITOSHI ISHI-DA, Tokyo, Japan, Nagano, Japan

In patients with type 2 diabetes, it is recommended that exercise therapy (ET) is performed on the basis of heart rate as an index of exercise intensity.

This study was designed to clinically to evaluate whether continuous ET with a portable pulsimeter (PP) for self-monitoring of the pulse rate in 23 patients with type 2 diabetes infl uences glycemic control. We randomly as-signed patients to the pulse displayed group (PDG) (the group in which the PP displayed a pulse rate) and the pulse non-displayed group (PNDG) (the group in which the PP did not display a pulse rate, only recording the data) and pa-tients then performed ET for one month. Patients in the PDG were instructed to regulate walking speed always remaining aware of maintaining their PP in the zone of the target pulse rate (ZTP), whereas patients in the PNDG were instructed to regulate walking speed while taking their pulse rate and using the Bourg index to maintain the ZTP by the conventional method. We found the mean walking time within ZTP during ET to be signifi cantly increased in the PDG (p<0.01). Similarly, glycoalbumin and 1,5 AG improved signifi cantly in the PDG as compared to the PNDG (respectively, p<0.01). We conclude that diabetic patients performing ET while maintaining awareness of a pulse rate displayed by a PP clearly showed an increase in the time spent at the ZTP and signifi cantly improved glycemic control as compared with those using the conventional method. We suggest that this therapeutic device might be very useful for preventing the onset and progression of diabetic complications.


2477-POThe Effect of Diabetes-specifi c Nutritional Formulas on Postpran-dial Insulin and GLP-1 Hormones and Their Impact on Postprandial Serum Glucose and Free Fatty AcidsADHAM MOTTALIB, MOHAMED SHEHABELDIN, RANI POLAK, MAHMOUD SAKR, JOHN TROUP, TANUSHREE BOSE, MARTIN J. ABRAHAMSON, OSAMA HAMDY, Boston, MA, Aliso Viejo, CA

Diabetes-specifi c nutritional formulas (DSNF) are frequently used to replace calories as a component of medical nutrition therapy for diabetic patients with the aim of achieving optimal glucose control. The mechanism through which they reduce postprandial (PP) glucose is not yet known. We compared the PP effects of 2 DSNFs; Glucerna (GL, Abbott Nutrition) and Ultra Glucose Control (UGC, Metagenics); on PP insulin and glucagon-like peptide-1 (GLP-1) hormones versus oatmeal (OM). After an overnight fast and withholding of antihyperglycemic medications, 22 overweight or obese patients with type 2 diabetes (weight 97.4±21.3 kg; BMI 33.2±5.9 kg/m²; age 62.3±6.8 years; A1C 6.8±0.7%) were randomly given 200 kcal of each of the three meals on 3 separate days. Blood samples were collected at baseline and after 30, 60, 90, 120, 180 and 240 minutes of starting the meal. The positive areas under the curve (AUC) for serum glucose, insulin, active GLP-1 and free fatty acids (FFA) were calculated. Glucose positive AUC0-240 after GL and UGC was signifi cantly lower than after OM (p<0.001 for both). Insulin positive AUC0-240 showed no difference between the 3 meals but adjusted insulin levels were signifi cantly higher at 60 and 90 min after UGC versus after OM (p=0.006 and p=0.039 respectively) and at 60 min after UGC versus after GL (p=0.039). GLP-1 positive AUC0-240 after GL and UGC were signifi cantly higher than after OM (p<0.001 and p=0.003 respectively). FFA positive AUC0-240 was signifi cantly higher after GL compared to UGC and OM (p=0.02 and p=0.006 respectively). In conclusion, the intake of DSNFs results in sustained PP glucose control for 4 hours. This is achieved by stimu-lating insulin secretion and indirectly by stimulating GLP-1 secretion. The difference in their potency to stimulate insulin and GLP-1 hormones may be related to their different protein and amino acid profi les and fat content.

Supported By: Metagenics, Inc.

2478-PODieckol, a Marine Algal Polyphenol, Attenuates Blood Glucose Level by Akt Pathway in Alloxan-induced Hyperglycemia Zebrafi sh ModelEUN-A KIM, NALAE KANG, SEUNG-HONG LEE, DAE-HO LEE, YOU-JIN JEON, Jeju, Republic of Korea, Cheongju, Republic of Korea, Iksan, Republic of Korea

Zebrafi sh (Danio rerio) has been used to a powerful model. Because ze-brafi sh has several advantages such as short life cycle, easy husbandry and physiological similarity to mammals. Recently it becomes an attractive experimental model in molecular genetics, development biology, drug dis-covery and evaluation of the human disease. Therefore, the anti-diabetic compound of Dieckol (DK), one of marine algal polyphenols isolated from Ecklonia cava was confi rmed for its anti-diabetes activity in zebrafi sh model. The zebrafi sh were divided to 4 groups, the normal (alloxan-untreated) as well as alloxan-induced diabetic zebrafi sh without (control) and with DK or Metformin (a commercial antidiabetic drug). The DK group was decreased more 3.3 times compared with the control group in the blood glucose levels at 90 min (Fig1). Furthermore, reduced glucose-6-phosphate and phospho-enolpyruvate carboxykinase were observed in the liver tissues of the DK group and increased phosporylation of protein kinase B (Akt) in the muscle tissue. Akt activation was involved in mediating the effect of DK on glucose transport activation and insulin sensitivity. These results suggest that DK exerts an anti-diabetic effect by improvement of blood glucose regulation, hepatic glucose metabolic regulation and Akt up-regulation in alloxan in-duced hyperglycemia zebrafi sh.

2479-POAdherence to the Mediterranean Diet and Binge Eating Behavior in Metabolically Obese Normal Weight Italian WomenSIMONA BERTOLI, ALESSANDRO LEONE, GIORGIO BEDOGNI, LAILA VIGNATI, VERONICA PONISSI, VALENTINA BEGGIO, ALBERTO BATTEZZATI, Milan, Italy

The category of Metabolically Obese Normal Weight (MONW) subjects has been proposed because they exhibit most of the abnormalities associ-ated with obesity despite being normal-weight. The contribution of altered body fat to MONW phenotype is established but that of dietary pattern, eating behavior and physical activity is not. 116 MONW women (HOMA-R > 1.69) were matched with 164 non-MONW women (HOMA-R ≤ 1.69) using coarsened exact matching (CEM) on body mass index (BMI) and age. Weight, height, waist circumference and skinfolds (triceps, biceps, subscapular and suprailiac) were measured. Resting energy expenditure (REE) was measured by indirect calorimetry, adherence to Mediterranean dietary pattern by the MEDscore questionnaire and eating behavior by the Binge Eating Scale (BES). Median and logistic regression with robust confi dence intervals were used to compare MONW and non-MONW women taking CEM into account. In the pooled sample, age was between 18 and 62 years. Familiarity for obe-sity, diabetes, dyslipidemia and cardiovascular disease was similar in the two groups. MONW women had higher waist (median difference = +2.2 cm, p < 0.01), skinfolds sum (+9.4 mm, p < 0.01) and triglycerides (+14 mg/dl, p < 0.01). REE, MEDscore and BES were similar in the two groups. The odds ratio of being engaged in physical activity was 0.56 (p < 0.05) for MONW vs. non-MONW women. In conclusion, we confi rm that MONW women have in-creased central fat despite being normal weight and we suggest that among lifestyle factors the level of physical activity is important in determining this phenotype.

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2481-PODissociation of Circulating Branched-chain and Aromatic Amino Acids and Glucose Metabolism with Weight Loss and Stabilization after Hypocaloric DietingSVEN HAUFE, HENNING WITT, STEFAN ENGELI, JANA KAMINSKI, VERENA HAAS, FRIEDRICH C. LUFT, MICHAEL BOSCHMANN, JENS JORDAN, Hannover, Germany, Berlin, Germany, Potsdam, Germany

Amino acids may interfere with insulin action, particularly in obese individu-als. We hypothesize that diet-induced change in amino acid levels are related to changes in glucose homeostasis with periods of weight loss and mainte-nance. In 76 overweight to obese subjects branched-chain and aromatic amino acids (tryptophan, tyrosine, phenylalanine) were measured by metabolic profi l-ing before and after six months hypocaloric diet either reduced in carbohy-drates or fat, and at 6-months follow-up. In addition, a 2-hour oral glucose tol-erance test was performed to analyse amino acids levels post-prandial and to calculate insulin sensitivity indices. Before diet, plasma concentrations of all six amino acids were related to insulin sensitivity, visceral adipose tissue and intrahepatic fat, but not to intramyocellular- or subcutaneous fat. Body weight and insulin resistance changed with weight loss and stabilisation with differ-ent responses in aromatic and branched-chain amino acids. No associations were observed between individual changes in amino acids intake or plasma concentrations with changes in insulin sensitivity with weight loss and sta-bilisation, irrespective of dietary macronutrient content. Before diet, plasma levels of branched-chain and aromatic amino acids are linked with increasing amounts of detrimental body fat depots and insulin resistance but changes in weight and insulin action following weight loss are not interrelated to in-dividual changes in circulating concentration of amino. Altered insulin action through dietary interventions is dissociated from circulating levels of amino acids in overweight to obese subjects.

2482-PODose-Response Effect of Whey Protein Consumed as Premeal on Postprandial Lipemia in Subjects with the Metabolic SyndromeANN BJOERNSHAVE, CHRISTIAN WÜRTZ HEEGAARD, KJELD HERMANSEN, Aarhus, Denmark

Whey protein (WP) is a potent insulinotropic secretagogue. Consumption of WP as pre-meal reduces postprandial glycemia after a subsequent meal and induces an early insulinemic response. No studies have examined, if a pre-meal of WP infl uences the subsequent postprandial lipemia. Therefore, we

examined if the triglyceride (TG) and ApoB-48 responses to the second meal were dose-dependently affected by a WP pre-meal prior to a fat-rich test meal in subjects with metabolic syndrome (MeS). Additionally, we assessed the im-pact on insulin, glucose, glucagon, free fatty acids (FFA) and appetite.

We performed an acute, randomized, cross-over study with three arms. A standard diet was provided before each test day. At the test day fast-ing data were collected (blood, urine, anthropometric measurements and visual analogue scale (VAS)). A 200 mL pre-meal containing 0, 10 or 20 g WP was served at -15 min. A fat-rich breakfast (second meal) was served at 0 min. The subjects were then observed for 360 min after the second meal and VAS was carried out every 30 min. ANOVA for repeated measurements was applied to determine the effect of WP and time on the postprandial responses. Twenty subjects (8 women and 12 men) with MeS completed the study. We observed no effects on TG or ApoB48. The response of insulin was increased after consumption of 20 g WP compared to 10 g (P<0.001) and placebo (P<0.0001). Likewise, the postprandial glucagon response was higher after 20 g WP compared to 10 g WP (P<0.0001) and 0 g WP (P<0.0001) as pre-meals. Blood glucose was lower after 20 g WP compared to placebo (P<0.05). A pre-meal of WP had neither effect on FFA or on appetite (VAS).

In conclusion, consumption of a pre-meal of WP prior to a fat-rich second meal did not alter the postprandial lipid responses in MeS subjects. As ex-pected, WP stimulated insulin and glucagon secretion in a dose-dependent manner, while blood glucose remained low after the highest dose of WP.

Supported By: Danish Dairy Research Foundation

2483-POThe Role of a Fixed Berberis Aristata/Silybum Marianum Combina-tion in the Treatment of Type 1 Diabetic PatientsGIUSEPPE DEROSA, DAVIDE ROMANO, ANGELA D’ANGELO, PAMELA MAFFIOLI, Pavia, Italy

The aim of this study was to evaluate if the addition of Berberis aristata/Sylibum marianum (Berberol®) leads to a reduction of insulin dose and to an improvement of glycemic control in type 1 diabetic patients.

We enrolled 85 type 1 diabetic patients and randomized them to take pla-cebo or Berberis aristata/Silybum marianum 588/105 mg, 1 tablet during the lunch and 1 tablet during the dinner, for six months. We evaluated if there was a reduction of insulin dose necessary to reach an adequate glycemic control. We also evaluated at baseline, and after 6 months: body mass index (BMI), glycated hemoglobin, fasting plasma glucose (FPG), post-prandial glu-cose (PPG), total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), triglycerides (Tg).

We observed a reduction of total insulin consumption in Berberis aristata/Silybum marianum, both compared to baseline and to placebo. Regarding in-sulin administration at meals, we recorded that the group treated with Ber-beris aristata/Silybum marianum used less insulin at meals, and at bedtime. Glycated hemoglobin decreased with Berberis aristata/Sylibum marianum compared to baseline, but not compared to placebo. There was a decrease of FPG, and PPG with Berberis aristata/Sylibum marianum both compared to baseline and to placebo. Regarding lipid profi le, we recorded a decrease of TC, Tg and LDL-C and an increase of HDL-C with Berberis aristata/Sylibum marianum, both compared to baseline and to placebo.

In conclusion, the addition of Berberis aristata/Sylibum marianum to insu-lin therapy in type 1 diabetic patients leads to a reduction of the insulin dose necessary to have an adequate glycemic control.

2484-POOctaphlorethol A, a Natural Marine Algae Product, Activates AMP-activated Protein Kinase with Benefi cial Metabolic Effects in Type 2 Diabetic MiceSEUNG-HONG LEE, SEOK-CHUN KO, MIN-CHEOL KANG, EUN-A KIM, NALAE KANG, DAE HO LEE, YOU-JIN JEON, Cheongju, Republic of Korea, Jeju, Republic of Korea, Jeollabuk-do, Republic of Korea

Recently, there has been a growing interest in alternative therapies and in the therapeutic use of natural products for diabetes, especially those derived from marine algae. Octaphlorethol A (OPA) a type of phlorotannin, isolated from the brown algae Ishige foliacea has been shown to have antidi-abetic activities. However, the mechanism of action of OPA have rarely been investigated in type 2 diabetes. Here, we have investigated the antidiabetic effects and mechanism of OPA in C57BL/KsJ-db/db mice, a model of type 2 diabetes. Although body weight was not signifi cantly different between the control db/db and OPA treated db/db mice, the levels of fasting and post-prandial blood glucose were signifi cantly lower in the OPA treated db/db mice than in the control mice. OPA also signifi cantly decreased the level of plasma insulin. OPA treatment augmented the activation of AMP-activated

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protein kinase (AMPK) and increased the expression of glucose transporter 4 (GLUT4) protein in skeletal muscle. In addition, OPA lowered the mRNA expression of phosphoenolpyruvate carboxykinase (PEPCK) and fatty acid synthase (FAS) in the liver. AMPK and GLUT4 contributed to glucose metabo-lism regulation and had an essential function in the development of type-2 diabetes mellitus. Therefore, the mechanisms of OPA may be related to sup-pressing gluconeogenesis by inhibiting PEPCK activity in the liver and affect-ing GLUT4-mediated glucose uptake in skeletal muscle through activating AMPK. These fi ndings provided a new insight into the antidiabetic clinical applications of OPA and demonstrated the potential of OPA as a new drug candidate for type-2 diabetes.

2485-PODietary Fibers in the Prevention of Type 2 Diabetes: A Randomized Crossover StudyANNE GRETHE SCHIOLDAN, SOEREN GREGERSEN, STINE HALD, KNUD ERIK BACH KNUDSEN, JENS JUUL HOLST, KJELD HERMANSEN, Aarhus, Denmark, Tjele, Denmark, Copenhagen, Denmark

A high intake of dietary fi bers (DF) is inversely associated with the de-velopment of type 2 diabetes. The mechanisms behind this association are poorly understood. Dyslipidemia plays a key role in the pathogenesis of type 2 diabetes, however, little is known about the impact of DF on postprandial lipemia. Arabinoxylan and resistant starch are important DFs that may exert benefi cial effects on lipid metabolism.

We compared the effects of a high-fi ber (HDF) diet rich in resistant starch and arabinoxylan- with a low-fi ber (LDF) diet in subjects with metabolic syn-drome (MeS). Our primary aim was to estimate postprandial lipid-responses. Furthermore, we investigated the postprandial glucose and incretin re-sponses.

Nineteen subjects with MeS completed the randomized, cross-over study with two 4-week dietary interventions. The HDF diet contained 21g/day re-sistant starch and 16g/day arabinoxylan, and the LDF diet 3 g/day resistant starch and 4g/day arabinoxylan. Dietary adherence was monitored by mea-suring fecal DF residues and short chain fatty acids (SCFA).

After an overnight fast, we measured triglyceride, ApoB-48, NEFA, glu-cose, insulin, glucagon,GLP-1 and GLP-2-responses to a high-fat meal. The meal test was performed before and after each intervention. We compared postprandial responses over time (dietXtime), and as AUC using Anova for repeated measurements.

A good dietary adherence was supported by signifi cantly higher fecal DF residues and SCFA (butyrate, acetate and total SCFA) after HDF compared with LDF diet (p<0.01). However, the lipid responses were not altered by 4 weeks on the diets, nor did glucose, insulin, glucagon or incretin responses change.

In conclusion, a 4-week intervention with a HDF diet rich in resistant starch and arabinoxylan compared with a LDF diet did not reveal differences in postprandial lipid or glucose responses in subjects with MeS. However, we cannot exclude that an extension of the HDF diet intervention may induce postprandial metabolic advantages.

Supported By: Danish Council for Strategic Research

2486-POExploring and Resolving the Impact of Food on Postprandial Glyce-mic Excursions in a Rice-Eating Population in S. IndiaJOTHYDEV KESAVADEV, ARUN SHANKAR, GEETHU SANAL, NEETHU ANNIE AJAI, GOPIKA KRISHNAN, SUNITHA JOTHYDEV, Trivandrum, India, Kochi, India

Rice is the staple food for a large part of Asia including India where people consume on an average 4 servings of white rice/day. Polished white rice is devoid of fi bre, lignans but rich in starch with high GI.

We aimed to investigate the impact of white rice on postprandial glucose (PPG) levels.

2127 T2DM on regular follow up with telemedicine (DTMS®), with high post lunch and dinner values; reportedly consuming white rice were random-ized to receive a recommended modifi ed diet (Table).

Mean age 46±12, A1c 8.2±1.3% either on OHA or basal insulin + OHA. FBS and PPG levels were measured once weekly. Baseline values 2 hrs after lunch and dinner were 234 ±17.3 mg/dL and 243±12.7 mg/dL respectively. Diet advices were rendered on a weekly basis. The dosages of oral and in-jectable medications were down titrated based on blood glucose values.

Paired samples t-test was conducted to compare A1c and PPG at baseline and 3 months. 2 hrs post lunch and post dinner values reduced to 143±6.6 mg/dL and 149±7.1 mg/dL respectively (p<0.0001, sig.) at 3 months. Final A1c 7.1±1.2%.

Traditionally, being a rice eating population, rice is believed to provide en-ergy and longevity. With transition in lifestyles, huge intake of rice need to

be discouraged and modifi ed either by reducing its servings or by replacing with brown rice or whole grain which being low in GI is more nutritious with dietary fi bre and other health benefi cial nutrients.

Table. Traditional Menu and Recommended Modifi ed Menu with Calories.Traditional Lunch Rice - 2 cup

Sambhar -1cupTapioca -1cupFish curry - 3 small piecesVegetable curry - 1 cup

Calories Involved in Traditional Lunch Carbohydrates - 125gmProtein - 30gmFat - 15gmTotal Calories - 755cal

Recommended Modifi ed Lunch Rice - 1 ½ cupSambhar - ½ cupFish curry - 3pieces (with less coconut)Vegetable curry - 1 cup (with less coconut and oil)Vegetable salad - 1 cup

Calories Involved in Recommended Modifi ed Lunch Carbohydrates - 95gmProtein - 28gmFat - 10gmTotal Calories - 585cal

Traditional Dinner Rice - 2 ½ cupSambar - 1 cupVegetable curries - 1 cupFish curry - 3 pieces

Calories Involved in Traditional Dinner Carbohydrates - 115gmProtein - 30gmFat - 15gmTotal Calories - 655calories

Recommended Modifi ed Dinner Rice - 1 ½ cupSambar - ½ cupFish curry - 3 pieces ( with less coconut)Vegetable curries - 1 cup(with less oil and coconut)Vegetable salad - 1 cup

Calories Involved in Recommended Modifi ed Dinner Carbohydrates - 95gmProtein - 25gmFat - 10gmTotal Calories - 570cal

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PSYCHOSOCIAL, BEHAVIORAL MEDICINE

2488-POIntra-individual Variability of Percentage of Body Fat Estimated by Bioelectrical Impedance Analysis in Patients with Type 2 DiabetesGABRIELA BRENNER BELLO, CRISTINA PAVINATTO, MAIRA ZOLDAN, LORENZO CATUCCI BOZA, MIRELA J. AZEVEDO, THEMIS ZELMANOVITZ, Porto Alegre, Bra-zil

The aim of the study is to determine the intra-individual coeffi cient of variation (CV) of percentage of body fat (PBF) estimated by Bioelectrical Impedance (BIA) in patients with type 2 diabetes and to evaluate factors associated with this variability. The patients were submitted to clinical and laboratory evaluation, and anthropometric assessment. The measurement of PBF by BIA (InBody 230, Biospace, Korea) was performed three times with a range of up to two days. Forty-three patients were evaluated (22 male, mean age 64 ± 8 years, body mass index [BMI] 28 ± 3 kg/m2). The mean PBF was 29.4 ± 6.1% in men and 37.9 ± 5.5% in women. The CV was 2.6% (0.4 to 17.9%) in the whole group, and 3.1% (0.5 to 17.4%) in men and 1.6% (0.4 to 17, 9%) in women (p=0.14). The group with a higher CV (>2.6%) had a lower BMI (27 ± 3 vs. 29 ± 3 kg/m2; p=0.014), lower glomerular fi ltration rate (GFR; 77 ± 14 vs. 88 ± 17 ml/min/m2; p=0.045), lower values of PBF (29.6 ± 6.1% vs. 37.7 ± 5.7%; p<0.001) and a lower percentage of fat in the trunk (PFT; 31.6 ± 6.6% vs. 38.9 ± 5.1%; p<0.001) than patients with a lower CV. Logistic regression analysis showed that the presence of a CV > 2.6% (dependent variable) was inversely associated with the PBF (OR=0.77; 95% CI: 0.64 to 0.92; p=0.005), after adjustment for age and GFR. In another model, the PFT was also in-versely associated with the presence of a CV > 2.6% (OR=0.78; 95% CI=0.65 to 0.94; p=0.008). In conclusion, intra-individual CV of the PBF estimated by BIA is on average 2.6% and may be as high as approximately 18% in patients with type 2 diabetes. Among the evaluated clinical characteristics, this vari-ability was only associated with the PBF and PFT values.

2489-POPotential Antidiabetes Compound from Pyropia Yezoensis, a Marine Red Macroalga, Regulates Glucose Transporter, GLUT-4 Transloca-tion through Akt and AMPK PathwaysJI-HYEOK LEE, EUN-A KIM, NALAE KANG, YOU-JIN JEON, Jeju, Republic of Korea

This study demonstrated on anti-diabetes mechanism of compounds from Pyropia yezoensis, a marine red macroalga. Among the fractions (n-hexane (PYH), CHCl3 (PYC), EtOAc (PYE) and water (PYW)) from the 70% EtOH extract of P. yezoensis, PYH showed the strongest inhibitory activity on ¥á-glucosi-dase (%) comparing with the other fractions. And (E)-5-(8-hydroxynon-6-enyl)cyclohexa-2,4-dienol (C24D) among seven compounds from PYH showed the strongest inhibitory activity on ¥á-glucosidase as well as increased glucose uptake level without cytotoxicity on C2C12 mouse muscle cells, whereas other six compounds didn’t affect to glucose uptake at all concentrations. Glucose transpotor, GLUT4 was controlled by AKT and AMPK pathways, so we evaluated role of C24D for AKT and AMPK pathways. Insulin only up regulated the phosphor-AKT protein, whereas C24D increased the activa-tion of phosphor-AKT and -AMPK proteins, also PI3K and AMPK inhibitors restricted the GLUT-4 expression in cytosol of C2C12 under the treatment of C24D. In vivo results, the blood glucose level in zebrafi sh which damaged by alloxan slightly was decreased whereas, C24D strongly decrease the level of blood glucose level. Thus, blood glucose level increased in alloxan damaged zebrafi sh by administration of starch was regulated by C24D. Consequently, (E)-5-(8-hydroxynon-6-enyl)cyclohexa-2,4-dienol was main agent of anti-diabetes in P. yezoensis. And we suggest that C24D inhibits the activation of glucosidase in vitro and in vivo and regulates the GLUT-4 via AKT and AMPK pathways.

2490-PODaily Food Intake in Young Adult Patients with Newly Diagnosed Diabetes Compared with ControlsMONA LANDIN-OLSSON, MARCEL PERSSON, BENGT LITTORIN, THE DIABETES INCIDENCE STUDY IN SWEDEN, Lund, Sweden

Environmental triggers are of importance for the development of both type 1 and type 2 diabetes. For type 1 diabetes certain food items and quan-tity of food has been proposed to induce disease in genetically predisposed subjects. The aim of this study was to compare dietary habits in newly diag-nosed patients with type 1, type 2 diabetes and controls.

Consecutively diagnosed patients with diabetes in the ages 15-34 yrs were asked to self-report daily intake of food. The patients were clinically classifi ed as type 1 (n=584) or type 2 diabetes (n=117). For each patient two controls matched to gender, age and residency were selected (n=968). Re-sults from the food questionnaire were converted into daily intake of energy, fat, carbohydrates, protein, vitamins and minerals.

Patients with type 1 diabetes reported a 14% higher intake of energy (2528 vs. 2219 kcal; p<0.001) compared to controls and 11% higher than type 2 patients (2269 kcal; p=0.02). Patients with type 2 reported an equal intake compared to controls (2219 kcal; p=ns), despite a higher BMI in type 2 (27.5 vs. 22.7; p<0.001). There was a clear correlation between BMI and energy intake in controls (r=0.1; p=0.02), but a negative correlation for type 1 (BMI 23.0; r=-0.9; p<0.05) and no correlation for type 2 (r=-0,1; p=0,26). The ap-portionment of energy sources was similar for all groups, 15-16% from pro-tein, 32% from fat and 50-51% from carbohydrates. The absolute intake of carotene, tocoferol, ascorbic acid, zinc, selenium and fi bre were signifi cantly higher in all patients and vitamin D higher in type 1.

The higher energy intake and lack of positive correlation to BMI in patients with type 1 diabetes could be due to a longstanding catabolic situation and loss of glucose. A similar but less pronounced disturbance is seen in type 2 diabetes. The proportional intake of protein, fat and carbohydrate did not differ between patients with diabetes and controls. No defi cient intake of minerals or vitamins could be demonstrated for patients with diabetes.

Supported By: Swedish Research Council; Swedish Diabetes Foundation


2491-POMorning Cortisol Level and Cognitive Abilities in People with Type 2 Diabetes MellitusSHARWAN SINGH, JUGAL K. SHARMA, RAJENDRA P. AGRAWAL, Bikaner, India, New Delhi, India

Increasing evidences suggest that elevated glucocorticoid levels have widespread effects within the central nervous system (mainly hippocam-pus), a key locus for cognitive function and cortisol levels are increased in patients of diabetes. Keeping these two points in mind, relation between morning cortisol level and cognitive abilities in people of type 2 diabetes were assessed.

100 participants, aged 60-75 years were recruited randomly of type 2 dia-betes, living in North-west Rajasthan. A fasting venous blood sample was taken for measurement of plasma cortisol. Cortisol levels were measured by radioimmunoassay with intra-assay coeffi cient of variation (CV) 5.1-7.0% and interassay CV 6.0-7.9%. Cognitive ability was assessed by a battery of psychometric tests including Mini-Mental State Examination (MMSE), Executive function- Verbal Fluency Test (VFT) and Mental fl exibility-Trail Making Test (TMT).

This study showed signifi cant relationship between cortisol levels and cognitive dysfunctions. Odds ratio of morning cortisol levels with mini-mental state examination (MMSE), mental fl exibility-trail making test (TMT) and executive function- verbal fl uency test (VFT) were 4.407, 2.647 and 0.195 respectively. Increased age, poor glycemic control, increased waist hip ratio, deranged lipid profi le also had negative impact on cognitive functions.

There is highly signifi cant causal correlation between cortisol level and cognitive dysfunctions in diabetic patients. Increased age and other compli-cations of diabetes also have impact on cognitive function spectrum.

2492-POThe Impact of Subjective Well-Being on People Living with Type 1 DiabetesNICOLE JOHNSON, ASHLEY WINGERT, STEPHANIE T. MELTON, Tampa, FL

Investigation of the link between psychological well-being and chronic disease management is currently developing. Assessments of psycho-social impacts of diabetes among young adults often involve measuring negative effects such as distress, depression and anxiety, but measures of subjective well-being (SWB) have not yet been extensively studied. The current study draws from positive psychology to assess the impact of SWB on diabetes self-management and health outcomes.

The pilot study surveyed 65 young adults with type 1 diabetes (T1DM), aged 18-40, using validated scales to measure diabetes management self-effi cacy, diabetes distress, and SWB. Independent samples t-tests examined differ-ences among gender and continuous glucose monitor usage, while Pearson correlation coeffi cients were calculated to examine relationships between demographic variables and diabetes self-effi cacy, self-care adherence, physi-cian-related distress, interpersonal distress, and satisfaction with life.

Pearson correlation coeffi cients determined SWB is strongly related to di-abetes self-effi cacy, diabetes management, and diabetes health outcomes. Participant scores were further categorized into three groups according to high, average, and low SWB based on composite scores. No differences were found between those with high SWB and low SWB regarding gen-

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der, age, years living with diabetes, level in school, or student/employment status. However, bivariate analysis found higher SWB is associated with greater diabetes self-care adherence and lower HbA1c. Those with low SWB experienced greater levels of physician-related distress and interpersonal distress compared to those with high SWB. Notably, the mean score of interpersonal distress for those with low SWB was at a clinically signifi -cant level. Thus, interventions focused on improving interpersonal support and increasing SWB may be useful for improving health outcomes in young adults with T1DM.

Supported By: Patterson Foundation

2493-POFactors of Subjective Well-Being among Young Adults with Type 1 Diabetes: A Qualitative StudyPAIGE WAGNER, NICOLE JOHNSON, STEPHANIE T. MELTON, Tampa, FL

Young adults with type 1 diabetes (T1DM) struggle with transitioning into adulthood. Diabetes management needs and achieving independence increases the risk of poor health outcomes and increased psychological distress among this cohort. Given the role of psychological health in physi-cal health, better understanding of the lived experiences and perceptions of patients should inform interventions. The purpose of this study was to expand understanding of the factors that contribute to or detract from posi-tive subjective well-being (SWB).

This qualitative study involved interviews with 45 participants aged 18-36 living with T1DM. Interview transcripts were coded using applied thematic analysis approach. Researchers initiated open coding and then refi ned codes to improve reliability. Coding was compared to ensure inter-rater agreement. Analysis identifi ed core themes of support, frustrations, quality of health care, and the impact of diabetes on perspectives and life decisions, as sa-lient factors of SWB.

Participants identifi ed emotional support as the most benefi cial in af-fecting daily well-being and self-perceptions. Emotional support included positive feedback, acknowledgment of the effort of diabetes management, or interest in daily diabetes activities. Frustrations resulted from misinfor-mation about T1DM among the public, the relentless nature of diabetes, fi nancial costs, and emotionally unsupportive relationships, especially with health care providers. Participants reported that feeling unconnected with providers negatively affected their self-care. Despite the challenges T1DM poses, participants described the resiliency and positive outcomes of living with diabetes such as caring for one’s health.

Findings from this study identify areas of intervention such as strengthen-ing peer support among T1DMs, improving patient-provider communication during the clinical transition, and focusing on resiliency as mechanisms to improve subjective well-being.

Supported By: Patterson Foundation

2494-POIntention of Patients to Use ICT-based Diabetes Self-Management Systems: A Cross-Sectional SurveyTOMOMI SHIBUTA, KAYO WAKI, HANAE LEE, NOBUKO TOMIZAWA, NORIKO YAMAMOTO-MITANI, AYUMI IGARASHI, SHIGEKO KATO, HIDEO FUJITA, TOSHI-MASA YAMAUCHI, TAKASHI KADOWAKI, KAZUHIKO OHE, Tokyo, Japan

Our self-management support system DialBetics which is based on infor-mation and communication technology (ICT), signifi cantly improved HbA1c in diabetes patients. This study aimed to determine the prevalence among dia-betes patients of intention to use an ICT-based self-management tool, and the characteristics of such patients, plus the kinds of functions and features they would like in such an ICT tool.

We conducted a cross-sectional interview survey with diabetes patients. Multiple logistic regression analysis was used to identify factors related to their intention to use such an ICT tool. Participants with that intention were further classifi ed by their need of such tools using cluster analysis; the characteristics related to their needs were examined using classifi cation and regression tree analysis.

The mean age of the 244 participants was 66±12 years; 65% of them were men. A total of 131 (54%) participants expressed an intention to use an ICT device for self-management. Associated factors included: outpatient visits more than once a month (vs. less than once for 2 months; OR = 2.2, 95% CI = 1.0-4.7) and being in the contemplation/preparation/action stage of chang-ing diet (vs. not yet contemplating such change, OR = 3.3, 95% CI = 1.2-9.1). Participants with the intention were divided to three groups according to their need: those who needed personalized education; those who needed most of the functions including contact with healthcare providers; and those with no particular needs. These categories differed by participants’ char-

acteristics: those in the “education” group were more likely to have longer diabetes duration; those in the “everything” group tended to be struggling with self-management.

Potential interest in using an ICT-based self-management tool existed among diabetes patients. Intention and specifi c tool needs differed by pa-tients’ characteristics and their diabetes attitudes, suggesting the possibil-ity of multiple tools tailored for each patient by need.

Supported By: NTT DoCoMo of Japan

2495-POAdult Low Blood Sugar Survey (ALBSS) and Insulin Treatment Satis-faction Questionnaire (ITSQ) Patient-Reported Outcomes (PROs) in LY2963016 Insulin Glargine (LY IGlar) and Lantus® Insulin Glargine (IGlar) TrialsMAGALY PEREZ-NIEVES, ROBYN K. POLLOM, AMY M. DELOZIER, RAN DUAN, SAMANEH KABUL, LIZA L. ILAG, Indianapolis, IN

LY IGlar and IGlar are insulin glargine products with identical amino acid sequences. In 2 Phase 3 clinical trials comparing LY IGlar to IGlar, one in type 1 diabetes mellitus patients on basal-bolus insulin therapy (ELEMENT 1 [LY IGlar, n=268; IGlar, n=267]) and one in type 2 diabetes mellitus patients on oral agents with or without previous basal insulin (ELEMENT 2 [LY IGlar, n=376; IGlar, n=380]), fear of hypoglycemia and treatment satisfaction were assessed using ALBSS and ITSQ PRO measures, respectively. The ALBSS has 2 domains, behavior and worry, and is rated on a 5-point Likert scale where higher scores indicate increased fear of hypoglycemia. The ITSQ has 5 do-mains, inconvenience of regimen, lifestyle fl exibility, glycemic control, hypo-glycemic control, and insulin delivery device satisfaction, and is rated on a 7-point Likert scale where higher converted scores indicate higher treatment satisfaction. In both studies, comparing LY IGlar versus IGlar, analysis of co-variance models indicated no signifi cant treatment differences between groups; treatment comparisons on ALBSS or ITSQ showed no statistically signifi cant differences between LY IGlar and IGlar in change from baseline to week 52 and endpoint (ELEMENT 1) or from week 4 to week 24 and endpoint (ELEMENT 2). In ELEMENT 1, LY IGlar and IGlar showed improvements in ITSQ inconvenience of regimen, glycemic control, and insulin delivery de-vice satisfaction domains. Also, IGlar showed improvement in hypoglycemic control and LY IGlar showed improvement in both domains of the ALBSS. In ELEMENT 2, both treatment arms showed improvement in ITSQ glycemic control; LY IGlar also showed improvement in insulin delivery device sat-isfaction domain. In conclusion, patients using LY IGlar in ELEMENT 1 and ELEMENT 2 reported similar levels of fear of hypoglycemia and insulin treat-ment satisfaction as patients using IGlar.

Supported By: Eli Lilly and Company/Boehringer Ingelheim

2496-POAnalyzing Caregiver Blogs to Identify Type 1 Diabetes Mellitus Self-Management Barriers and Facilitators: An Exploratory Qualitative StudySEAN M. OSER, TAMARA K. OSER, HEATHER L. STUCKEY, Hershey, PA

The self-management demands of type 1 diabetes mellitus (T1D) on pa-tients and their caregivers are immense. Sources of real-time support have been limited but have grown in the era of social media. Blogs have become particularly popular, but there is little data on blog use itself. The goal of this study is to identify barriers and facilitators to self-management for caregiv-ers through blog analysis, and to begin to understand the role of blogs in self-management support.

We retrospectively analyzed caregiver blogs, beginning with posts dated August 2014 and proceeding back chronologically for 20 months, or until saturation. Blogs were imported into qualitative analysis software (QSR International NVivo 10). Using grounded theory, we created a codebook for blog analysis, including blog posts and associated visitor comments.

Emergent themes include:1. Caregiver fear of nighttime hypoglycemia in the T1D child.2. Loss of sleep for caregivers.3. Diabetes management as a never-ending, always present, overwhelm-

ing job.4. T1D as the family’s “new normal”—although extra work is required, it

is anticipated and becomes incorporated into routine.5. Public misconceptions of similarities/differences of T1D and type 2 dia-

betes, and educating people about them.6. Unpredictable results from informed care decisions, and therefore con-

tinuously seeking new ways to improve self-management.7. Technological advances as mixed blessings, bringing both new capabili-

ties and new challenges.

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8. Appreciation for and support derived from sharing common feelings and situations.

Blog use for self-management and peer support is a rare example of “re-verse translation” wherein the intervention was developed by the patient/caregiver community and requires scientifi c evaluation, rather than having been conceived by academia and then brought to the community.

2497-POFamilies Defeating Diabetes (FDD): A Canadian Intervention for Family-Centered Diabetes Prevention following Gestational Diabe-tes (GDM): Initial ResultsRUTH M. MCMANUS, LOIS DONOVAN, DAVID MILLER, MICHELLE MOTTOLA, ISABELLE GIROUX, PATRICIA ROSAS-ARELLANO, London, ON, Canada, Calgary, AB, Canada, Victoria, BC, Canada, Ottawa, ON, Canada

Women with GDM are at risk for type 2 diabetes (DM), while their off-spring are at risk for childhood obesity. Family context can inform food and activity decisions. FDD is a multi-centre post-partum healthy living interven-tion for women with recent GDM as well as their family members.

Women and their spouses in London, Calgary and Victoria Canada were recruited in their fi nal weeks of pregnancy, and randomized to control or intervention. Control women were provided with standard DM prevention information from the Canadian Diabetes Association. At 3 months post-partum, interventional women participated in a one-on-one DM prevention seminar; were provided with access to a password-protected FDD website that included biweekly DM prevention emails; and invited to a weekly walk-ing group. Total FDD recruitment is 178 women. We report 3 months fol-lowup for spouses, and 6 months followup for women and offspring.

Interventional (50) vs. Control (47) women results at 6 months: weight 94.7±24.0 vs. 88.0± 19.3 kg (NS); weight change 6 vs. 3 months: -0.45 ±3.2 vs. -0.74±3.3 kg (NS); BMI: 35.0±7.0 vs. 33.0±6.2 (NS). Weight loss by 6 months occurred in 29 interventional vs. 28 control women (NS). Interventional (21) vs. Control (17) spouses results: initial weight: 95.5±20.8 vs. 95.3±22.6 kg (NS); initial BMI: 31.5 ± 8.0 vs. 30.8 ±5.9 (NS); 3 month weight: 96.0±21.5 vs. 95.2±95.21.6 kg (NS); 3 month BMI 31.1±7.2 vs. 20.9±5.6 (NS). Interventional (50) vs. Control (47) infants weight at 6 months: 8.02±1.0 vs. 7.79±1.03 kg (NS); BMI at 6 months: 17.5±2.0 vs. 17.1±2.2 (NS).

At 6 months post-partum, there were no differences in weight or weight loss for women with recent GDM after 3 months of a healthy lifestyle inter-vention. These results, along with spousal and offspring outcomes, provide the foundation for comparisons after 12 months of FDD intervention.

Supported By: International Diabetes Federation

2498-POAssessing the Impact of CampJILL WEISSBERG-BENCHELL, KAREN RYCHLIK, Chicago, IL

Diabetes camp provides a safe and fun environment where youth feel nor-mal while learning new diabetes-specifi c skills. While camp may offer a va-riety of psychosocial and self-care behavior benefi ts, research assessing the impact of camp is relatively sparse. This study assessed the impact of camp on self-care skills and psychosocial functioning from 42 diabetes camps throughout the U.S. Participants were 249 parent/youth pairs (youth age 6-18 years, M=12.6 + 2.5; 57% female; 89% Caucasian; 74% pumpers; 2% CGM us-ers; 32% fi rst time campers). Pre/post-camp data included measures of self-care skills, diabetes-specifi c emotional distress and quality of life. Post-camp data included qualitative assessment of camp experiences. Paired sample T-tests revealed signifi cant improvements in self-care skills among all respon-dents (Child: pre M=90.42 +13.98, post M=94.17 +14.85; t(110) =-3.44, p<.001; Teen: pre M=95.78 +12.84, post M=98.44 +12.76; t(146) =-3.99, p=.0001; Parent: pre M=84.97 +13.76, post M=88.90 +12.26; t(387) =-9.26, p<.0001), and signifi cant improvements in diabetes-specifi c emotional distress for children and parents, but not for teens (Child: pre M=64.27 +21.31, post M=59.96 +21.56; t(117)=2.87, p<.005; Parent: pre M=76.30 + 23.38, post M=68.64 +23.84; t(421)=9.10, p<.0001). Other signifi cant fi ndings include: fi rst timers and their parents saw improvements in diabetes-specifi c skills; boys’ emo-tional distress improved more than girls’; parents with less education and less income felt more distressed than their better educated/wealthier peers; pumpers report better self-care skills and less emotional distress than those using syringes or pens; youth experience less emotional distress than par-ents; youth report having better self-care skills than their parents do. Youth and their parents report the best thing about camp is being with people who are like them, the fun activities, and making friends. Youth report engaging in more self-care behaviors, such as pump/site rotations, after camp.

Supported By: The Leona M. and Harry B. Helmsley Charitable Trust

2499-PO

2500-POPredictors of Quality of Life and Glycemic Control among Saudi Adults with DiabetesMOSTAFA A. ABOLFOTOUH, Riyadh, Saudi Arabia

Introduction: The aims of the present study are; (i) to assess the QoL and glycemic control (GC) among Saudi diabetic patients, and (ii) to determine the signifi cant predictors of QoL and GC.

Methods: A cross sectional survey was conducted to assess the Qol and glycemic control in 420 Saudi adult diabetics at outpatient clinics of KAMC using a previously validated Arabic version of Diabetes QoL Brief Clinical In-ventory. Personal characteristics (age, gender, education, occupation, etc.), disease characteristics (age at onset, duration, type of diabetes, treatment regimen, complications) and lifestyle characteristics (dietary habits, smok-ing behavior, exercising) were obtained. Medical chart data of the duration of diabetes, and most recent HbA1c levels were extracted. Logistic regres-sion analysis was applied to identify the signifi cant predictors of good QoL. Signifi cance limits were set at P <0.05.

Results: The overall percentage mean score of Qol was 74.1+11.6, with good Qol in 29.8% of all patients. Diabetics reported lack of satisfaction of exercise (49.1%), burden on family (31%), and sex-life (28%) due to diabetes, and reported worry of: physical illness (31%), bad night sleep (26%), pain by treatment (24%), and limitation of career (22%) due to diabetes. After adjust-ing for possible confounders, higher QoL score was signifi cantly associated with male gender (t=3.26, p=0.001), treatment with oral pills (2.14, p=0.03), healthy diet (t=2.63, p=0.009), physical inactivity (t=2.28, p=0.023) and ab-sence of diabetic complications (t=3.47, p=0.001). Two-thirds (68.8%) of all patients showed poor glycemic control (PGC). Presence of diabetic complica-tions was the only signifi cant predictor of PGC (OR=1.66, p=0.024).

Conclusion: Changing the lifestyle of Saudi diabetics is necessary to im-prove their QoL. Avoidance of complications is a safeguard against possible deterioration in Qol and glycemic control.

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2502-POComparative Effectiveness Trial of the Diabetes Prevention Pro-gram in FamiliesJENNIFER WESSEL, ERIN PHILLIPS, KELLY PALMER, CHANDAN SAHA, TAMARA S. HANNON, AARON CARROLL, DAVID G. MARRERO, Indianapolis, IN

Up to 70% of mothers and 40% of their children exposed to gestational diabetes (GDM) will develop obesity and type 2 diabetes (T2D). Family based lifestyle interventions targeting either children, parents or both have report-ed mixed results. We modifi ed the Diabetes Prevention Program curriculum to use with families (DPPF) and recruited mothers with a history of GDM and their children 8-15 years old. We randomized n=130 families to test if the DPPF delivered to mothers only (M) or mothers and their children (M+C) is more effective at lowering T2D risk. Baseline characteristics of women and their children were similar among each intervention group. Mothers and their children’s mean age were 38±7 and 11±3years, and body mass index (BMI) and BMI percentile were 37±8 and 78±25, respectively; 55% were black and 23% were Latino. In children 42% were overweight or obese and 55% were male. Women self-reported for themselves and their children low levels of moderate/vigorous physical activity (PA, 54% and 28%, ≤2 days/week), high levels of sedentary activities (SA, 54% and 54%, ≥3 hours/day) and high levels of diet related obesogenic behaviors (75% and 72%, ≥3 days/week of eating meals while watching TV or at restaurants), respectively. Follow-up is ongoing and currently n=66 families have completed 3-month follow-up. Preliminary analyses of mothers by intervention group (M vs. M+C) show decreases in BMI (-1±1.5 vs. 0.30±1.6), SA (32% vs. 34%), eating while watching TV or at restaurants (50% vs. 69%); and increases in PA (42% vs. 40%). In their children decreases in BMI percentile (-1.1±10 vs. -0.4±16), SA (40% vs. 57%), eating while watching TV or at restaurants (52% vs. 76%); and increases in PA (35% vs. 43%) were reported. Results were not signifi -cantly different by intervention group, except in children’s obesogenic eating behaviors (p=0.01). Preliminary results support lifestyle changes in mothers and children’s reduces their T2D risk however evidence is still inconclusive in determining who the intervention should target.

Supported By: Jeffrey Picower Foundation

2503-PODiabetes Medication Adherence in Cancer SurvivorsALEXANDRA ROSENBERG, YAEL HARRIS, JUAN P. WISNIVESKY, JENNY J. LIN, New York, NY, Great Neck, NY

An increasing number of cancer survivors live with diabetes but it is un-clear if self-management of diabetes differs in cancer survivors versus those without cancer.

We recruited diabetic patients with newly-diagnosed early-stage cancer taking ≥1 oral hypoglycemic agent and control patients of similar age, sex and hemoglobin A1c level without cancer. We provided an electronic pill bottle (ECaps®) for three months to objectively assess medication adherence. Self-reported adherence was measured using the 8-item Morisky Medication Ad-

herence Scale© (MMAS). Non-adherence was defi ned as <75% adherence by ECaps or MMAS score <6. Descriptive and univariate analyses were used to assess differences between adherent vs. non-adherent participants.

We have recruited 56 participants. Of these, 26 (46%) had both cancer and diabetes, 30 (54%) were male, and most (89%) were taking metformin. Compared to controls, participants with diabetes and cancer more fre-quently reported being sad (46% vs. 14%, p=0.01), loss of appetite (42% vs. 10%, p=0.01), and fearing something bad was going to happen (23% vs. 3%, p=0.04). Twenty participants (55%) were adherent by self-report whereas 28 (74%) were adherent as measured by ECaps. Objective adherence correlated with MMAS scores (r=0.43, p=0.01).

Of those who were adherent, 83% did not have cancer and 60% had can-cer (p=0.15). Adherent participants were more likely to be concerned about their diabetes (79% vs. 30%, p=0.02) and agree that treatment could help diabetes (100% vs. 50%, p<0.01). Adherence was not associated with de-pression scores or beliefs about medications.

Although participants with cancer have more symptoms of depression, their medication adherence does not appear to differ from those without cancer. Those who are non-adherent are less concerned about diabetes and less certain that treatment will help diabetes. Further work should assess whether enhanced education about diabetes treatment effi cacy will improve medication adherence.

Supported By: National Institutes of Health; National Cancer Institute (1K07CA166462-01 to J.J.L.)

2504-POPsychometric Validation of the Diabetes Technology QuestionnaireTIM WYSOCKI, GRAFTON REEVES, MARK KUMMER, JUDITH ROSS, MILES YU, Jacksonville, FL, Wilmington, DE, Pensacola, FL, Philadelphia, PA, Orlando, FL

Assessing existing and coming technologies for type 1 diabetes (T1D) care (e.g., insulin pumps, continuous glucose monitors, iterations of an artifi cial pancreas) is impeded by the lack of a well validated measure of participant-reported outcomes. This paper describes validation of the 30-item Diabetes Technology Questionnaire (DTQ), a measure of adolescent and parent per-spectives of the impact of, and their satisfaction with, their currently used diabetes technologies (“Current” items) and about newly adopted technolo-gies after >3-mo use (“Change” items). In a prospective study of benefi t from CGM, 116 adolescents with T1D and HbA1C >7.5% and a parent completed the DTQ at Baseline and quarterly clinic visits. Several psychometric prop-erties of the DTQ were calculated. Compared with a maximum DTQ score of 150, results of DTQ Current items yielded approximately normally dis-tributed mean + SD scores for youth (101.2+23.9) and parents (94.4+23.8). Mean DTQ Change item scores were 97.3+14.3 for youth and 95.8+24.6 for parents. Alpha coeffi cient for Current items was 0.94 for youth and 0.95 for parents, while that for Change items was 0.95 for youth and 0.92 for parents. Split-half reliability ranged from 0.79 (Child DTQ Current) to 0.88 (Parent DTQ Change). For Current items, 3-mo test-retest reliability (Pearson r) averaged 0.61 for youth and 0.73 for parents. For Change items, test-retest reliability was 0.49 for youth and 0.58 for parents. Parent and adolescent scores cor-related 0.31 for Current items and 0.34 for DTQ Change items. Youth mean Change item scores were unrelated to either Youth or Parent-reported qual-ity of life (PedsQL Diabetes Module). Parent Change item scores were sig-nifi cantly correlated with both parent and youth PedsQL at 3-mo (r=0.43 and 0.29, respectively) and with parent PedsQL at 6-mo (r=0.40). Affi rmation of the psychometric merits of the DTQ supports use of the DTQ as an outcome in patient-centered research on use of new diabetes technologies by adoles-cents with T1D and their parents.

Supported By: National Institutes of Health-National Institute of Diabetes and Digestive and Kidney Diseases

2505-POSexual Function of 26- to 36-Year-Old Healthy and Type 1 Diabetic Males Using the European Male Aging Study Sexual Function QuestionnaireZILVINAS VENCLOVAS, INDRE MATULEVICIUTE, RYTAS OSTRAUSKAS, RASA VERKAUSKIENE, VAIDOTAS URBANAVICIUS, VALENTINAS MATULEVICIUS, Kaunas, Lithuania, Vilnius, Lithuania

The aim of the study was to evaluate differences of various sexual aspects comparing the groups of healthy and type 1 diabetic (T1D) males. Healthy (n=82) and T1D males (n=123) fulfi lled the European Male Ageing Study (EMAS) sexual function questionnaire (SFQ). Participants were 26-36-year-old. Males were divided into three groups: having permanent sex partner, having irregular sex partner, without sex partner. Statistical analysis was performed using IBM SPSS Statistics (20.0). Statistically signifi cant differ-

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ences of percentage values were determined using Student T test and differ-ences between groups were determined using Chi square and Kruskal Wallis tests for independent samples.

Healthy males masturbated more frequently than T1D males (2.27; 1.94 [M; SD] and 0.71; 0.82, p<0.004) from the beginning of the disease. Sexual functioning distress (SFD) was signifi cantly higher in T1D males (3.68; 3.77 and 1.42; 1.93 respectively, p<0.0001), starting from 5 years of diabetes du-ration. Overall sexual functioning (OSF) became lower in T1D patients after 10 years of the disease duration (19.24; 5.34 and 21.2; 5.62, p<0.026). Males with permanent sex partner masturbated more frequently than T1D males (74.6% and 44.2%, p<0.05). There were no statistical differences between healthy and T1D males with irregular sex partner or without partner (66.2% and 55.2%; 80.0% and 70.6%). Results of EMAS-SFQ show that differences of domains of sexual function appear progressively in 3 out of 4 sexual do-mains in the step forward fashion (masturbation-SFD-OSF) and are all fi nally found at 10-19 years of T1D duration. Masturbation is lower in T1D males from the beginning of the disease. Masturbation did not differ between the groups of males with regular, irregular sexual partner and without partner at all. Results deny the myth that Lithuanian males with regular sex partner often do not masturbate while males without sex partner masturbate more frequently.

2506-PODepression, Illness Perception, Compliance, and HbA1c Level in Pa-tients with Type 2 DiabetesEWA WOJTYNA, AGNIESZKA WITKOWSKA, WLADYSLAW GRZESZCZAK, JANUSZ GUMPRECHT, Katowice, Poland, Zabrze, Poland

The therapy of type 2 diabetes requires a good patient’s compliance, but it depends on illness perception. Depression can affect both compliance and metabolic balance, however, the patient condition and the level of metabolic control alone predict of the depression risk. This study aimed to evaluate the relationship between depression, compliance and HbA1c level. The pa-tients structured interview regarded to compliance, HbA1c serum level and Beck Depression Inventory (BDI) test were assessed among 202 patients (104 M , 98 F aged 55.38 ± 7.93 years) in the cross-sectional study. In results only 58.2% subjects fulfi lled doctor’s recommendations. The average HbA1c blood level was 7.83% (SD=1.35) and 49.5% of the patients was diagnosed with the clinical depressive episode. The path analysis revealed that the study model explains 30% of compliance variance and 74% of HbA1c level variance. Among studied parameters the only compliance has a direct effect on HbA1c level (β=-.44). The others as treatment control (β=.36) and depres-sion (β=-.38) are linked directly to compliance level. The illness perception is also linked to compliance level but indirectly that is mediated by depressive-ness. Most important indirect impact on compliance has the personal control and this connection is mediated by patient’s treatment control opinion. The risk of depression itself depends on the illness perception. Negative view of after - consequences and recurrence of diabetes promotes exacerbation of depressive symptoms. On the other hand, high control perception as per-sonal as infl uenced by treatment affects on reduction of depressive signs.

In conclusion, the clinical programs for diabetic patients should be profi led on reduction of depressive symptoms and enhancement of patients opinion on personal infl uence on disease and treatment effectiveness.

2507-POA Greater Impact of Diabetes Complications on Depression in Im-migrant Australian Chinese: A Hidden ComorbidityMARGARET MCGILL, ZHAOLIN MENG, LYNDA MOLYNEAUX, TED WU, DENNIS K. YUE, JENCIA WONG, Camperdown, Australia, Beijing, China, Sydney, Australia

Immigrant Chinese (CI) may experience higher levels of diabetes-related distress given different cultural attitudes. The Patient Health Question-naire-9 (PHQ9) was administered to 100 CI and 88 Europeans (E) with type 2 diabetes to screen for depression, (minimal, mild and moderate to severe grades defi ned in Table). Association of PHQ9 scores with metabolic fac-tors and complications burden were studied. The distribution of depression scores were equivalent, with moderate-severe depression scores in 19% and 18% of CI and E respectively. Only 2% of CI acknowledged a history of depression. Interpreter use was associated with a higher depression score in CI. There was a commensurate rise in severity of depression with increas-ing prevalence of complications in CI, a relationship not seen in E (p=0.007). By multivariate analysis, CI PHQ-9 scores were independently associated with hypoglycemia, diabetes-complications, time spent alone, and ability to speak English, collectively explaining 36.4% of the variance in CI PHQ-9 scores (p<0.001). In contrast, PHQ9 score was not associated with metabolic or diabetes complication factors in E cohort. Depression in CI was more ro-

bustly associated with diabetes-related factors than in E. Depression is a hidden comorbidity especially for CI with diabetic-complications.Table. Depression Demographic Profi le European and Chinese.

2508-PODoes a Drama-included Educational Program, Diabetes Theater, for Health Care Professionals Improve the Participants’ Attitude toward Diabetes Care?KENTARO OKAZAKI, HIROSHI OKADA, KEN OHASHI, TOSHIKAZU YAMAMOTO, TAKAYUKI ASAHINA, Nagoya, Japan, Kyoto, Japan, Tokyo, Japan, Okinawa, Japan

Diabetes Theater (DT) is an educational workshop designed for audience to learn about the philosophy of the empowerment. They refl ect on their own practice by watching the play based on common problems of misunder-standing between a patient and healthcare professionals (HCP) in a clinical practice, and joining the discussion by focusing the good points and improve-ments of the practice in the drama. The aim of our study was to investigate the effect of DT on participants’ attitude toward diabetes care. Participants of DT held at the 57th annual scientifi c meeting of Japan Diabetes Society were requested to answer a questionnaire before and after the program. To compare the scores before and after, a paired t-test was performed with a signifi cance level of alpha = 0.05. We analyzed the data of 131 respondents (nurses 54%; dietitians 16%; doctors 11%; pharmacists 11%; and others 8%). Attitude was measured by four items from the Diabetes Attitude Scale, us-ing 11 point Likert scale with 0=strongly disagree and 10=strongly agree. In the attitudes toward diabetes care, HCPs’ score increased signifi cantly in each item. In detail, “HCPs should be trained how to communicate with their patients” (from 8.1±2.0 to 9.1±1.5); “HCPs should learn the counseling skills” (from 8.0±1.9 to 9.2±1.4); “HCPs should learn how to set goals with patients” (from 8.5±1.6 to 9.4±1.3); “people with diabetes have the right not to take good care of their diabetes” (from 6.2±2.5 to 7.4±2.5) (from before to after, mean ± SD). In conclusion, HCPs who participated in DT changed their attitudes toward diabetes care positively. They put more focus on the importance of special training in key elements of the empowerment, such as communication, counseling, and collaboration skill with patients. This result suggests that DT could be useful to improve the attitudes of HCPs in diabe-tes care in terms of the empowerment.

Supported By: Japan Society for the Promotion of Science

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2510-POHow Patients and Their Families Feel Distress or Relief in the Initial Treatment and Guidance at the Onset of Pediatric Type 1 DiabetesMASAKAZU HIROSE, TOMOYUKI KAWAMURA, MEGUMI HATANO, YUKO HOTTA, KAYAKO HASHIMURA, YONEO KASHIHARA, TOMOMI HASHIMOTO, TAKASHI HIGASHIDE, KAYO KIMURA, MAYUMI AONO, SHIGEO AONO, HARUO SHINTAKU, Osaka, Japan, Tokyo, Japan

We aimed to investigate psychological burdens and satisfaction in initial treatment and guidance in pediatric patients with type 1 diabetes and their parents by conducting a qualitative study based on interviews.

Nineteen patients were enrolled and interviewed about their hospitaliza-tion duration, treatment, dietary instruction, exercise therapy, physician’s explanation of the disease, and so on. The interviews were coded by NVivo 9 software for analysis.

The subjects’ age was 7.3 ± 3.3 years; age at onset, 4.9 ± 3.1 years; disease duration, 2.5 ± 0.95 years; and HbAlc level, 7.6% ± 0.78%. In the analyses, the subjects were divided into those admitted for 2 weeks or less (group 1, 8 patients) and those admitted for more than 2 weeks (group 2, 10 patients). For guidance, many of the opinions were regarding dietary instructions, which were mostly negative in group 2. Many patients had negative feelings about snacks and dietary restrictions (7 patients, 15 comments), and some patients felt distress about food from fi xed insulin dose regimens without obvious calorie restrictions (8 patients, 15 comments). Most of the subjects in group 1 were instructed about carbohydrate counting and insulin pump therapy. While some reported that carbohydrate counting was diffi cult to do, most patients had positive feelings thatit was reasonable (7 patients, 7 com-ments). Also insulin pump therapy decline their psychological anxiety about their insulin injection and dietary restrictions (5 patients, 7 comments).

In conclusion, our fi ndings indicate that by providing specialized knowl-edge and treatment methods, patients’ satisfaction levels could be increased within a short hospitalization duration. In the initial treatment, the patients’ quality of life (QOL) declined due to dietary restrictions. The patients also felt restricted by the fi xed insulin dose regimens.

CLINICAL THERAPEUTICS/NEW TECHNOLOGY—GLUCOSE MONITORING AND SENSING

2511-POThe Effect of Altitude and Exercise on Blood Sugar Control in a Type 1 Diabetic Compared with Nondiabetic Age-Matched PeersBLAKE A. COOPER, JULIE JONES, ALLISON JONES, AMEILA COOPER, Shawnee Mission, KS, Kansas City, MO

While skiing is an excellent form of exercise it can have severe effects on blood sugar (BS) that needs to be better understood. Altitude and cold have been reported to have profound effect on BS control. Ascending to high altitudes releases extra cortisol to help with the lower levels of oxygen; but cortisol, like other stress hormones, may also raise BS levels. Being cold throughout the day makes it harder to check and maintain ones BS. Most people regardless of exercise tend to have more lows when they are cold for extended periods of time. Our study examines the effects of altitude, temperature, exercise (in the form of downhill skiing), and carbohydrate in-take on the BS in a type 1 diabetic compared to age matched non-diabetic peers. All participants wore a Dexcom G4 sensor and BS, carbohydrate con-sumption, insulin usage, level and type of exercise, and temperature were recorded for 5 days near sea level and again at high altitudes. Maintaining a safe blood sugar level while skiing can be challenging. Our results suggest that this is possible in a T1DM population. Careful monitoring is the only way to make sure that BS level remains within a target range. Continuous glucose monitoring was especially helpful for preventing hypoglycemia and ensuring a safe BS level prior to riding a chairlift and while skiing. Key results are summarized in the Table.

Table. The Effect of Altitude and Exercise on Blood Sugar Control.Mean

Blood Sugar (mg/dL)

Standard Deviation

% Hypoglycemia (

% In Target

(80-130 mg/dL)

% High

% Low

Total Daily Insuiln U(Basal/Bolus)

Near Sea Level (800 feet)Non-diabetic Control group 96 24 1 76 6 18Type 1 Diabetic 104 36 3 45 24 31 25.20/18.14

Altitude (6000-10000feet)Non-diabetic Control group 86 16 2 73 1 26Type 1 Diabetic 111 41 4 50 26 22 36.89/27.01

2512-POImpact of Blood Glucose Reporting on Glycemic Variability in Dia-betic VeteransCHRISTIAN MANGRUM, LYNETTE SMITH, VIJAY SHIVASWAMY, Omaha, NE

There is limited data regarding frequency of blood glucose reporting by diabetics to their treatment teams, and how this frequency affects glycemic control. We hypothesized that patients who report glucoses at least monthly would have less hypoglycemia and hyperglycemia than those who report less frequently. We performed a prospective, observational study of all our diabetic veterans on insulin pumps via analyses of their submitted glucose downloads over 4 months. Hyperglycemia was defi ned as blood glucose > 180 mg/dl, hypoglycemia as < 70, and severe hypoglycemia as <50. Univari-ate analysis was done with t-test and chi-square tests. Poisson regression was used to compare hypoglycemia and hyperglycemia rates. Frequent reporters showed a higher rate of hypoglycemia (7.5% vs. 6.2%, p <0.001) and severe hypoglycemia (1.6% vs. 1.3%, p <0.034), compared to infrequent reporters. Frequent reporters showed a trend towards less hyperglycemia compared to infrequent reporters (36.8% vs. 38.2%, p <0.078), though not statistically signifi cant. Frequent reporters were older and had a longer dura-tion of diabetes. Patients who were younger, female, and had higher A1c all had more hyperglycemia while those who were female, had shorter duration of diabetes, lower BMI, and higher A1c showed more hypoglycemia. More frequent blood glucose reporting by diabetics to their treatment team may help predict glycemic trends and guide glycemic effi cacy.

Table. Baseline Characteristics.Frequent Reporters (≥ 4)

(n=20)Infrequent Reporters

p-value

Age (years) 62 54 .034BMI 27.8 29.8 .31Years DM 31 22 .025Baseline A1c 7.9 8.1 .55Hyperglycemia rate (>180) 36.8% 38.2% .078Hypoglycemia rate (<70) .075 .061 <.0001Severe Hypoglycemia rate (<50) .016 .013 .034

2513-POEffect of Linagliptin on Glycemic Control and Variability in Patients with Impaired Glucose ToleranceESPERANZA MARTÍNEZ-ABUNDIS, TONATIUH GONZÁLEZ-HEREDIA, DIANA M. HERNÁNDEZ-CORONA, MANUEL GONZÁLEZ-ORTIZ, Guadalajara, Mexico

The impaired glucose tolerance (IGT) frequently progresses to diabetes in few years. The IGT and the glycemic variability (GV) may be associated with an incremented risk of micro- and macro-vascular complications. Linagliptin enhances glucose-induced insulin secretion, decreases glucagon secretion, and reduces postprandial glycemic excursions, which make to this drug, a good candidate to improve the glycemic control and GV in IGT patients. The aim of this study was to assess the effect of linagliptin on glycemic control and GV in patients with IGT.

A randomized, double blind clinical trial with parallel groups, was per-formed in 16 adults with IGT and overweight or obesity. All patients signed an informed consent. Pharmacological intervention was indicated orally dur-ing 90 days and assigned at random: a) Linagliptin 5 mg in the morning and placebo in the evening; or b) Metformin 500 mg twice a day. At the beginning and 90 days later, fasting glucose, lipid profi le, glycated hemoglobin A1c, oral glucose tolerance test (75 g) and GV, were measured. GV was assessed by the mean amplitude of glycemic excursion (MAGE) and by area under the curve (AUC), through of the sensor-based continuous glucose monitoring

diabetes education category...a623 for author disclosure information, see page a810. category...

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