1School of Nursing, University of North Carolina-Greensboro, Greensboro, NC, USA2School of Nursing, University of North Carolina-Greensboro, Greensboro, NC, USA
The Science of Diabetes Self-Management and Care2024, Vol. 50(4) 320 –327© The Author(s) 2024Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/26350106241276809journals.sagepub.com/home/tde
Background/Purpose: Type 2 diabetes in non-Hispanic Black adults continues to rise along with co-morbid conditions, disability, and mortality despite advances in diabetes pharmacology and technology. Self-care of diabetes and diabetes distress can influence self-management of T2D in non-Hispanic Black adults. Recruitment of non-Hispanic Black adults with T2D in clinical research is essential to implement culturally appropriate interventions. The purpose of the session was to discuss recruitment strategies implemented in a crosssectional, correlational research study examining the relationship between self-care of diabetes and diabetes distress in non-Hispanic Black adults.
The study research questions were:
Why is it essential to recruit non-Hispanic Black adults with T2D?
Who are the stakeholders?
What are the acceptable delivery methods and language for recruitment?
What recruitment strategies (flyers, in-person presentations, virtual meetings, and social media) may be implemented?
Methods: Recruitment strategies began by identifying community partners to try to access potential participants in community settings or organizations frequented by non-Hispanic Black adults. Faith-based and social organizations (sororities and a fraternity), nurse practitioner-owned practices, business establishments, and a predominantly Black professional nursing organization were selected and contacted. Templates were created for consistent communication with recruitment partners and social media postings. The templates included the title of the study, the purpose, and the participant’s role. The recruitment partners selected recruitment strategies (flyer, email, video-embedded PowerPoint, in-person, or social media). Participants completed an online survey accessed via a QR code on a flyer or a URL link via social media or email communication. The online survey included a sociodemographic questionnaire and two instruments measuring self-care of diabetes and diabetes distress.
Results: Letters of support were received from sixteen recruitment sites, with thirteen becoming active sites. The recruitment strategies selected by the recruitment partners varied. Many participants (30%) learned about the study via social media (Facebook, Instagram, and GroupMe), which was used the most by the fraternity and the professional nursing organization. Recruitment occurred from July 2022 – September 2022. The required number of participants was reached in August 2022. The number of participants recruited exceeded the planned sample of 110. The online survey was accessed by 512 individuals, most using the URL link versus the QR code. After data screening of the 512 individuals, 275 participants were used for data analysis.
Conclusions: Recruiting non-Hispanic Black adults with T2D is necessary to build knowledge about the effectiveness of interventions and prevent diabetes-related complications. The participation of non-Hispanic Black adults in clinical research is critical and can support the generalizability of research findings. Effective recruitment strategies can engage this population in clinical research by using community groups, social media, community health workers, and peer groups.
Disclosures: None.
1Sansum Diabetes Research Institute, Santa Barbara, CA, USA
Background/Purpose: Technosphere Insulin (TI) is an ultra-rapid-acting inhaled insulin used to manage post prandial glucose excursions. The purpose of the study was to determine its effectiveness in managing post meal blood glucose compared to usual care.
Evaluating the efficacy and safety of TI when used in conjunction with once daily insulin degludec (TI-D, N=62) compared with usual care insulin delivery (UC, N=61), which included multiple daily injections (MDI), nonautomated pump, or automated insulin delivery (AID) in CGM-using adults with T1D.
Methods: A multi-center randomized trial that, following 1:1 randomization, included an in-clinic standardized meal (Boost nutritional shake with 37g carbs) challenge that was performed in which the TI-D group bolused with TI and the UC group received their usual-care rapid acting analogue (RAA). The TI group took their inhaled insulin dose immediately before the meal and the UC group took their rapid-acting insulin at 10 +/- 5 minutes before the meal.
Results: Mean age was 45±15 y, 54% female, mean baseline A1C 7.6±0.9%. Pre-study insulin delivery was MDI in 44%, non-automated pump 6%, and AID 50%. The mean glucose excursion during the first 2 h of the meal challenge was 84±61 mg/dL in the TI-D group and 110±44 mg/dL in the UC group (difference = -24 mg/dL, 95% CI -41 to -6.0, p=0.01) as seen in the Figure. The treatment group difference was -31 mg/dL in pre-study MDI/nonautomated pump users and -17 mg/dL in AID users.
Conclusions: The meal challenge results indicate substantially reduced post-meal glucose excursion with TI compared with RAA subcutaneous insulin.
Disclosures: KC receives research support provided to her institution from Dexcom, Abbott, Medtronic, Ely Lilly, MannKind and Insulet and receives consulting fees from Dexcom, MannKind and Laxmi.
1College of Nursing, University of Central Florida, Orlando, FL, USA
2Disability, Aging and Technology Cluster, University of Central Florida, Orlando, FL, USA
3Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
4College of Pharmacy, University of Texas at Austin, Austin, TX, USA
Background/Purpose: Telehealth coverage, including the Medicare telehealth Diabetes Self-Management Training (DSMT) benefit, was expanded during the COVID-19 public health emergency. Virtual DSMT requires beneficiaries to have access to digital resources, including a computer and the Internet. Some beneficiaries may not have access to these resources, resulting in digital disparities. This study examined factors associated with access to digital resources required for virtual DSMT participation among Medicare beneficiaries. The aim was to determine whether sociodemographic characteristics (e.g., race/ethnicity, education level, income, area of residence) and health status (e.g., number of chronic conditions) were associated with access to digital resources among Medicare beneficiaries aged ≥65 years with reported diabetes and no prior diabetes self-management training.
Methods: Using the 2021 nationally representative Medicare Current Beneficiary Survey Public Use File, a binary dependent variable of having a computer/laptop/tablet and history of using the Internet was created. A surveyweighted multivariable logit model, adjusted for socio-demographics and comorbidities, was conducted to estimate predictive margins and marginal effects for comparing the prevalence of having a computer/laptop/tablet and Internet usage between groups.
Results: Of 1,779 study beneficiaries (representing 10.3 million beneficiaries), 38.6% did not have a computer/laptop/tablet and did not use the Internet. Hispanic, non-Hispanic black (NHB), and other minority beneficiaries (e.g., NHB, marginal effect [ME]=-13.5% CI [-22.1%, -4.8%]) were less likely than non-Hispanic white beneficiaries to have a computer/laptop/tablet and to use the Internet. Beneficiaries with less education (< high school (HS) and HS education) (e.g., < HS, -54.5% [-62.9%, -46.1%]) were less likely to have a computer/laptop/tablet and to use the Internet. Beneficiaries with lower incomes (< $25,000) (-15.3% [-21.8%, -8.8%]) and those living in non-metro areas (-5.9% [-11.3%, -0.5%]) were less likely to have a computer/laptop/tablet and to use the Internet.
Conclusions: This study found that approximately two-fifths of DSMT-eligible beneficiaries, potentially representing 3.9 million beneficiaries, lacked the digital resources necessary to receive full-service virtual DSMT. Digital disparities were observed based on race/ethnicity, income, education, and area of residence. Efforts to encourage enrollment in DSMT through telehealth and develop accessible programs must address digital disparities among at-risk beneficiaries.
1Venice Family Clinic, Los Angeles, CA, USA
2David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
3School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
4VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
Background/Purpose: Despite the numerous benefits of continuous glucose monitors (CGMs) in patients with diabetes (PWD), studies have consistently reported inequities in its use in racial-ethnic minorities, those of lower socioeconomic status, and those with public insurance. In January 2022, a California policy eased Medicaid criteria for CGMs, thus presenting an ideal time to evaluate CGM use from these underserved and understudied populations. The purpose of the study was to evaluate impacts of CGM use post-policy change in patients using multiple daily injections of insulin from an urban, multi-centered, federally qualified health center (FQHC). Patients were initiated and managed on CGMs by certified diabetes care and education specialists (CDCES) in a nurse practitioner-led diabetes management program.
Methods: PWD were studied retrospectively at an FQHC from January 2022 through June 2023. Patients were stratified by CGM use: current, former, and never users. Descriptive statistics were used to summarize and report demographics and clinical characteristics. Chi-squared test was used to assess group differences. Multivariate logistic regression was performed to evaluate predictors of >1% improvement in A1C change over the study period.
Results: One hundred and seventeen patients met inclusion criteria. The majority were Hispanic (97%), Spanish speaking (67%), with a diagnosis of type 2 diabetes (85%) and a baseline A1C ≥ 10% (38%). At the end of the study period, 48% were current CGM users, 14% were former users and 38% were never users. Among current and former CGM users, 34% had an A1C improvement ≥ 2% (P=0.025). Among never users, 47% experienced worsening A1C (P=0.025). In an adjusted analysis, being a current or former user of CGM was associated with a 4-fold increased odds ratio for having an A1C improvement greater than 1% over the study period (OR 4.0 95% CI 1.34-11.85).
Conclusions: Among vulnerable PWD seen at an FQHC, CGM use showed a statistically significant improvement in A1C in those using multiple daily injections of insulin. In populations that historically experience more barriers accessing diabetes technology, the DCES is at the forefront of introducing these devices to underserved communities, while playing a pivotal role in leading the movement for equitable diabetes care.
Disclosures: This research was supported by UC END-DISPARITIES Grant #P50-MD017366, NIH National Center for Advancing Translational Science (NCATS):UCLA CTSI UL1TR001881 or UCI ICTS UL1TR000153.
1College of Pharmacy, University of Houston, Houston, TX, USA
Background/Purpose: The use of a continuous glucose monitor (CGM) has been shown to improve glycemic control in patients with uncontrolled diabetes. The 2024 American Diabetes Association guidelines recommend CGM to assist patients with diabetes to reach glycemic targets while providing convenience and improved quality of life. However, data regarding the impact of short-term CGM is lacking in patients at a federally qualified health center (FQHC). A pharmacist-run CGM program was implemented as a quality improvement initiative to improve glycemic control in patients with diabetes at Vecino Denver Harbor Family Clinic. The purpose of the program was to evaluate the impact of a 3-month pharmacist-run CGM pilot service on glycemic control at a FQHC.
Methods: Enrolled patients were provided the Freestyle Libre 2 system, closely followed by clinical pharmacists every 2-4 weeks for 3 months, and medications were adjusted and/or initiated based on CGM results. A retrospective chart review was performed on patients who completed the program. The primary outcome was a change in A1C from baseline after 3 months in the program.
Results: A total of 93 patients were enrolled in the program. Sixteen patients were lost to follow up, 2 were discharged due to nonadherence, and 2 did not have a final A1C. Among the 73 patients who successfully completed the program, the mean baseline and final A1C levels were 11.4% and 8.4%, respectively. Over the course of 3 months, there was an average change in A1C of -3.0%. Notably, of the 70 patients who started the program with A1C >9%, 49 patients (70%) ended with A1C < 9% which assisted the clinic in meeting national quality measures.
Conclusions: A pharmacist-run CGM service was found to decrease A1C from baseline after 3 months in the program. The significance must be reassessed with a larger population in the future. Future assessment will include evaluating other contributing factors and whether the HgbA1c lowering is maintained after program completion.
Disclosures: Dexcom (Research Grant).
1College of Nursing, University of Utah, Salt Lake City, UT, USA
2College of Nursing, University of Utah, Salt Lake City, UT, USA
3College of Nursing, University of Utah, Salt Lake City, UT, USA
4College of Nursing, University of Utah, Salt Lake City, UT, USA
5Global Deaf Research Institute
6College of Nursing, University of Utah, Salt Lake City, UT, USA
Background/Purpose: Managing diabetes is complex, and care partners (CP), including family or friends, exhibit helpful and harmful behaviors to people with diabetes (PWD). Deaf and hard of hearing (DHH) individuals have higher diabetes rates and face unique challenges accessing diabetes self-management education and support (DSMES). DHH-PWD’s CP have mixed hearing status (deaf, hard of hearing, hearing) and may need special training on how to support DHH-PWD.
A community board of 6 CPs engaged in 2 meetings to explore CP experiences providing support to DHH-PWD and suggestions for DSMES that include CP needs. CP feedback was then implemented into Deaf Diabetes Can Together. DHH-PWD who participated in DDCT (N=15) were asked to nominate a CP who could participate with them.
Methods: A community board of DHH (N=4) and hearing (N=2) CP engaged in 2 two-hour meetings to explore how CP experience providing support to DHH-PWD and their suggestions for DSMES. Individual and collective responses were thematically analyzed. CP feedback was then implemented into DDCT. DHH-PWD who participated in DDCT were asked to nominate a CP who could participate with them.
Results: CP provided emotional, informational, and tangible support and were often overwhelmed in meeting the demanding and ongoing needs of DHH-PWD. Specific challenges to diabetes care included communication barriers with healthcare providers, inability to use hearing cues if the DDH-PWD falls from hypoglycemia, and access to DSMES in sign language. CP recommended DSMES to include children of deaf adults (CODA) aged 12+, so CODAs are educated in how and why to provide diabetes support. Among 15 DHH-PWD who participated in DDCT, only 1 CP co-participated. Low CP participation was due to schedule conflicts, other disabilities, being too shy, DHH-PWD choice to not include, and DHH-PWD who did not have a CP.
Conclusions: CP to DHH-PWD experience unique challenges and require support that is different from hearing populations. A DSMES program that includes both DHH-PWD and CP may be untenable for CP. Future work should explore a CP training program that is separate, rather than in conjunction with DSMES, that also considers other disabilities. Additional work should include CODA-specific training.
Disclosures: This work was funded by the Diabetes Research Center at Washington University through grant P30 DK020579 and in part by the Gordon and Betty Moore Foundation through grant GBMF9048.
1Grand Valley State University, Allendale, MI, USA
2University of Kentucky, Lexington, KY, USA
Background/Purpose: Diabetes care is an important aspect of keeping children with diabetes safe at school. In Kentucky, non-medical school personnel have been granted the ability to provide diabetes care and medications to children with diabetes, however access to systematic training for school personnel is limited. The Diabetes in KY Schools training program, an ongoing online and on-demand program, was developed for use in KY schools to provide consistent, evidence-based diabetes care and management education for non-medical school personnel. Continuous quality improvement for the training program is guided by input from the school personnel. Therefore, the purpose of this analysis was to explore program participants’ experiences with the training program for continuous quality improvement.
Methods: Qualitative description was used to explore de-identified program participant feedback (N=33) for guiding continuous quality improvement. Program feedback was collected between July 2020 to July 2022. Using the process of thematic analysis, two coders reviewed participant feedback to identify common themes. After initial coding, a guide was developed and used for further identification of emerging themes through constant comparison.
Results: Three overarching themes emerged: 1. Commitment to Practice Change, including impact of the training on practice, acquisition of hard and soft skills related to identification of emergent symptoms and corrective treatments, monitoring blood glucose levels and urine ketones, medication administration, carbohydrate counting, and use of person-first language versus “diabetic” references to students; 2. Student Support, which included identification of healthy versus risky coping strategies, student involvement in their own care during the school day, strategies to support students, and areas for addressing student safety; and 3. Program Evaluation, including benefits of the training, such as enhanced confidence, and areas for improvement, such as additional training content and content delivery methods.
Conclusions: Program participant feedback provides insight regarding training needs for non-medical school personnel who provide diabetes care to children. These findings aid the process of continuous quality improvement of a state-wide training program developed to support school personnel in the provision of safe and equitable care for children with diabetes within the Kentucky school system and can inform the development of similar programs in other states.
Disclosures: This project was funded through the Kentucky Department of Public Health through a cooperative agreement with the Centers of Disease Control and Prevention’s 2018 Prevention and Public Health Funds (grant ID #: CDC-RFA-DP18-1815PPHF18).
1The College of Nursing, The University of Utah, Salt Lake City, UT, USA
2The College of Nursing, The University of Utah, Salt Lake City, UT, USA
3The College of Nursing, The University of Utah, Salt Lake City, UT, USA
4The College of Nursing, The University of Utah, Salt Lake City, UT, USA
Background/Purpose: Women diagnosed with gestational diabetes (GDM) during pregnancy experience challenges managing glucose levels with dietary changes. Women with GDM have a sevenfold higher risk of developing future Type 2 diabetes mellitus (T2DM). Evidence-based recommendations for managing GDM include prompt nutritional counseling with a registered dietitian experienced in diabetes management and/or a certified diabetes care and education specialist, with three additional follow-up appointments with this individual. The purpose of the study was to describe women’s experiences/perceptions after dietary counseling for GDM, and to identify potential barriers for adopting dietary patterns to prevent T2DM.
Methods: Focus groups were conducted over Zoom with women who managed GDM by diet alone. Women were recruited from the electronic health record. Topics discussed were the types of clinicians providing dietary counseling, the nutritional messages given, dietary changes adopted, and gaps in nutritional counseling. Participants completed a GDM dietary self-efficacy questionnaire which included questions on confidence of dietary management knowledge and action after a diagnosis of GDM. The recorded focus-group transcripts were content-analyzed by two researchers with a thematic, iterative approach. The survey data were analyzed with descriptive statistics.
Results: In this qualitative descriptive study, participants (N=15; n=5, n=7, n=3) had a mean age of 33 (±3.7SD) and a mean body mass index of 23 kg/m2 (±3.9SD), with high self-efficacy for GDM management based on survey data. Four themes emerged: 1) limited contact and variability in type of clinician providing the dietary education; 2) the dietary intervention was generalized and lacked individual tailoring, resulting in women conducting their own research; 3) rebounding to unhealthy dietary behaviors after delivery; and 4) identification of several gaps in care (e.g., help with diet/psychological burdens of GDM, nutritional counseling from a clinician trained in GDM management).
Conclusions: Our results indicate that women are not receiving the recommended care from experienced dietitians or diabetes care and education specialists for the dietary management of GDM. To address these critical gaps in the delivery of GDM care and education, next steps include developing an intervention for providers working with women with GDM. The intervention would include education on the psychological components of a GDM diagnosis, how to provide dietary counseling to enhance life-long healthy eating to prevent future T2DM, and strategies to provide dietary education in a culturally sensitive manner to improve outcomes.