Greenville University

Introduction and Objective: Poor prognostic factors are present early in the disease course of type 1 diabetes (T1D) among socioeconomically disadvantaged African American and Hispanic youth, contributing to disparities in diabetes outcomes and complications. Few empirically supported interventions exist for this population. The Early Links proof of concept pilot study evaluated the feasibility and acceptability of an intervention for African American and Hispanic parents of youth with new-onset T1D that included a videoconferencing four-session behavioral intervention and social needs screening and navigation program. The present study examined parent satisfaction with the behavioral intervention to guide future intervention refinement and potential implementation. Methods: Nine parents of youth (ages 6-12 years) with public or no insurance and recently diagnosed (M diabetes duration = 8.8 weeks) with T1D participated in the behavioral intervention. On average, parents endorsed 1.1 social needs at baseline. Transcripts from semi-structured qualitative interviews were coded and thematic analysis was used to generate themes related to participants’ satisfaction. Results: All participants were highly satisfied with the intervention. Parents described benefits of the intervention (receiving support from other parents, learning T1D management skills, enhancing coping skills) and barriers to intervention attendance (discomfort sharing personal information, balancing participation with competing demands). Suggestions for improvement included having asynchronous intervention content and including children with T1D in the intervention. We generated three themes: social support, acquiring knowledge, and suggestions for improvement. Conclusion: Results suggest parents found the Early Links behavioral intervention valuable and highly acceptable. Future research is needed to identify ways to promote parent engagement with the intervention. M. Baudino: None. L.C. Williams: None. R. Ghaddar: None. S.A. Carreon: None. M.J. Redondo: None. S.A. Dei-Tutu: None. A. Butler: None. Baylor College of Medicine

Introduction and Objective: Approximately 556,000 adults in the state of South Carolina live with diabetes and only 50% have participated in a diabetes self-management/support class. Community-based DSMS programs improve participant's A1C values, nutrition and physical activity behaviors, and diabetes knowledge. With ADA funding, Clemson University partnered with Prisma Health, the largest health system in the state, to create CDST/PDST to increase awareness and referrals to Health Extension for Diabetes (HED), a DSMS program. Methods: Two CDSTs were created: an EPIC SmartPhrase (.HEDREF) and a DSMES (Diabetes Self-Management Education and Support) referral order set which was modified to include HED. Inclusion criteria given to providers included: a diagnosis of Type 1 or Type 2 diabetes and being 18 years of age or older. Exclusion criteria included: pregnancy, end-stage renal disease, or patient not overseeing their own care plan. Healthfeed, the PDST created, displayed a banner with a program summary and sign-up link in the EHR MyChart of adults with Type 1 or 2 diabetes. Results: Since its creation in June of 2022, HEDREF has resulted in 1,888 referrals to the HED program. Since January 2024, the referral order set has resulted in 120 referrals. Healthfeed was activated in English from January to March 2024 and resulted in 2,325 patient interaction interest “clicks”. From September through December 2024, the Spanish Healthfeed banner resulted in 44 “clicks”. Conclusion: The EHR SmartPhrase tool was the most successful at increasing referrals to the diabetes management and support program. Nevertheless, adults with diabetes in the health system are largely unengaged by these decision support tools. Future efforts should focus on identifying more effective referral mechanisms and increasing the participation of underserved populations. M.D. Stancil: None. W.W. Sherrill: None. A. Diblin: None. A. Pulido: None. J.H. Evatt: None. American Diabetes Association (11-22ICTSN-04)

Introduction & Objective: Metabolic inflexibility is the inability to appropriately switch substrate use in response to a metabolic challenge and is seen in individuals with metabolic disease. Metabolic inflexibility can be observed in seemingly healthy individuals, potentially predisposing them to metabolic disease. The goal of this study was to examine if whole-body metabolic inflexibility is reflected by differential substrate use at the skeletal muscle (SkM) level. Methods: This study recruited young (27 ± 8 years) healthy individuals with overweight. Anthropometric measures, VO2max test, hyperinsulinemic-euglycemic clamp, and a vastus lateralis biopsy was performed. Based on difference in the respiratory quotient (ΔRQ) during the clamp, participants were median stratified to a “metabolically flexible” (FLEX) (ΔRQ>0.06; n=10) or “metabolically inflexible” (INFLEX) (ΔRQ<0.06; n=9) group. SkM biopsy samples were assessed for substrate oxidation with 14C-pyruvate and 14C-palmitate, mitochondrial respiration, and muscle fiber type. Data was analyzed with descriptive statistics, Mann-Whitney U-test, and Student’s t-test. Results: FLEX had a lower BMI than INFLEX (26.4 ± 1.3 vs 28.7 ± 1.5 kg/m2; p=0.002) but had a similar percentage of body fat (p=0.3) or lean mass (p=0.2). Groups did not differ in age (p=0.06), VO2max (p=0.3), M value (p=0.1), or basal RQ (p=0.5). FLEX had lower palmitate oxidation than INFLEX (p=0.03) and trended towards a higher ratio of pyruvate to palmitate oxidation (p=0.06). Incomplete palmitate oxidation was also higher in FLEX (p=0.003). Groups did not differ in mitochondrial respiratory capacity (p=0.3) or fiber type (p=0.9). ΔRQ was significantly associated with the M value (p=0.02, r=0.55) and did not associate with fiber type (p=0.6, r=0.16). Conclusions: FLEX and INFLEX individuals differ in substrate oxidation in SkM tissue with INFLEX showing greater and more efficient fat oxidation. Differences in ΔRQ are not influenced by muscle fiber type. Disclosure P. Krassovskaia: None. F. Jevtovic: None. M. Chorzepa: None. T.E. Jones: None. C.J. Tanner: None. D. Zheng: None. W.J. Pories: None. L. Dohm: None. J.A. Houmard: None. N.T. Broskey: None. Funding National Institutes of Health R01DK120296

Introduction and Objectives: The rate of diabetes in pregnancy is increasing at a rapid rate increasing risks for adverse perinatal and maternal health outcomes in the peripartum period and beyond. This cycle is exacerbated by historically low rates of preconception counseling and low rates of post-partum follow-up with primary care for patients with Type 1, Type 2, and Gestational Diabetes. Thoughtful coordinated transitions of care for this patient population are needed to address this rising concern. Methods: Through a facilitated transfer of care from a previously existing program for pregnant patients with diabetes into the primary care setting we aimed to continue glycemic control postpartum, completion of testing to confirm resolution of gestational diabetes, provide glycemic control prior to conception, and offer general primary care services. A team-based approach consisting of physicians, diabetic educators, clinical pharmacists, and clinical navigators was utilized. Results: Patients with Type 1, Type 2 and gestational diabetes enrolled in our year long program showed decreased A1c and average of 8.7 to 8.2, decreased BMI from 37 to 33, and an increased attrition with a primary care team. Increased access to healthy food options, exercise programs, and diabetes technologies (continuous glucose monitors) was achieved. Conclusion: Through a team-based approach and increased coordination of care we have demonstrated avenues to utilize existing structures within our healthcare system to provide meaningful care to patients of childbearing age with diabetes. This intervention not only benefits the patient but their children and ultimately the general health of the state of South Carolina. Disclosure J. Amidon: None. J.L. Knapp: None. M. Jindal: None. Funding BlueCross BlueShield of South Carolina Foundation (2022-07)

Introduction & Objectives: Offspring exposed to metformin treatment for gestational diabetes (GDM) experience altered growth patterns, increasing the risk of cardiometabolic diseases later in life. The adaptive cellular mechanisms underlying these altered growth patterns in offspring remain unclear. Therefore, the objective of this study was to determine if chronic metformin exposure from GDM treatment elicits infant cellular metabolic adaptations. Methods: In a cross-sectional design, 22 pregnant women with GDM treated solely with metformin (Met; n=12) were compared to those treated exclusively by diet (A1DM; n=10). GDM was diagnosed between 24-28 weeks gestation by 2-hr 75g oral glucose tolerance test. Women were matched for age, race, BMI, and infant sex. Umbilical cord derived mesenchymal stem cells (MSCs) were used to study infant metabolism in vitro. Content of mitochondrial respiratory complexes were assessed by Western blot and intracellular lipid content was measured by Oil Red O staining. Substrate oxidation and insulin action were measured with 14C radiolabeled glucose, palmitate, and oleate at baseline and following a 24-hr lipid challenge. ANOVAs and t-tests were used to examine differences between groups. Results: No differences in gestational age at delivery (p=0.55), infant blood glucose at delivery (p=0.52), birth weight (p=0.88), ponderal index (p=0.23), or infant circumferences of abdominal (p=0.38), chest (p=0.88), or head (p=0.46) were observed between groups. MSC outcomes revealed no differences in substrate metabolism except for lower rates of oleate oxidation among Met-MSCs at baseline (p=0.03). No differences in mitochondrial content or lipid content were detected. Conclusions: Met-MSCs had no differences in substrate oxidation (albeit oleate), lipid storage, or mitochondrial content compared to A1DM. These cellular outcomes may not explain the altered growth patterns in infants exposed to metformin in utero. Disclosure E.M. Biagioni: None. J.C. Rowe: None. S. Yendamuri: None. D. Zheng: None. B.L. Wisseman: None. K.H. Fisher-Wellman: None. P. Neufer: None. L. May: None. N.T. Broskey: None. Funding National Institutes of Health (R01DK120296)