Background:The University of Illinois Chicago (UIC) Community Outreach Intervention Project (COIP) established a low-threshold mobile medical unit that dispensed medications to treat opioid use disorder (MOUD) to individuals with high need. Knowledge of mobile unit utilization is limited to binary retention metrics. This study identified and characterized patterns of patient follow-up at a mobile unit dispensing MOUD. Methods:Group-based trajectory modeling (GBTM) identified patterns of follow-up observed at the mobile unit. The data source was an internal database of every UIC COIP mobile unit patient encounter, maintained by clinicians. Individuals visiting the mobile unit for MOUD services while the UIC mobile unit carried buprenorphine onsite were included. In the GBTM, follow-up data for each patient over 12 months after their first visit were aggregated to yield groups of individuals with similar follow-up patterns. After GBTM, a multinomial logistic regression was used to compare demographic, substance use, and treatment characteristics between identified follow-up pattern groups. Results:Of the 964 eligible individuals, 429 had more than one mobile unit visit and were included in the GBTM. The best fitting GBTM model had four-groups, and the resulting follow-up patterns were labeled based on trajectory shape. Adding a group of individuals who only visited the mobile unit once in the one-year observation period yielded five total groups of mobile unit utilizers: slow-decline (n, %: 53, 6%), fast-decline (159, 16%), infrequent (175, 18%), continued use (42, 4%), and single-visit (535, 56%). Characteristics within the five groups were generally similar, with the continued use group having the highest average number of visits in the one-year period. The slow-decline group had the highest rates of insurance and of receiving buprenorphine during their visit. Discussion/Conclusion:This study identified five follow-up patterns at a mobile unit providing MOUD to neighborhoods with unmet needs: slow-decline, fast-decline, infrequent, continued use, and single-time visitors. These findings contextualize previously reported dichotomous retention rates and provide insights into how patients may utilize the mobile unit to accomplish individualized treatment goals. Future research should incorporate behavioral characteristics and treatment received elsewhere to contextualize how follow-up patterns at a mobile unit relate to MOUD adherence.

PURPOSE:As the prevalence of diabetes continues to rise, innovative strategies are essential to optimize patient outcomes while curbing the economic burden on healthcare systems. This study aims to describe the costs of implementing a team-based mobile health intervention for diabetes management (the mDAS intervention) that successfully lowered glycated hemoglobin (HbA1c) in African American and Latinx adults with type 2 diabetes from a health-system perspective, and to compare healthcare resource utilization (HCRU) and associated costs between the intervention and usual care groups over one year. METHODS:Intervention delivery costs were described by providing a breakdown of start-up and operating costs. Frequencies of outpatient, inpatient, and emergency department (ED) visits and associated charges were obtained using health system billing data. Negative binomial regression models were employed to compare frequencies of visits, and gamma regression models to assess differences in total healthcare costs. RESULTS:The total cost of implementing the mDAS intervention for 1 year was $56,032. This included $11,627 in start-up costs and $44,660 in annual operational costs. The intervention (n = 108) and usual care (n = 112) groups exhibited similar rates of outpatient visits (rate ratio [RR], 1.07; P = 0.52), ED visits (RR, 0.82; P = 0.68), and total healthcare costs (cost ratio, 1.03; P = 0.86) over 1 year. CONCLUSION:The mDAS intervention incurred modest implementation costs. It did not result in significant differences in short-term HCRU and associated costs when compared to usual care. Future research should explore specific mechanisms impacting HCRU and the long-term cost-effectiveness of implementing such interventions more broadly in nonacademic clinical environments.

PURPOSE:Type 2 diabetes imposes a significant economic burden on healthcare systems. Interdisciplinary healthcare teams can offer patient-centered care by integrating medical, behavioral, and social support services. This approach has the potential to lower complication rates while reducing healthcare expenditures. This study evaluated the cost-effectiveness of an evidence-based clinical pharmacist and community health worker team-based mobile health intervention for diabetes adherence support (mDAS), compared to usual care, among urban African American and Latinx individuals with elevated glycated hemoglobin (HbA1c). METHODS:Direct medical costs from a health system perspective and quality-adjusted life-years (QALYs) were compared between the intervention and usual care groups, using a Markov state transition model to simulate the occurrence of cardiovascular and renal complications. Model inputs were derived from published literature and electronic health records. Comprehensive sensitivity and scenario analyses were conducted to assess the robustness of model findings. RESULTS:Compared to usual care, the mDAS intervention resulted in higher QALYs and lower costs over 5-year, 10-year, and lifetime horizons. Incremental QALYs and cost savings were 0.01, 0.03, and 0.17 and $695, $2,393, and $6,829, respectively. Benefits were more pronounced with longer time horizons. Sensitivity analyses indicated that while the magnitude of cost savings diminished as the risk of complications decreased, the intervention consistently resulted in lower costs and higher QALYs. CONCLUSION:The mDAS intervention resulted in cost savings and long-term health benefits, indicating its potential value for policymakers, healthcare systems, and insurers.

Background and introduction The University of Illinois Chicago (UIC) Community Outreach Intervention Projects (COIP) established a low-threshold mobile unit that offers opioid use disorder (OUD) treatment and dispenses buprenorphine on-site in Chicago neighborhoods with high opioid overdose rates. This study aimed to explore patients' perceived facilitators and barriers to accessing and maintaining OUD treatment through the mobile care model. Methods This qualitative study used brief, semi-structured, one-on-one, post-visit interviews and content analysis to explore patients' perspectives on receiving OUD treatment from a mobile unit that dispenses buprenorphine at point-of-care. The interview guide was informed by a conceptual model categorizing barriers associated with accessing OUD treatment into healthcare-, structural-, and patient-level barriers. A purposive sample of individuals receiving OUD treatment at the mobile unit was recruited and all interviews were conducted on-site in person. At least two independent researchers coded each interview, and conflicts were resolved in discussion. Codes were generated both inductively and deductively (from the conceptual model) through an iterative process and summarized to identify relevant categories and themes using MAXQDA. Results A total of 42 individuals were offered participation, and 30 individuals were interviewed. The sample was demographically similar to the general patient population of the UIC mobile unit and had notable variation in substance use history, previous treatment experiences, engagement with the mobile unit, and commute lengths. Among structural factors, a convenient location that was easy to commute to was a mobile unit facilitator. Key healthcare factors that facilitated mobile unit use included welcoming and knowledgeable staff, buprenorphine dispensed on-site, non-OUD services offered, and logistical operations of the mobile unit. The non-stigmatizing environment and adaptable treatment goals were patient factors influencing use of the mobile unit. Limited barriers were identified, but potential barriers included proximity to drug distribution sites and timing of services provided. Conclusion We characterize structural, healthcare system, and patient influences in utilization of a mobile unit for OUD treatment. These findings highlight patients' perceptions of a mobile unit for OUD care and validate that the mobile model addressed access barriers. Future research may engage individuals facing barriers that preclude them from presenting to a mobile unit for treatment.

Introduction:High rates of medication nonadherence contribute to poor outcomes in chronic obstructive pulmonary disease (COPD), but the mechanisms driving nonadherence remain poorly understood. Methods:We conducted qualitative semistructured interviews to evaluate barriers and facilitators of inhaler adherence. The Capability, Opportunity, and Motivation model of Behavior informed the semistructured interview guide and analysis. Results:Short-term lapses in inhaler use commonly resulted from inhaler unaffordability, not possessing the inhaler, forgetfulness, and geographical or logistical issues accessing health care services. Participants overcame these barriers by requesting more affordable inhalers, keeping inhalers in strategic locations, routinizing inhaler use, utilizing reminders or cues, having extra inhalers, and leaning on social support. Nearly half of participants reported using their inhalers differently than prescribed because of insufficient knowledge, skills, or complex motivational barriers. Participants who reported using an incorrect dosage schedule or poor inhaler technique were unaware of their inhaler misuse. Although participants collectively saw some benefit to using inhalers, many were intentionally nonadherent due to conflicting motivational factors. Common motivational barriers to adherence included beliefs that inhalers were not always necessary, nonadherence carried little risk, their self-identity conflicted with having COPD, and emotional distress related to numerous medications. There were strong interactions between reinforcement and other motivational factors that created feedback loops which strengthened or weakened adherence. Conclusions:Barriers to medication adherence were common and varied by individual. Knowledge and skills barriers are well-suited for interventions that utilize instruction or enablement, whereas motivational barriers could be addressed through reinforcement or interventions tailored at the individual level.

Introduction: Obesity and chronic psychosocial stress (CPS) may drive early-onset colorectal cancer (EOCRC) through overlapping pathways, including disruption of the gut microbiome (reduced microbial diversity, overgrowth of pro-inflammatory microbial species, and altered metabolite production), which generates immune activation and persistent local and systemic inflammation. Methods: We conducted an 8-week randomized controlled pilot study evaluating time restricted eating (TRE) (ad libitum eating 12-8pm and fasting the remaining hours) and Mindfulness (“Mindfulness for Beginners” in the Calm.com app) among young adults (18-39 years old) with obesity (BMI ≥ 30 and ≤ 49.9 kg/m 2 ) and a Perceived Stress Score (PSS) ≥14 (indicating moderate to severe perceived stress). Individuals were randomized 1:1:1:1 to: TRE; Mindfulness; TRE & Mindfulness; or Control. We explored changes to the gut microbiome structure and composition using 16S amplicon sequencing (V4 region). We also measured serum-based tryptophan (TRP) and related metabolites, short-chain fatty acid (SCFAs), and systemic and intestinal inflammation. Results: Thirty-one (n=26 F) participants were included in the analysis who had stool and serum samples at both baseline and post-intervention. Mean age was 31.95 (±4.68) years, 16 participants were married/living with a partner, 14 were single/never married, and one was widowed. Over half of the participants (n=24) had completed graduate school or attained a professional degree. Twelve (39%) participants reported an annual household income of ≥ $80,000 US dollars. There was no statistically significant difference in alpha or beta diversity within or between study arms post-intervention. When assessing change in the relative abundance of taxa (genus-level) from baseline to post-intervention, all four groups had taxa that were differentially expressed between the two assessment periods. However, there was no clear pattern, likely because of the high individual variability of the gut microbiome. There was an inverse linear relationship in PSS difference between baseline and post-intervention in alpha (Shannon index) diversity (Adj R2=0.089; intercept=4.417; B=-0.0122; p=0.01), but not beta diversity. The Mindfulness and TRE & Mindfulness arms demonstrated decreases in circulating TRP, kynurenine, and kynurenic acid post-intervention suggesting a downregulation of the kynurenine pathway and an increase in circulating acetic acid. This was not the case in the TRE or Control arms. All three intervention arms had a decrease in circulating C-reactive protein at post-intervention, and only the TRE & Mindfulness arm had a decrease in fecal calprotectin, a marker of intestinal inflammation. Conclusion: Combined lifestyle interventions targeting both weight management and stress management may offer unique benefits for gut health in young adults with risk factors for EOCRC. Future research should investigate the clinical significance of these changes and their potential long-term impact on EOCRC risk reduction. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.

Health-related quality of life (HRQL) assessment provides insights into the lived experiences of diverse populations. This study evaluated the convergent validity and responsiveness of the EQ-5D-3L in racial/ethnic minority populations with type 2 diabetes and elevated hemoglobin A1c (HbA1c). Secondary data from a clinical trial of a diabetes adherence support intervention for African-American and Latinx patients with type 2 diabetes (NCT02990299) were analyzed. Clinical (HbA1c, systolic blood pressure [SBP], body mass index [BMI]), psychological (brief 4-item diabetes distress scale [DDS4] for diabetes-related distress, 9-item patient health questionnaire [PHQ-9] for depressive symptoms), and HRQL (EQ-5D-3L) data were collected at baseline and every 6 months for 2 years. Convergent validity was assessed by examining the strength of associations between clinical/psychological measures and EQ-5D scores. A responder analysis using generalized estimating equation models was used to evaluate the EQ-5D's sensitivity to changes in clinical/psychological factors over time. Among 221 individuals analyzed, HbA1c and SBP levels did not differ across those reporting varying levels of problems in any EQ-5D dimension. Individuals with higher BMI were more likely to report problems with mobility, usual activities, pain/discomfort, and anxiety/depression. DDS4 scores were moderately correlated with EQ-5D anxiety/depression dimension and index score, while PHQ-9 scores were strongly correlated with both. EQ-5D index score was insensitive to improvements in clinical measures but sensitive to improvements in psychological measures over time. The EQ-5D-3L captured variations in BMI and psychological measures but not in HbA1c and SBP. This study provides HRQL estimates that can be compared with other populations or studies.

BACKGROUND:Black and Hispanic adults with diabetes are more likely to experience diabetes complications and die from diabetes compared to non-Hispanic whites. This disparity may be due to medication adherence being negatively affected by social determinants of health (SDOH) and negative beliefs about diabetes and diabetes medicines. Pharmacist delivered medication therapy management (MTM) improves clinical outcomes. However, pharmacists have limited capacity and expertise to address SDOH barriers and health misperceptions. Supplementing MTM with Community Health Workers (CHWs) to address these factors may be more effective with potential for implementation. AIM:To investigate what combination of two possible components, pharmacist delivered MTM and CHWs addressing SDOH barriers and health misperceptions, represents the optimized intervention for Black and Hispanic adults with uncontrolled diabetes. METHODS/DESIGN:We will use a 2 × 2 factorial design (MTM, CHW: ON vs. OFF) where participants will be randomized to one of four treatment conditions in a 6-month intervention delivered mostly by phone. We will recruit 376 Black or Hispanic adults with type 2 diabetes and hemoglobin A1C of ≥8 %, a clinical indicator of uncontrolled type 2 diabetes. The primary outcome is A1C measured at 6 months, and at 12 months for sustained change. The secondary outcome is medication adherence. Several psychosocial factors will be examined as potential mediators. An embedded experimental mixed methods approach will be used to obtain participant perspectives through qualitative interviews and integrated to assess intervention acceptability. DISCUSSION:Our findings will identify the optimized intervention, e.g., comprising MTM or CHW or both intervention components, that effectively and efficiently improves diabetes outcomes among Black and Hispanic adults with uncontrolled diabetes, informing dissemination.

RATIONALE:High rates of medication non-adherence contribute to poor outcomes in chronic obstructive pulmonary disease (COPD). Studies suggest minority race/ethnicity and low socioeconomic status (SES) increase the risk of COPD medication non-adherence, but it is unclear how the experiences and perspectives of these vulnerable groups mediate adherence behavior. METHODS:Qualitative semi-structured interviews were conducted with predominately racial/ethnic minority and low SES individuals with COPD. Interviews were audio recorded, transcribed, coded by two independent coders, and analyzed using thematic analysis. The Capability, Opportunity, and Motivation model of Behavior (COM-B) informed the semi-structured interview guide and analysis of barriers and facilitators to inhaler adherence. RESULTS:Of the 17 individuals who participated in the study, 10 (59%) identified as Black, 3 (18%) identified as Hispanic, and 12 (71%) reported an annual household income of <$30,000/year. Short-term lapses in inhaler use commonly resulted from forgetfulness, not carrying the inhaler outside the home, inhaler costs, and lack of stock at the pharmacy. Participants described overcoming short-term barriers by establishing routines, using physical reminders or cues, keeping inhalers in a portable location, having an excess inhaler supply, and requesting a less expensive inhaler. Approximately half of participants reported using their inhaler(s) differently than prescribed long-term because of insufficient knowledge, skills, or complex motivational barriers. Participants who reported using an incorrect dosage schedule or poor inhaler technique were often unaware that they used their inhaler(s) incorrectly. Although participants collectively saw some benefit to using inhalers, some participants were intentionally non-adherent long-term due to considerable ambivalence or conflicting motivations towards using inhalers. Common motivational barriers to inhaler adherence included the perceived lack of need to use inhalers, belief that non-adherence was inconsequential, discordance in the participant's personal identity and being ill with COPD, depression, and substance abuse. There were strong interactions between participants’ beliefs about using inhalers, intentions, negative reinforcement (i.e., relief from unpleasant symptoms following inhaler use), and their emotional state. These interactions can create a feedback loop that strengthens or weakens the incentive to use inhalers. CONCLUSIONS:Short-term and long-term barriers to inhaler adherence were common among this sample of racially/ethnically diverse and low SES individuals with COPD. Knowledge gained from this study will be used to develop intervention components that address the adherence barriers. Future interventions to address intentional non-adherence must include components that are tailored to the individual.

Introduction and Objective: A fully automated multivariable artificial pancreas, or multivariable automated insulin delivery (mvAID) system, is developed as an Android app that supplement the continuous glucose monitoring (CGM) data with additional physiological signals from wearable devices to alleviate the requirements of user inputs for meals, physical activities (PA), and acute psychological stress (APS) episodes. The purpose of this preliminary crossover study was to compare the performance of the mvAID to commercial hybrid closed-loop automated insulin delivery (AID) systems in people with type 1 diabetes (T1D) Methods: Three subjects with T1D (2 F/1M; age 36.3 ± 20.8 yrs; weight 66.3 ± 11.4 kg; body mass index 23.7 ± 1.5 kg/m?; HbA1c 6.0 ± 1.5%; carbohydrate-to-insulin ratio 9.2 ± 2.6 g/U; correction factor 34.0 ± 11.5 mg/dL/U) using Dexcom G6 CGM and two commercially available AID systems available in the U.S. participated in a crossover experiment involving one-day of typical glucose control followed by one-day of fully automated mvAID implemented without announcements for meals, PA, and APS episodes. Both days involved meals, exercise sessions, activities of daily living (simulated driving or chores), and episodes of APS inducement (mental math). Results: Comparing the performance of the commercial AID systems versus the fully automated mvAID, there was no difference in the time spent in the target glycemic range (blood glucose concentration [BGC] in 70-180 mg/dL: 59.6 ± 7.3% vs 61.0 ± 13.7%; p = 0.82), time spent in hyperglycemia (BGC > 180 mg/dL: 43.3 ± 12.2% vs 38.1 ± 15.3%; p = 0.50), time spent in the tight glycemic range (BGC in 70-140 mg/dL: of 22.4 ± 15.6% vs 36.6 ± 11.8%; p = 0.14), and glycemic risk index (37.0 ± 13.8 vs 33.0 ± 8.2; p = 0.54), respectively. Conclusion: The preliminary study shows that a fully automated mvAID that does not require announcements for meals, PA, and APS episodes can maintain glycemic control despite unannounced glycemic disturbances. Further studies with more subjects and experiments are needed to confirm the findings. M.M. Rashid: None. A. Cinar: None. L.T. Quinn: None. L. Sharp: None. M. Park: None. T. Jeamjitvibool: None. U.G. Bronas: None. National Institutes of Health (R01DK135116); National Institutes of Health (1R01DK130049); National Institutes of Health (1DP3DK101075); JDRF (3-APF-2022-1134-A-N)

Increased adiposity and chronic psychosocial stress (CPS) are plausible modifiable contributors of the recent increase in early-onset colorectal cancer (EOCRC). We conducted an 8-week randomized controlled pilot trial evaluating the feasibility and acceptability of time restricted eating (TRE) (daily ad libitum eating between 12-8pm) and Mindfulness ("Mindfulness for Beginners" course from the Calm® app) among young adults. Participants were randomized to the following groups: TRE (n = 10); Mindfulness (n = 11); TRE & Mindfulness (n = 11); or Control (n = 11). Forty-three participants were randomized. Acceptability of the trial was high and attrition rates were low (7%). Participants completed 92% of the Mindfulness course, and 90-92% were adherent to the TRE intervention. PSS decreased significantly within the TRE, Mindfulness, and TRE & Mindfulness arms from pre- to post-intervention, but not within the Control arm. The TRE & Mindfulness arm had improvements in visceral fat mass, fasting insulin, fasting glucose, HOMA-IR, hemoglobin A1c, and fecal calprotectin, pre- to post-intervention, compared to the TRE and Mindfulness arms. This study was feasible and well-accepted. Results were promising for the combined TRE & Mindfulness protocol showing superior improvements in perceived stress, visceral adiposity, cardiometabolic and inflammatory markers. It is important to note the limited generalizability of our sample.

OBJECTIVE:While the American Diabetes Association (ADA) screening guidelines have been used widely, the way they are implemented and adapted to a particular setting can impact their practical application and usage. Our primary objective was to validate a best practice advisory (BPA) screening algorithm informed by the ADA guidelines to identify patients eligible for hemoglobin a1c (HbA1c) testing in the emergency department (ED). METHODS:This cross-sectional study included adults presenting to a large urban medical center's ED in May 2021. We used sensitivity, specificity, likelihood ratios, and predictive values to estimate the algorithm's ability to correctly identify patients eligible for diabetes screening, with manual chart review as the reference standard. Eligibility criteria targeted patients at risk for diabetes who were likely unaware of their elevated HbA1c. We also calculated the area under the receiver operating characteristic curve (AUC). RESULTS:In May 2021, 2,963 (77%) of the 3,850 adults admitted to the ED had a routine lab ordered. Among those, 796 (27%) had a BPA triggered, and of those 631 (79%) had an HbA1c test completed. The algorithm had acceptable sensitivity (0.69, 95% confidence interval [CI] 0.66-0.72), specificity (0.91, CI 0.89-0.92), positive predictive value (0.75, CI 0.72-0.78) and negative predictive value (0.88, CI 0.86-0.89). The positive likelihood ratio (7.39, CI 6.35-8.42) was adequate, and the negative likelihood ratio (0.34, CI 0.30-0.37) was informative. The AUC of 0.74 (CI 0.72-0.77) suggests that the algorithm had acceptable accuracy. CONCLUSION:Findings suggest that an electronic health record-based algorithm informed by the ADA guidelines is a valid tool for identifying patients presenting to the ED who are eligible for HbA1c testing and may be unaware of having prediabetes or diabetes. The ease of workflow integration and high yield of potentially undiagnosed diabetes and prediabetes makes the BPA algorithm an appealing method for diabetes screening within the ED.

Aims: We developed a prediction model for elevated hemoglobin A1c (HbA1c) among patients presenting to the emergency department (ED) at risk for diabetes to identify important factors that may influence follow-up patient care. Methods: Retrospective electronic health records data among patients screened for diabetes at the ED in May 2021 was used. The primary outcome was elevated HbA1c (≥ 5.7%). The data was divided into a derivation set (80%) and a test set (20%) stratified by elevated HbA1c. In the derivation set, we estimated the optimal significance level for backward elimination using a 10-fold cross-validation method. A final model was derived using the entire derivation set and validated on the test set. Performance statistics included C-statistic, sensitivity, specificity, predictive values, Hosmer-Lemeshow test, and Brier score. Results: There were 590 ED patients screened for diabetes in May 2021. The final model included nine variables: age, race/ethnicity, insurance, chief complaints of back pain and fever/chills, and a past medical history of obesity, hyperlipidemia, chronic obstructive pulmonary disease, and substance misuse. Adequate model discrimination (C-statistic = 0.75; sensitivity, specificity, and predictive values > 0.70), no evidence of model ill fit (Hosmer-Lemeshow test = 0.29), and moderate Brier score (0.21) suggest acceptable model performance. Conclusion: In addition to age, obesity, and hyperlipidemia, a history of substance misuse was identified as an important predictor of elevated HbA1c levels among patients screened for diabetes in the ED. Our findings suggest that substance misuse may be an important factor to consider when facilitating follow-up care for patients identified with prediabetes or diabetes in the ED and warrants further investigation. Future research efforts should also include external validation in larger samples of ED patients.

BACKGROUND AND OBJECTIVES:Care Recipient Self-Perceived Burden (CR-SPB) to Caregivers is an important but overlooked aspect within the caregiver-care recipient relationship. This study aimed to (a) develop and validate the CARE-2B (Care Recipient's Two Burden) Scale, assessing both CR-SPB and their proxy assessment of caregiver burden (Proxy-CB); and (b) examine whether the CR-SPB and Proxy-CB differ from caregiver burden's own assessment and other health and social care constructs. RESEARCH DESIGN AND METHODS:Data were collected from 504 caregiver-care recipient dyads in the United States using an online panel between August 2022 and February 2023. Care recipients completed the CARE-2B Scale, which includes two subscales: CR-SPB and Proxy-CB. Care recipients also completed measures related to health and well-being: SPB-scale, EQ-5D-5L, and EQ Health and Well-Being (EQ-HWB). Caregivers completed Care-Related Quality of Life (CarerQoL) and Adult Social Care Outcomes Toolkit for Carers (ASCOT-Carer). Psychometric analysis included exploratory and confirmatory factor analysis, item response theory (IRT), and construct validity. RESULTS:CR-SPB correlated strongly with the SPB-scale (r = 0.73), whereas Proxy-CB correlated more strongly with caregiver-reported burden (r = 0.61). Both CR-SPB and Proxy-CB items demonstrated good discrimination and information coverage in IRT analysis. Exploratory factor analysis further supported the distinctiveness of CR-SPB and Proxy-CB, with CR-SPB items loading on a separate factor from caregiver burden and health constructs, whereas Proxy-CB aligned with caregiver-reported burden. DISCUSSION AND IMPLICATIONS:The CARE-2B Scale innovatively assesses both CR-SPB and Proxy-CB from the care recipient's perspective, providing new insights into the caregiving relationship. This dual-perspective measure has implications for enhancing care strategies for individuals with chronic conditions or disabilities and their caregivers.

BACKGROUND:This qualitative study examined how primary care providers (PCPs) prioritize addressing diabetes prevention with patients newly diagnosed with prediabetes and identified barriers and facilitators to providing diabetes prevention services (DPS). To examine transitions of care, we also evaluated how PCPs received and acted on screening information obtained outside of a primary care visit among their patients with prediabetes. METHODS:We interviewed PCPs practicing in Chicago using semi-structured interviews guided by the updated Consolidated Framework for Implementation Research (CFIR 2.0) from March to May 2023. Framework analysis in combination with hybrid coding was used to analyze transcripts. RESULTS:Nineteen PCPs were interviewed, and most (58%) prioritized talking to patients with prediabetes about diabetes prevention. Major themes identified included: (1) social determinants of health (SDOH) undermining diabetes prevention care, (2) perceptions of barriers and facilitators differing by provider background, and (3) delay of DPS due to prioritizing the patient's other needs. Providers noted challenges in sharing information across health systems despite existing interoperability platforms. CONCLUSIONS:Our study observed challenges in providing DPS, particularly among PCPs serving patients impacted by SDOH. We also identified opportunities for improving transitions of care and engagement between patients with prediabetes and PCPs.

Introduction and Objective: Stress has been shown to impact blood glucose levels, presenting significant challenges for individuals with type 1 diabetes (T1D). However, there is limited research on the relations among stress, diabetes-related worry, and glucose variability (GV) in free-living conditions. The purpose of this study was to examine the differences in diabetes-related worry and GV in a free-living environment between two groups based on subjective stress level, measured using visual analog scale (VAS). Participants were divided into two groups: high stress (VAS ≥ 7) (n = 3) and low stress (VAS <7) (n = 9). Methods: Participants completed questionnaires and wore a Dexcom G6 continuous glucose monitor (CGM), ActiGraph (GT3x_BT) for 7 days under free-living conditions. Questionnaires included Hypoglycemia Fear Survey II, Diabetes Quality of Life, Diabetes Distress Scale and stress VAS. The Mann-Whitney test was used to analyze data using SPSS 29.0. Results: Twelve people with T1D (ages: 31.73 ± 8.02 years; A1C: 6.59 ± 1.19 %; BMI: 26.00 ± 3.69 kg/m2; duration of diabetes 16.44 ± 10.35 years) participated. Individuals who reported experiencing high stress level exhibited greater diabetes-related worry (41.33 ± 5.77 vs. 26.22 ± 7.55; z = -2.130, p<.05) and higher diabetes-related regimen stress (3.13 ± .42 vs. 1.98 ± .70; z = -2.045, p<.05). However, they had a lower Low Blood Glucose Index (.85 ± .39 vs. 3.13 ± 1.98; z = -2.041, p<.05) and a lower Time Below Range (.15 ± .22 vs. 3.36 ± 3.23; z = -1.944, p<.05). Conclusion: These results suggest that subjective stress may be associated with increased vigilance in diabetes management through diabetes-related worry and regimen related stress. Further research with a larger sample size is needed to confirm these findings and determine additional glycemic effects of stress. M. Park: None. T. Jeamjitvibool: None. S. Prakot: None. E. Huerta: None. M.M. Rashid: None. M.M. Abdel Latif: None. L. Sharp: None. A. Cinar: None. L.T. Quinn: None. National Institutes of Health (5R01DK130049-02)

Introduction: Cannabis use among cancer patients is increasing, supported by studies demonstrating its efficacy in alleviating cancer- and treatment-related symptoms such as pain and nausea, while offering a reduced risk of developing physiological dependence compared to opioid options. Despite this, provider implicit bias and lack of knowledge, absence of high-quality data, and regulatory challenges have caused hesitancy among providers in recommending its use. This survey aimed to improve our understanding of patient-reported efficacy and safety of cannabis among patients with multiple myeloma (MM). Methods: Using the HealthTree Cure Hub platform, a prospectively administered 23-question survey was fielded from May 2023 to July 2024 to those with a diagnosis of a plasma cell dyscrasia and enrolled on the online platform. Results: 505 participants completed the survey, with 98% having a diagnosis of symptomatic MM. Average age was 63 ± 10.5 years. Most were female (63%), and 88% were White. 197 (30%) patients reported using cannabis prior to their MM diagnosis, with 123 (62%) reporting regular use, defined in the survey as consistent use for least 1 month. While most indicated its use as recreational (n=123, 62%), 74 (38%) reported using it for medicinal purposes to treat an illness or a symptom of an illness. 240 (48%) reported cannabis use during MM treatment, with 115 (48%) describing use on a regular basis. Multiple logistic regression revealed that prior cannabis users were more likely to continue use during MM treatment (β=0.40, p<0.001). Patients reported using both THC- and CBD-containing products (59%) or THC-containing products alone (27%). Concern over high cost (25%) and side effects/drug interactions/dosing (38%) were identified as barriers experienced during cannabis use, while “fear of addiction” (3%) was rare. The most common formulations used were ‘edibles’ or cannabis-infused food products (75%), smoking/vaping (37%), tincture/oil (35%), and topical agents (33%). 181 (75%) obtained cannabis under a prohibitive policy or reported growing their own (n=48, 20%). Indications were pain (71%), sleep (75%), depression (34%), anxiety (32%), stress reduction (22%), appetite (21%), and numbness/tingling (20%). When used for pain, a majority administered it daily (n=54, 27%), 2-3 times/week (n=71, 36%), or 4-6 times/week (n=20, 10%). More than half (52%) of respondents reported high efficacy of cannabis use for pain. 70 (30%) indicated that taking cannabis enabled them to “avoid taking opioids for pain,” while 42 (18%) reported they were able to reduce the dose of opioids. 39% reported that cannabis use resulted in reduced healthcare utilization, with “completely”/“mostly” effective improvement in physical symptoms (43%), mental health (38%), and quality of life (36%). A high prevalence of side effects was reported including dry mouth (44%), feeling foggy (48%), and dizziness (15%). Of those who did not use cannabis during MM treatment, 129 (50%) considered its use for symptom control; however, barriers that prevented them from using included: not knowing it was an option/possible treatment (24%), lack of information/education (23%), or concerns over legal or work repercussions (19%). Overall, 280 (56%) reported never having a discussion with their oncologist about using cannabis. Among those who did, discussions were, for the most part, initiated by the patient (87%). Only 14% indicated that the oncologist recommended its use, with pain (68%), sleep (55%), nausea/vomiting (23%), anxiety (20%), or symptoms related to cancer (36%) being the major indications. Most reported that the oncologist was “somewhat” (38%) or “not at all” (25%) able to discuss the risks/benefits. Only 31 (14%) reported that the oncologist made a referral to another doctor (i.e. pain specialist) to discuss cannabis use. Conclusion: Here we report results of the first national survey addressing patient-reported efficacy and safety of cannabis in MM. Patients have a high level of acceptance towards and benefit from the use of cannabis during MM treatment, in particular a positive impact on sparing or reducing the use of opioids. Involvement of the oncology provider in recommending, educating, and discussing cannabis was minimal, highlighting the need for improved training and education strategies. Based on these data, investigation of the potential medical benefits of cannabis in MM is warranted.