IntroductionUnderstanding how race and ethnicity affect health outcomes in patients with atopic dermatitis (AD) is crucial to optimizing patient-centered care and narrowing health disparities. Here, we aim to explore social drivers of health, treatment experiences, and healthcare professional (HCP) interactions in AD, stratified by patient race and ethnicity.MethodsThis was a cross-sectional, non-interventional, web-based survey study, conducted from September 2023 to December 2023. Participants were recruited through the National Eczema Association and the AmeriSpeak panel. Adult US residents self-reporting a diagnosis of AD completed an electronic survey including questions on AD severity and stress over the last month, current AD treatment satisfaction, AD provider type, and perceptions of HCP interactions.ResultsOf 260 survey participants, 55.0% were White, 23.5% were Black/African American, 11.5% were Asian, and 10.0% ("Other") were American Indian/Alaskan Native, Native Hawaiian/Other Pacific Islander, or multiracial; 13.5% of participants were Hispanic/Latino; 43.1% of all participants rated their AD severity as moderate and 7.3% as severe; 37.7% reported being "quite a bit" or "very much" stressed by their AD. While most participants had health insurance and faced few issues procuring essential goods and services, Black/African American and Hispanic/Latino participants had higher uninsurance rates, were least often privately insured, and experienced more procurement issues than other groups; housing insecurity was high among "Other" participants. Most participants reported positive interactions with HCPs, but Black/African American participants most valued HCP cultural similarity, encountered it least often, and were likely to delay or not schedule appointments with culturally dissimilar HCPs. A fifth to a quarter of Black/African American, "Other," and Hispanic/Latino participants did not receive all needed healthcare services for AD, and nearly a third of all participants were dissatisfied with their treatment. Asian participants most frequently reported concerns about interactions with their HCPs, with only half trusting their HCP to effectively treat their AD.ConclusionRace- and ethnicity-related heterogeneity in social drivers of health, treatment experiences, and HCP interactions among patients with AD emphasize the importance of including diverse patient populations in clinical research, highlight the importance of patient-physician concordance and/or HCP cultural sensitivity, and may help inform clinical practice considerations in AD management.

Abstract Background/Aims Psoriasis vulgaris (PsO) and psoriatic arthritis (PsA), (together, psoriatic disease [PsD]) are chronic inflammatory conditions that significantly impair quality of life (QoL). Obesity is a prevalent condition amongst people with PsD. Comorbid obesity and PsD can exacerbate each other. Weight control is vital for improving health outcomes for patients with PsD, which can be achieved through diet, exercise, medications, and surgery. The real-world experiences of individuals receiving advanced therapies for PsD and overweight/obesity, with the more recently approved incretin hormones remain largely unexplored.This study qualitatively summarized the experiences of adults with PsD and overweight/obesity receiving concomitant treatment for both conditions. Methods Adults with PsD and overweight/obesity were invited to participate in a survey followed by virtual semi-structured interviews. Eligible participants self-reported taking a biologic or advanced therapy for PsD for ≥1 year, initiating an incretin hormone ≥3 months after PsO/PsA treatment, and using it for at least 6 months but no longer than 12 months to mitigate recall bias. Interview transcripts were coded for emergent concepts using NVivo v12.0, and thematic analysis was conducted to assess patterns across responses. Results Twenty U.S. adults (PsO and PsA:N=9; PsO only:N=6, PsA only:N=5) were recruited from market research panels (N = 19) and the National Psoriasis Foundation (N = 1). Participants (mean age: 50±12.4; 60% female) discussed impaired QoL across physical health and social engagement (100%), daily functioning (90%), and mental health (90%) prior to initiating incretin hormone therapy. Joint pain (50%) and skin symptoms (35%) were cited as most distressing symptoms during interviews. Participants primarily initiated incretin hormone therapy to lose weight (90%), with 20% seeking improvement in PsD symptoms. Following initiation, all reported physical health improvements, including weight loss (95%), PsO/PsA symptom relief (90%), and improved ability to exercise (80%). Participants discussed improvements in mental health, ability to perform daily activities, and social engagement. Most participants (60%) initiated the conversations about weight-loss medications with their healthcare providers; 40% recalled providers discussing the potential connection between PsD and weight. Many (80%) wished these discussions had occurred earlier, with 25% specifically wishing these occurred at PsO/PsA diagnosis. Additionally, 30% sought for more information from providers about weight-loss treatment options. Four key themes were identified: 1) impact of living with PsD and overweight/obesity before weight-loss medications was largely negative; 2) weight-loss medications contributed to meaningful improvements in QoL, including physical and mental health; 3) individuals wanted more interaction and information from providers of weight-loss medications and PsD; and 4) individuals perceived a relationship between weight and health, but not always between weight and PsD. Conclusion Individuals with PsD and overweight/obesity reported physical health and QoL improvement after incretin hormone therapy. Early and proactive provider engagement around PsD and weight management options may enhance health outcomes. Disclosure U. Desai: Corporate appointments; Employee of Analysis Group. B. Mitchell: Corporate appointments; Employee and shareholder of Eli Lilly and Company. A. Cohee: Corporate appointments; Employee and shareholder of Eli Lilly and Company. Y. Wang: Corporate appointments; Employee of Analysis Group. A. Holub: Corporate appointments; Employee of Analysis Group. M. Mattera: Corporate appointments; Employee of Analysis Group. E. Sears: Corporate appointments; Employee of Analysis Group. C. Bakewell: Consultancies; Novartis, Lilly, Pfizer, Johnson & Johnson, AbbVie, Sanofi, Sobi, BMS, UCB. T. Bhutani-Jacques: Corporate appointments; Owner and CEO of Synergy Health. N. Kirson: Corporate appointments; Employee of Analysis Group. H. Stuckey-Peyrot: None. J. Swift: Corporate appointments; Employee and shareholder of Eli Lilly and Company.

Hidradenitis suppurativa (HS), an inflammatory skin disorder characterized by painful nodules and abscesses, has varying prevalence among different races/ethnicities. This study explored the social drivers of health, burden, and impact of HS among different racial and ethnic groups. An online, cross-sectional survey was conducted among adult patients with HS (September 2023–December 2023) in the USA. Patients were recruited through HS Connect (patient advocacy group) and AmeriSpeak (US national sample panel). Descriptive data were collected using patient-reported outcome measures and de novo questions about patients’ disease knowledge and perception, healthcare access and utilization, impact on quality of life (QoL), and social impact. All analyses were descriptive and stratified by racial/ethnic groups. The study included 583 patients (mean age, 34.8 years; 95.5

Psoriasis, a chronic immune-mediated inflammatory skin condition with systemic implications and substantial psychosocial burden, affects individuals across races and ethnicities. This study explored social drivers of health (SDOH), disease burden, and the impact of psoriasis across races and ethnicities. An online, cross-sectional survey was conducted among adult US patients with psoriasis (September–December 2023). Participants were recruited through the National Psoriasis Foundation and AmeriSpeak, a national sample panel. Descriptive data were collected using patient-reported outcome measures and questions on disease knowledge, healthcare access and utilization, quality of life (QoL), and social impact. Analyses were stratified by races and ethnicities. Among 285 participants (mean age 46.7 years; 50.9

IntroductionSeveral current therapies for autoimmune diseases do not provide sustained remission. Therapies that focus on the restoration of homeostasis within the immune system (i.e., immune resolution) could overcome the limitations of current therapies and provide more durable remission. However, there is no established consensus on appropriate clinical trial designs and endpoints to evaluate such therapies. Therefore, we conducted a systematic literature review (SLR) focusing on five index diseases (asthma, atopic dermatitis, rheumatoid arthritis, systemic lupus erythematosus [SLE], and ulcerative colitis) to explore published literature on 1) expert opinion on immune-resolution outcomes that should be measured in clinical trials; and 2) quantification of immune resolution in previous clinical trials.MethodsThe SLR was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Embase and MEDLINE databases were systematically searched (2013–2023) for published English language articles. Conference proceedings (2020–2022) from American Academy of Dermatology, American College of Rheumatology, Digestive Disease Week, European Alliance of Associations for Rheumatology, and European Academy of Dermatology and Venereology were searched to include relevant abstracts. The study protocol was registered in PROSPERO (CRD42023406489).ResultsThe SLR included 26 publications on 20 trials and 12 expert opinions. Expert opinions generally lacked specific recommendations on the assessment of immune resolution in clinical trials and instead suggested targets or biomarkers for future therapies. The targets included thymic stromal lymphopoietin (TSLP) in asthma; T helper (Th)2 and Th22 cells and their respective cytokines (interleukin [IL]-4R and IL-22) in atopic dermatitis; inhibitory/regulatory molecules involved in T-cell modulation, and protein tyrosine phosphatase, non-receptor type 22 (PTPN22) in rheumatoid arthritis; low-dose IL-2 therapy in SLE; and pro-resolution mediators in ulcerative colitis and asthma. In the interventional studies, direct biomarker assessments of immune resolution were the number/proportion of regulatory T-cells (Treg) and the ratio Th17/Treg in SLE and rheumatoid arthritis; the number of T follicular helper cells (Tfh), Th1, Th2, Th17, and Th22 in atopic dermatitis, rheumatoid arthritis, and SLE; and mucosal proinflammatory gene signatures (tumor necrosis factor [TNF], interleukin 1 alpha [IL1A], regenerating family member 1 alpha [REG1A], IL8, interleukin 1 beta [IL1B], and leukocyte immunoglobulin-like receptors A [LILRA]) in ulcerative colitis. Several studies reported a statistically significant relationship between clinical remission and immune-resolution biomarkers, suggesting a link between T-cell homeostasis, cytokine production, and disease activity in autoimmune diseases.DiscussionExisting literature does not offer clear guidance on the evaluation of immune resolution in interventional studies. Further research and consensus are needed to assess a treatment’s ability to induce long-term remission or low disease activity.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023406489, identifier CRD42023406489.

Hidradenitis suppurativa (HS) is an inflammatory skin disease associated with high morbidity and disability that has limited treatment options. People from racial and ethnic minority groups may experience greater disease severity and delay to diagnosis. This study assessed the impact of race/ethnicity on HS diagnosis and management in real-world clinical settings. Data were derived from the Adelphi Real World Hidradenitis Suppurativa Disease Specific Programme, a survey of dermatologists and their consulting HS patients in five European countries and the USA in 2020/2021. Dermatologists returned demographic and clinical data, and treatment goals and satisfaction for their next five to seven consulting patients. Patients completed a questionnaire on disease history and diagnosis, disease burden, and treatment satisfaction. Groups were compared with bivariate tests. In total, 312 physicians returned data on 1787 patients; 57.6% were female and 77.7% White. People from racial and ethnic minority groups were younger than White patients (32.9 ± 11.6 vs. 34.9 ± 12.4, mean ± standard deviation) and reported symptoms at a younger age (23.3 ± 10.8 vs. 26.2 ± 11.1), but their time to first consultation was longer than for White patients (2.6 ± 5.7 vs. 1.2 ± 2.5 years). People from racial and ethnic minority groups took longer to receive a correct diagnosis following first consultation (2.7 ± 5.3 vs. 1.5 ± 4.1 years) and were more likely to be misdiagnosed with boils (73.5% vs. 40.4%). People from racial and ethnic minority groups had a greater disease awareness at diagnosis and reported wanting greater support. People from racial and ethnic minority groups reported a greater impact on life, more severe pain, and a greater level of activity impairment in the Work Productivity and Activity Impairment: General Health (27.0 ± 25.2 vs. 20.0 ± 20.6). All P values were ≤0.05. These data show evidence of delayed diagnosis and higher HS symptom burden amongst people from racial and ethnic minority groups, highlighting health disparities in HS.

To address issues regarding health disparities and differential access to health care in diverse racial and ethnic populations, many of whom are part of underserved communities, current and robust data on atopic dermatitis (AD) prevalence by race/ethnicity are needed. Whereas data on pediatric prevalence of atopic dermatitis in diverse race/ethnicity populations have been reported, there are limited epidemiologic data on adult populations with AD. Analyses were conducted using cross-sectional data from the 2021 National Health Interview Survey. Weighted overall frequencies of subject reports of diagnosed AD or eczema were estimated by race/ethnicity. Adjusted odds ratios were estimated to compare prevalence rates between subgroups. Corresponding population denominators for use in estimating prevalence rates were obtained from the US Census Bureau (2020 Census Demographic Profile). Prevalence is reported as percentage (standard error). Pediatric data was also analyzed for the presentation. Overall US prevalence of AD in adults ages 18-64 was 7.6% (0.2) and age 65+ was 6.1% (0.3), with a weighted US estimate of 15.3 and 3.2 million respectively. Race/ethnicity prevalence rates for all adults were Black/African American 8.5% (0.6), White 7.7% (0.2), Asian 6.5% (0.7), American Indian/Alaskan Native 4.9% (2.1), and Hispanic 4.8% (0.4). The odds ratio for Hispanic vs Non-Hispanic White was 0.6 (95%CI 0.5-0.7; p<0.0001). Total US prevalence of AD in all adults is approximately 18 million. Hispanic adults have a lower prevalence AD than all other adult groups. Additional studies are needed to understand sociodemographic variations in AD prevalence.

BACKGROUND:Conventional injectable glucagon (IG) and nasal glucagon (NG), both having similar efficacy, are two options for the emergency treatment of severe hypoglycemia in Spain. This study elicited the effect of changes in key attributes on preferences for NG and IG medication profiles of people with diabetes and caregivers in Spain.METHODS:The relative attribute importance (RAI) that participants placed on glucagon preparation, preparation and administration time, delivery method, recovery time, device size, storage temperature, and headache risk was estimated from an online discrete choice experiment. In addition, patients and caregivers were presented with NG and IG profiles that included rates of successful administration; the proportion of participants choosing each profile was summarized.RESULTS:The analysis included 276 adults with diabetes (65% type 1) and 270 caregivers (49% type 1). Overall mean age was 40 years; 51% were female. The most important attributes were storage temperature (RAI [95% confidence interval] = 27.3% [22.9-32.2]) and delivery method (17.4% [13.1-21.9]). Headache risk (16.2% [11.8-20.7]), time to prepare and administer (14.5% [10.1-18.8]), glucagon preparation (11.4% [6.8-15.8]), recovery time (8.9% [4.3-13.3]), and device size (4.3% [0.3-8.8]) were also relevant. When comparing medication profiles, significantly more participants (78%) preferred NG over IG profiles (P < .001).CONCLUSION:Adults with diabetes and caregivers prefer a glucagon treatment with a higher rate of successful administration, wider storage temperature, and nasal delivery method, when efficacy is similar. Participants favored NG over conventional IG as a rescue medication for severe hypoglycemia. This information may help decision-making by payers and treatment discussions between health care professionals and patients.

Background: Severe hypoglycemia (SH) is feared by people with diabetes (PwD) and those who care for them due to its impact on everyday life. Studies have shown that ready-to-use nasal glucagon (NG) is preferred over reconstitutable injectable glucagon; however, real-life experiences that PwD and health care providers (HCPs) have with NG are unknown. Objective and Methods: A cross-sectional, web-based study was conducted in the US and Germany among: i) insulin-treated adults who owned NG for at least 2 months to assess impact of NG on everyday life, and ii) HCPs who prescribed NG within 6 months of study initiation to assess HCPs’ experiences with NG in meeting their patients’ needs. Data were analysed descriptively, and US results are presented. Results: Of 292 PwD (mean age 42, 47% T1D, 86% high fear of hypoglycemia total screener score, 37% impaired hypoglycemia awareness), 68% had been treated with NG. Over 90% agreed that NG had positively impacted quality of life (QoL) items (Figure). Of 71 HCPs (endocrinologists 87%), 90% were satisfied with NG meeting patients’ needs. Over 80% of HCPs were satisfied with training time on NG and confident with patient and caregiver’s ability to apply the training for a SH event. Conclusion: The positive impact of NG on QoL, less fear of hypoglycemia, and high confidence in caregiver’s ability to use NG may help improve PwD’s everyday life related to hypoglycemia management. Disclosure B.Mitchell: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. A.Ponce-ibarra: Employee; Lilly Deutschland GmbH, Stock/Shareholder; Eli Lilly and Company. E.Moennig: Employee; Lilly Deutschland GmbH, Stock/Shareholder; Eli Lilly and Company. S.Odak: Other Relationship; Eli Lilly and Company. D.J.Mcsorley: Other Relationship; Eli Lilly and Company, Sage Pharmaceuticals, Novavax, Bristol-Myers Squibb Company, Seattle Genetics, Inc., Boston Scientific Corporation, Blood Centers of America, Inc. E.Spaepen: Consultant; Eli Lilly and Company. L.Jackson: Other Relationship; Eli Lilly and Company. L.Zografos: Other Relationship; Eli Lilly and Company. Y.Yan: Employee; Eli Lilly and Company, Stock/Shareholder; Eli Lilly and Company. Funding Eli Lilly and Company

Severe hypoglycemic events are distressing. Although past studies have shown that young adulthood is a potentially distressing time, few studies have explored distress about severe hypoglycemia in this age group. The real-world psychosocial experiences of potential severe hypoglycemic events and the perceived impact of glucagon treatments like nasal glucagon are currently unknown. We explored perceptions of severe hypoglycemic events and impact of nasal glucagon on psychosocial experiences with these events in emerging adults with type 1 diabetes and caregivers of emerging adults and children/teens. Further, we compared perceptions of preparedness and protection in handling severe hypoglycemic events with nasal glucagon versus the emergency glucagon kit that requires reconstitution (e-kit). This observational, cross-sectional study enrolled emerging adults (aged 18–26; N = 364) with type 1 diabetes, caregivers of emerging adults (aged 18–26; N = 138) with type 1 diabetes, and caregivers of children/teens (aged 4–17; N = 315) with type 1 diabetes. Participants completed an online survey about their experiences with severe hypoglycemia, perceptions of nasal glucagon impact on psychosocial experiences, and perceptions of feeling prepared and protected with nasal glucagon and the e-kit. Many emerging adults (63.7

Abstract Background Fear of Hypoglycemia (FoH) in people with diabetes has a significant impact on their quality of life, psychological well-being, and self-management of disease. There are a few questionnaires assessing FoH in people living with diabetes, but they are more often used in research than clinical practice. This study aimed to develop and validate a short and actionable FoH screener for adults living with type 1 diabetes (T1D) for use in routine clinical practice. Methods We developed an initial screener based on literature review and, interviews with healthcare providers (HCPs) and people with T1D. We developed a cross-sectional web-based survey, which was then conducted to examine the reliability and validity of the screener. Adults (aged ≥ 18 years) with diagnosis of T1D for ≥ 1 year were recruited from the T1D Exchange Registry (August–September 2020). The validation analyses were conducted using exploratory factor analyses, correlation, and multivariable regression models for predicting cut-off scores for the final screener. Results The final FoH screener comprised nine items assessing two domains, “worry” (6-items) and “avoidance behavior” (three items), in 592 participants. The FoH screener showed good internal consistency (Cronbach’s α = 0.88). The screener also demonstrated high correlations (r = 0.71–0.75) with the Hypoglycemia Fear Survey and moderate correlations with depression, anxiety, and diabetes distress scales (r = 0.44–0.66). Multivariable regression analysis showed that higher FoH screener scores were significantly associated with higher glycated hemoglobin (HbA1c) (b = 0.04) and number of comorbidities (b = 0.03). Conclusions This short FoH screener demonstrated good reliability and validity. Further research is planned to assess clinical usability to identify patients with FoH and assist effective HCP-patient conversations.

AIMS:Severe hypoglycaemia among people with diabetes who use insulin can be a life-threatening complication if left untreated. Although glucagon has been approved for treatment of hypoglycaemia since the 1960s, it has been underutilized. We aimed to understand the perceptions of people with diabetes and their caregivers about glucagon. METHODS:We conducted in-depth, one-on-one telephone interviews with people with diabetes and their caregivers in the United States. The interviews included questions around general awareness of glucagon, reasons for owning or not owning glucagon, and suggestions for improving understanding of glucagon as treatment for severe hypoglycaemia. Initial synopsis and inductive codebook schema were used to analyse the responses by two independent researchers. Themes were developed from the codes, and codes were re-mapped back to the themes. RESULTS:There were 60 dyads of people with diabetes and their caregivers (N = 120). Four themes developed from the interviews: (1) for most participants, the stated reasons for not owning or renewing a prescription for glucagon included unawareness of the medication, its advantages and its value; (2) misperceptions about glucagon occurred frequently; (3) caregivers often lacked confidence in administering reconstituted injectable glucagon; and (4) education and training from healthcare providers about glucagon would be welcomed. CONCLUSIONS:This study emphasizes the need for healthcare providers to discuss hypoglycaemia prevention and events at each clinical visit, including the use of glucagon in the case of severe hypoglycaemia. Healthcare providers are encouraged to assess the knowledge of people with diabetes and their caregivers regarding treatment and prevention of hypoglycaemia.

INTRODUCTION:Fear of hypoglycemia (FoH) affects quality of life, emotional well-being, and diabetes management among people with type 1 diabetes (PwT1D). American Diabetes Association's (ADA) guidelines recommend assessing FoH in clinical practice. However, existing FoH measures are commonly used in research and not in clinical practice. In this study, prevalence of FoH was assessed in PwT1D using a newly developed FoH screener for clinical practice; its association with established measures and outcomes was also determined. In addition, healthcare providers' (HCPs) perspectives on implementing FoH screener into real-world practice were explored.RESEARCH DESIGN AND METHODS:This multiphase observational study used mixed methods in two phases. First, we collected a cross-sectional survey (including the screener) from PwT1D (≥18 years) from T1D Exchange Quality Improvement Collaborative adult clinics. Pearson correlations and regression analyses were performed on diabetes outcome measures using screener scores. Second, we conducted focus groups among HCPs who treat PwT1D and descriptive analysis to summarize results.RESULTS:We included 553 PwT1D. Participants had a mean±SD age of 38.9±14.2 years and 30% reported a high FoH total score. Regression analyses showed that higher A1c and higher number of comorbidities were significantly associated with high FoH (p<0.001). High FoH worry and behavior scores were significantly associated with 8-Item Patient Health Questionnaire and 7-Item Generalized Anxiety Disorder Scale scores. Participants with ≥1 severe hypoglycemia event(s) and impaired awareness of hypoglycemia had higher odds of high FoH. Eleven HCPs participated in focus group interviews; they expressed that the FoH screener is clinically necessary and relevant but poses implementation challenges that must be addressed.CONCLUSIONS:Our results demonstrate FoH is common in PwT1D and affects their psychosocial well-being and diabetes management. In alignment with ADA position statement, HCP focus group results emphasize importance of screening for FoH. Implementing this newly developed FoH screener may help HCPs identify FoH in PwT1D.

Aims The CRASH study examined severe hypoglycemia (SH) experiences among people with diabetes (PWD) and caregivers across eight countries. Here we report findings from the Japan cohort, with references to data from the United Kingdom (UK) cohort. Materials and Methods Adults with type 1 (T1DM) or insulin-treated type 2 diabetes mellitus (T2DM) and caregivers (not necessarily related) were recruited from online patient panels. Participants who had experienced at least one SH event in the past 3 years were eligible for study inclusion. Participants completed an online survey regarding their experience with SH, its treatment, and actions during and after an event. Results Of the 9367 PWD and caregivers from the online patient panels, 8475 participants were ineligible and a total of 53 Japanese participants (35 T1DM, 9 T2DM, 9 caregivers) completed the survey. Most SH incidents occurred at home and were unattended by a healthcare provider. For T1DM, 29% of Japan PWD and 13% of the UK PWD called an ambulance during an SH event; of these, 90% (Japan) and 50% (UK) were transported to hospital. Glucagon use was low (3% Japan and 10% UK for T1DM). Japanese respondents reported emotional impacts of SH, including feeling scared (86% T1DM, 56% T2DM), unprepared (63% T1DM, 78% T2DM), and helpless (60% T1DM, 33% T2DM). Despite the emotional burden, most PWD did not immediately discuss their SH event with a healthcare provider, with the majority (75% T1DM, 71% T2DM) waiting until their next doctor’s appointment. Conclusion Conversations around SH between healthcare providers and PWD appear to be insufficient in Japan. An emotional burden of SH was reported by PWD and caregivers. Education regarding the prevention of SH and available treatment options may reduce SH events and improve treatment preparation, while alleviating PWD concerns.