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Background: Non-Hispanic Black (NHB) and Hispanic/Latinx (H/L) patients bear a disproportionate burden of type 2 diabetes and associated complications. Regular visits to a primary care doctor or diabetes specialist are warranted to maintain glycemic control, but for a myriad of reasons disparity populations may have difficulties receiving diabetes care. We seek to determine the feasibility of telehealth added to care as usual and secondarily to improve health outcomes (hemoglobin A1c [HbA1c]) in NHB and H/L with uncontrolled type 2 diabetes managed with two or three noninsulin agents. Methods: Twenty-nine patients were randomized to monthly phone calls or weekly to biweekly telehealth visits. Feasibility outcomes were summarized descriptively for the telehealth arm. Differences scores for A1C level and surveys were computed between baseline and three months and compared across arms using a two-sample t test or Mann-Whitney U test. Results: Patients in the telehealth arm completed a median of eight visits (IQR: 5, 8), and 53% of those in the telephone arm completed 100% of their calls. Change in HbA1c was greater for those in the telephone arm (–2.57 vs –2.07%, P = .70) but the mean baseline HbA1c was higher in the telephone group (11.1% vs 10.3%). Although the change in HbA1c was not statistically different across arms, it was clinically significant. Conclusions: Augmenting care as usual with telehealth provided by telephone or tablet can be of benefit in improving glycemic control in NHB and H/L with type 2 diabetes. Larger studies need to explore this further.

Purpose: Diabetic foot ulcers (DFUs) are a leading cause of lower extremity amputations among persons with diabetes (PWD) and a common cause of hospitalizations. This study identified demographic characteristics, lab values, and comorbidities associated with 30-day and 90-day hospital readmission in persons with DFU. Methods: A retrospective chart review at our institution examined 397 patients with type 2 diabetes admitted with DFU between January 2014 and December 2018. Variables were analyzed using descriptive statistics, t-tests, and logistic regressions. Results: None of the studied demographic, laboratory (including Hemoglobin A1c) or comorbid diseases were associated with 30-day readmission in persons with DFU. Risk factors for 90-day readmission included discharge location to home with health care (OR: 2.62, 95% CI: 1.39, 4.95), anticoagulant use (OR: 2.36, 95% CI: 1.27, 4.39), and SQ insulin use (OR: 2.08, 95% CI: 1.20, 3.61). Conclusions: None of the variables examined were associated with 30-day readmission; however, potential predictors for 90-day readmission included anticoagulation or insulin use and discharge home with healthcare services. Future studies should devise interventions to improve transition of care in patients with DFU to further assess the role of medications and home health care as a potential predictor of 90-day hospital readmission.

Background Diabetic foot ulcers (DFU) are the leading cause of lower-extremity amputations among patients with diabetes (DM)1. 15% of patients with DM develop DFU, with the potential for progression to osteomyelitis or gangrene with suboptimal glycemic control. Repeated readmissions are not only a negative prognostic indicator for these patients, but also contributes to increasing healthcare costs. Areas of Uncertainty Previous studies have examined associations among demographics, comorbidities and DFU, and the value of Hemoglobin A1c (HbA1c) and C-reactive protein (CRP) as a prognostic indicator and monitoring tool for progression and regression, respectively3,4. However, no studies to date have examined medical or pharmaceutical factors contributing to 30-day and 90-day readmission. Methods A retrospective chart review was conducted examining 397 patients with type 2 diabetes readmitted for DFU between 2014 and 2019. Variables were summarized using descriptive statistics, t-tests, chi-square, and logistic regressions. Results Majority of patients were white males with a BMI over 30 and HbA1c >7%. Patients with 30-day readmission were more likely to be using anticoagulants (30.00% vs. 17.24%, p= 0.0493). Patients with 90-day readmission were more likely to be discharged home with healthcare services (55.67% vs. 39.85%, p=0.0341) or to a skilled nursing facility (7.22% vs. 6.02%, p=0.0341). Although not statistically significant, patients with both 30-day and 90-day readmissions were also more likely to have HbA1c >7, while those with a 90-day readmission had higher CRP levels. Conclusions DFU patients with suboptimal glycemic control were more likely to experience a 30-day and 90-day readmission. Predicators for readmission in this population include: anticoagulation use, discharge to a skilled nursing facility or discharge home with healthcare services. As a result, patients not on anticoagulation, as well as those discharged home without services or to rehabilitation facilities have a reduced risk of readmission. 1. Lazzarini PA, Clark D, Derhy PH. What are the major causes of lower limb amputations in a major Australian teaching hospital? The Queensland Diabetic Foot Innovation Project, 2006 – 2007. 2011;4(1):O24. doi:10.1186/1757-1146-4-S1-O24 2. Vella L, Gatt A, Formosa C. Does Baseline Hemoglobin A1c Level Predict Diabetic Foot Ulcer Outcome or Wound Healing Time? Journal of the American Podiatric Medical Association. https://www.ncbi.nlm.nih.gov/pubmed/28880596. Published July 2017. Accessed September 28, 2019. 3. King DE, Mainous AG, Buchanan TA, Pearson WS. C-Reactive Protein and Glycemic Control in Adults With Diabetes. Diabetes Care. https://care.diabetesjournals.org/content/26/5/1535. Published May 1, 2003. Accessed September 28, 2019.

Background: Enhanced recovery protocols (ERP) are designed to achieve early improvement post-operatively by maintaining organ function and reducing stress response. Stress stimulates the hypothalamus-pituitary-adrenal (HPA) axis resulting in marked hyperglycemia 1 . Previous studies have shown that patients experience better outcomes and fewer complications when they use ERP 2,3 . ERP utilizes a high carbohydrate load in the form of liquid shakes or juice the night before and the morning of surgery. It remains to be seen how the use of this carbohydrate load can affect outcomes in persons with diabetes. The goal of this study is to determine the effectiveness of ERP on the length of stay (LOS) in persons with diabetes requiring colorectal surgery. Methods: A retrospective chart review was performed on 74 patients with diabetes: 37 received ERP and 37 did not. The participants had their surgery between September 2012 and February 2018. Both groups were matched according to age and sex and LOS was compared as the primary outcome. Secondary variables explored were race, insurance, and benign vs. malignant pathology results. A p-value of <0.05 was considered statistically significant. Results: Majority of patients were white (76%) and male (57%) with Medicare insurance. In the group of persons with diabetes who received the ERP, the average LOS was three days (95% CL of 3.0324-5.7244) as compared to an average of eight days (95% CL of 6.6450-10.5442) in the group who did not receive ERP (p=0.0006). Older age was the only variable which correlated positively (p=0.046) and significantly with LOS; there was no difference seen amongst race, insurance or pathology results. Conclusion: This study showed that using ERP in the form of carbohydrate loading in patients with diabetes can significantly reduce LOS as compared to those who did not receive the protocol. Utilization of an ERP has the potential to improve patient outcomes, especially in persons with diabetes. The limitations of our study include that it was retrospective in design and had a small sample size. As a result, future research should include large prospective trials which would help to determine the safety and efficacy of ERP in patients with diabetes. REFERENCES: 1) Hall GM. The anesthetic modification of the endocrine and metabolic response to surgery. Ann R Coll Surg Engl . 1985;67(1):25-9. 2) Cakir H, et al. Adherence to Enhanced Recovery after Surgery and length of stay after colonic resection. Colorectal Dis . 2013:15:1019-1025. 3) Ljungqvist O, et al. Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. Proc Nutr Soc . 2002; 61(3): 329-336.

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Introduction: Suboptimal glycemic control continues to be an ongoing problem in diabetes care. Poor glycemic control can be caused by a myriad of reasons including improper insulin storage or poor insulin pen technique. The Worldwide Injection Technique Questionnaire Study revealed a high level of poor insulin injection among participants, as well as a high prevalence of injecting complications such as lipohypertrophy (LH). 1 The primary objective of this study was to evaluate the injection technique of a sample of inpatients; the secondary objective was to assess the relationship between injection skill accuracy and glycemic control. Methods : Participants were inpatients admitted to med-surgical units at an urban quaternary care center. Included were those with type 1 (T1DM) or type 2 diabetes (T2DM), aged 18 to 75 that were using an insulin pen for at least 3 months. Subjects were given a questionnaire about glycemic control, insulin pen education, and diabetes characteristics. Injection skill was assessed using an institutional competency checklist. Poor glycemic control was defined as HbA1c ≥ 9.0, any hospitalization for uncontrolled diabetes within the past year and occurrence of hypoglycemia within the last month. For insulin skill, those who achieved 80% or higher (75 th percentile) were classified as high performers and those below were deemed poor performers. Data was analyzed using descriptive statistics. Results: 100 study subjects with mostly T2DM (90%) and a mean age of 58.7 years were consented. Majority of patients (n=67) were in the poor performer category while 28 were high performers (5 were excluded). There was no association between poor technique and glycemic control. However, a greater number of poor performers had at least 1 hospitalization for uncontrolled diabetes within the past year (21% vs 11%) (p=0.238). A larger number of those with poor technique were more likely to have had a hypoglycemic episode within the past month (66% vs 61%) (p=0.645). Majority of participants received initial pen training from an endocrinologist or primary care physician (PCP); most of which had never received reinforcement. Those with poor technique were using higher amounts of insulin (total daily dose over 50 units). Conclusion: This pilot study suggests that improved injection training has potential to reduce hospitalizations and episodes of hypoglycemia. The results highlight the overall lack of proper training and reinforcement and the need to emphasize its importance. A follow up study with a larger sample may have better ability to detect statistical significance. References: 1) Frid et al. Worldwide Injection Technique Questionnaire Study: Population Parameters and Injection Practices. Mayo Clinic Proc. 2016: 91 (9): 1212-1223

S77ObjectiveS: Characterize baseline clinical and patient-centric characteristics of type 2 diabetes mellitus (T2DM) patients who met criteria for an online patient engagement tool. MethOdS: This study analyzed pooled baseline data from T2DM patients identified for a prospective evaluation of an online patient engagement tool at two sites; Henry Ford Health System and Northwell Health. Patients were eligible if they were ≥ 18 years of age, diagnosed with T2DM, and had a baseline Patient Activation Measure (PAM) level 2 'Becoming Aware' or 3 'Taking Action'. Clinical assessments and patient reported outcomes (PROs) were collected online and described using summary statistics. ReSultS: 662 participants consented and provided PAM data, with 15.9% and 48.8% at PAM levels 2 and 3, respectively. Patients at levels 1 (5.4%) and 4 (29.9%) were ineligible. 363 patients met all eligibility criteria for this analysis. Participants were primarily white (58.4%), females (59.0%) with a mean age of 57.4 (SD: 11.1) years and PAM level of 3 (76.6%). Mean time since diagnosis of T2DM was 10.4 (SD: 8.3) years. The most common comorbidities were hypertension and hypercholesterolemia/hyperlipidemia (20.7% each). 39.4% of patients had hemoglobin A1c ≥ 8.0% (mean: 8.0%, SD: 1.8) and mean body mass index (BMI) was 36.3 (SD: 7.4) kg/m2, with 80.2% being considered obese (BMI ≥ 30 kg/m2). Mean physical and mental component summary scores from the Short Form 12 were 40.9 (SD: 16.1) and 44.9 (SD: 17.1), respectively, indicating impaired functioning in each dimension. Mean Diabetes Distress Scale scores indicated moderate regimen-related distress (3.1, SD: 1.2) and emotional burden (2.7, SD: 1.2), suggesting clinical attention is necessary. cOncluSiOnS: Clinical measurements and PROs in our population of T2DM patients with PAM level 2/3 suggest a need for clinical and lifestyle intervention. Further research is needed to confirm appropriate clinical intervention and the potential effectiveness of targeted patient engagement tools.