Clinical inertia is the failure to initiate or intensify treatment in a timely manner in people with type-2 diabetes mellitus (T2DM) in primary care (PC) where collaborative care can be an approach to overcome inertia. Diabetes care network (DCN) is a telehealth based collaborative care model to address clinical inertia in the PC environment. In DCN, initial care was delivered via E-Consult by hub diabetes team for Veterans with A1c of 9% or higher and the longitudinal collaborative care delivered by PC liaison with weekly team huddle. To study the difference in the clinical outcomes with DCN vs. PC practices, we compared the DCN cohort (97.7% male, 90.8% white, with a mean age 67.2 (8.9), with a PC cohort (100% male, 94.9% white, mean age: 68 year (10.5), with A1C >9%). Methods: Means (SD), frequencies and percentages were presented. The DCN cohort had a significant decline in the baseline A1C of 10.2% (1.4), to 8.1% (0.99), 7.6% (0.96), 7.5 % (0.86) at 3, 6, and 12 months while A1c in PC cohort stayed poor with baseline A1C of 10.1% (0.89), to 10.2% (1.69), 9.7% (1.74) and, 9.5% (1.83) at 3, 6, and 12 months. Patients who achieved A1c less than 8% in DCN cohort were 38 (43.6%), 56 (64%), and 56 (64%) at 3, 6, and 12 months and were 1(1.7%), 5(8.5%), and 6(10.2%) at 3, 6, and 12 months in PC cohort. An A1c of less than 7% was achieved in DCN cohort in 10 (11.4%), 21 (24.1%), and 23 (26.4%) patients at 3, 6, and 12 months and only 1(1.7%), 0(0%), and 0(0%) patients achieved A1c less than 7% at 3, 6, and 12 months in PC cohort. Our study shows participation in the DCN telehealth program for 1 year was associated with significant improvement in A1c. This improvement was not seen within the PC with traditional care practices. Thus, addressing clinical inertia in PC will need a paradigm shift in current practices. The proposed collaborative approach of DCN can overcome clinical inertia in PC and improve care for people with T2D by supporting PC access to specialty care expertise, decreasing the burden of diabetes care for patients and PC providers. Disclosure K. Clark: None. M. J. Larson: None. S. J. Lutz-McCain: None. A. Bandi: None.

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The field of organic electron donors is large and diverse, both in terms of the structures of the donors and the structures of the acceptors. In the past 15 years, organic donors have been developed that show remarkable strength, with ground-state or excited-state oxidation potentials rivalling even the most reactive metals. At the other end of the scale of reactivity, highly reactive oxidizing agents are now available upon photoactivation of a number of organic structures. The first part of this chapter reviews organic electron donors that are based upon an alkene that is activated by strongly electron-releasing substituents; these donors can be active in the ground and/or excited states. The chapter also covers anionic organic donors that emerged in the field of SRN1 and base-induced homolytic aromatic substitution (BHAS) reactions, as well as substrate-based anionic donors including borates and silicates. The use of photoexcited organic dyes as electron donors is described and, finally, some of the recent research with very weak organic donors is highlighted.

Vespa amino acid mixture (VAAM) is a synthetic blend of amino acids, which has been proven to increase rates of aerobic cellular metabolism by increasing net ATP production in various eukaryotes. The mechanism through which VAAM increases ATP production is unknown; our work suggests that VAAM augments the proton motive force. In order to quantitatively evaluate the effects of VAAM on mitochondrial metabolism, we measured the levels of reactive oxygen species, relative NAD+/NADH levels, caspase activation, mitochondrial membrane integrity, and ATP levels in yeast (Saccharomyces cerevisiae) with differing doses of VAAM at multiple time points. The levels of reactive oxygen species increased within five minutes of the exposure to the lowest dose of VAAM (0.003%, 1% of the recommended dose) and time points beyond five minutes yielded toxic levels and activation of caspase. This was also demonstrated with NAD+/NADH levels, higher levels of NAD+ were observed in the VAAM treated cells, indicating an increase in entry of electrons into the transport chain, leading to the observed increase in ATP production. We attempted to counteract the actions of VAAM by adding α‐tocopherol (an antioxidant) and 2,4‐dinitrophenol (DNP, a proton motive force uncoupler) to the VAAM treatment separately. The antioxidants reduced the production of reactive oxygen species only slightly, and did not significantly lower the production of ATP. Surprisingly, DNP, known to uncouple the proton motive force, was successful in prolonging the life of the cell in the presence of VAAM. This taken in account with the increase in ATP production leads us to believe that VAAM facilitates electron transport leading to enhanced coupling with the activity of ATP synthase.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.