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Background Although short-term blood glucose levels and variability are thought to underlie diminished function and emotional well-being in people with type 1 diabetes (T1D), these relationships are poorly understood. The Function and Emotion in Everyday Life with T1D (FEEL-T1D) study focuses on investigating these short-term dynamic relationships among blood glucose levels, functional ability, and emotional well-being in adults with T1D. Objective The aim of this study is to present the FEEL-T1D study design, methods, and study progress to date, including adaptations necessitated by the COVID-19 pandemic to implement the study fully remotely. Methods The FEEL-T1D study will recruit 200 adults with T1D in the age range of 18-75 years. Data collection includes a comprehensive survey battery, along with 14 days of intensive longitudinal data using blinded continuous glucose monitoring, ecological momentary assessments, ambulatory cognitive tasks, and accelerometers. All study procedures are conducted remotely by mailing the study equipment and by using videoconferencing for study visits. Results The study received institutional review board approval in January 2019 and was funded in April 2019. Data collection began in June 2020 and is projected to end in December 2021. As of June 2021, after 12 months of recruitment, 124 participants have enrolled in the FEEL-T1D study. Approximately 87.6% (7082/8087) of ecological momentary assessment surveys have been completed with minimal missing data, and 82.0% (82/100) of the participants provided concurrent continuous glucose monitoring data, ecological momentary assessment data, and accelerometer data for at least 10 of the 14 days of data collection. Conclusions Thus far, our reconfiguration of the FEEL-T1D protocol to be implemented remotely during the COVID-19 pandemic has been a success. The FEEL-T1D study will elucidate the dynamic relationships among blood glucose levels, emotional well-being, cognitive function, and participation in daily activities. In doing so, it will pave the way for innovative just-in-time interventions and produce actionable insights to facilitate tailoring of diabetes treatments to optimize the function and well-being of individuals with T1D. International Registered Report Identifier (IRRID) DERR1-10.2196/30901

The experiences of stigmatization among people living with specific Serious Mental Illnesses (SMI), such as Borderline Personality Disorder (BPD) has not been addressed by the scientific literature. In this study we wanted to explore how people living with BPD experience stigmatization. We examine the experiences of 8 people (7 women and 1 man) living and receiving treatment for BPD in Puerto Rico. We used an exploratory qualitative design with semi-structured interviews. To interpret our data, we conducted a thematic analysis. We discuss three categories that focus on one identified theme: the interpersonal dimension of the stigmatization process. These categories are (a) society’s views of people living with BPD, (b) family relationships, and (c) partner relationships. Our findings show that people with BPD experience a high attributed personal responsibility, discrimination, social exclusion, and lack of social support. In addition, our findings suggest that the stigmatization of BPD might be more complex than other mental illnesses as it shares characteristics of both SMI and less severe forms of mental illness. We also discuss the importance for practitioners to address stigmatization in therapy and the importance for research to address other aspects of the stigmatization process such as its structural dimension.

Background: Racial–ethnic inequity in type 1 diabetes technology use is well documented and contributes to disparities in glycemic and long-term outcomes. However, solutions to address technology inequity remain sparse and lack stakeholder input. Methods: We employed user-centered design principles to conduct workshop sessions with multidisciplinary panels of stakeholders, building off of our prior study highlighting patient-identified barriers and proposed solutions. Stakeholders were convened to review our prior findings and co-create interventions to increase technology use among underserved populations with type 1 diabetes. Stakeholders included type 1 diabetes patients who had recently onboarded to technology; endocrinology and primary care physicians; nurses; diabetes educators; psychologists; and community health workers. Sessions were recorded and analyzed iteratively by multiple coders for common themes. Results: We convened 7 virtual 2-h workshops for 32 stakeholders from 11 states in the United States. Patients and providers confirmed prior published studies highlighting patient barriers and generated new ideas by co-creating solutions. Common themes of proposed interventions included (1) prioritizing more equitable systems of offering technology, (2) using visual and hands-on approaches to increase accessibility of technology and education, (3) including peer and family support systems more, and (4) assisting with insurance navigation and social needs. Discussion: Our study furthers the field by providing stakeholder-endorsed intervention ideas that propose feasible changes at the patient, provider, and system levels to reduce inequity in diabetes technology use in type 1 diabetes. Multidisciplinary stakeholder engagement in disparities research offers unique insight that is impactful and acceptable to the target population.

Background: Diabetes-related stigma (DRS) globally affects patients’ lives. Over a third of adolescents with type 1 diabetes (T1D) in Puerto Rico reported concerns of others knowing about their diabetes and about being different. Participants and Procedures: We examined DRS among 65 T1D Latino youth (aged 12–17). During a depression-treatment study screening, they answered open-ended questions about diabetes-related concerns/difficulties and issues bothering them while interacting with peers, family, and healthcare professionals because of T1D. Using content analysis, we classified responses into Social Stigma (SS), Internalized Stigma (IS), and No Stigma. Four SS and IS sub-categories were developed. Results: After coding, inter-rater reliability (Cohen’s kappa) ranged from .73 to .1.00 (p≤.001). Forty-four youth (67.69%) reported at least one DRS verbalization, and 25 reported more than one. Both SS and IS were identified in 32 (49.23%) adolescents. Among SS experiences were: “they call me a junkie [because of insulin shots]”; “they call me a terrorist [because of insulin pump]”. IS verbalizations included: “I’ve never wanted to accept that I have T1D, so I don’t practice good self-care”; “at times I do not feel the same as others”. We found more stigma-related verbalizations among those from urban zones or larger families. DRS was related to increased depressive symptoms and risk of a depressive disorder. Peers were the main source of SS. Conclusion: DRS was common, pervasive, and linked to depression. This study innovatively examines DRS in an exclusively T1D Latino and adolescent sample. Understanding its extent and nature is essential for developing interventions to address DRS.

Introduction: While people with T1D report that blood glucose (BG) fluctuations affect their day-to-day functioning, these relationships are poorly understood. Using continuous glucose monitoring (CGM) , accelerometry, and momentary surveys and cognitive tasks, we sought to understand how various BG metrics during sleeping hours impact functioning the following day. Methods: Participants wore a blinded CGM and accelerometer for 10-14 days, during which they completed surveys and cognitive tasks 5-6 times per day. Using dynamic structural equation modeling, we evaluated the within-person impact of overnight BG on the following day’s functioning, while controlling for the prior day’s functioning. BG variables included % time <70 mg/dL, % time >250 mg/dL, and coefficient of variation (CV) . Functioning variables included cognitive measures of sustained attention and perceptual speed; daily step count; and self-reported fatigue, task performance, and net activity demand. Results: Among 127 adults with T1D (41±15 yrs, 46% male, 39% Latinx, 35% White, 10% Black, 4% Asian, 12% multiethnic/other) , all three BG variables predicted changes in next day functioning. More time <70 predicted poorer sustained attention (standardized b= -0.06) , while more time >250 predicted more fatigue (0.09) and lower step count (-0.12) (all p<0.05) . Higher CV had the broadest impact, predicting poorer sustained attention (-0.06) , more fatigue (0.05) , and less engagement in demanding activities (-0.05) (all p<0.05) . Conclusion: Our findings indicate that overnight BG impacts cognition, physical activity, fatigue, and activity engagement the following day. While effect sizes are small, the cumulative impact of these decrements in function should be considered in the context of a life-long disorder. The consistent findings among diverse outcomes, including both objective and self-report measures, strengthen confidence in the overall conclusion that overnight BG has wide-ranging implications for functioning in adults with T1D. Disclosure E. Pyatak: Research Support; Abbott Diabetes. D. Spruijt-Metz: None. S. Schneider: None. J.P. Crandall: Research Support; Abbott Diabetes. A.L. Peters: Advisory Panel; Abbott Diabetes, AstraZeneca, Eli Lilly and Company, Novo Nordisk, Shouti, Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S. Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Leona M. and Harry B. Helmsley Charitable Trust. Stock/Shareholder; Teladoc Health. Other Relationship; Omada Health, Inc. H. Jin: None. S. Agarwal: Advisory Panel; Medtronic. Consultant; Beta Bionics, Inc. L.T. Pham: None. A. Ali: None. C.J. Hoogendoorn: None. G. Crespo-Ramos: None. R. Basile: None. J.S. Gonzalez: Consultant; Virta Health Corp. Funding National Institutes of Health (1R01DK121298-01)

Introduction: While it is widely recognized that T1D can interfere with daily activities, the extent and impact of these disruptions are poorly understood. Using FEEL-T1D study data, we examined how T1D interfered with daily activities, and the association between activity disruptions, illness intrusiveness, and diabetes-related quality of life (DQoL). Methods: FEEL-T1D prompted 14 days of surveys via smartphone at 3-hr intervals 5-6x/day. At each survey, participants indicated what activity they were doing, their activity performance and satisfaction, and whether/how T1D interfered with the activity. At end-of-day, they noted activities they could not do due to T1D. At study end, participants completed the T1D and Life (T1DAL) measure of DQoL and Adapted Illness Intrusiveness Rating Scale (AIIRS). Descriptive statistics and multilevel regressions were used to identify daily activity disruptions and their associations with DQoL and illness intrusiveness. Results: Overall, 190 participants (40±14 yrs old, 54% female, 29% White, 40% Hispanic/Latinx, 31% other) completed 14,387 momentary surveys, of which 12.1% indicated activity disruptions, most often personal care (16.1% disrupted), sleep (14.6%), and housework/errands (13.4%). Participants were unable to do desired activities due to T1D on 8.2% of days, most often housework/errands (3.8% of days), work/school, personal care, and leisure (2.6% for each). Performance and satisfaction were poorer for disrupted vs. non-disrupted activities (p<.0001). Those with more activity disruptions had greater illness intrusiveness (p<.0001) and lower DQoL (p<.0001). Discussion: T1D-related activity disruptions are common and associated with poorer activity performance/satisfaction, more illness intrusiveness, and lower DQoL. Validating the impact of T1D on daily activities, and seeking strategies to minimize this impact, may improve QoL for adults with T1D. Disclosure E.Pyatak: Research Support; Abbott Diabetes. G.Crespo-ramos: None. R.Hernandez: None. L.T.Pham: None. J.S.Gonzalez: Consultant; Virta Health Corp. D.Spruijt-metz: None. P.Lee: None. S.Schneider: None. A.L.Peters: Advisory Panel; Abbott Diabetes, Medscape, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Zealand Pharma A/S, Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Stock/Shareholder; Omada Health, Inc., Livongo. J.P.Crandall: Research Support; Abbott Diabetes. S.Agarwal: Advisory Panel; Medtronic, Consultant; Beta Bionics, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. H.Jin: None. C.J.Hoogendoorn: None. Funding National Institutes of Health (1R01DK121298)

Background: The Glycemia Risk Index (GRI) was introduced as a single value derived from the ambulatory glucose profile that identifies patients who need attention. This study describes participants in each of the five GRI zones and examines the percentage of variation in GRI scores that is explained by sociodemographic and clinical variables among diverse adults with type 1 diabetes. Methods: A total of 159 participants provided blinded continuous glucose monitoring (CGM) data over 14 days (mean age [SD] = 41.4 [14.5] years; female = 54.1%, Hispanic = 41.5%). Glycemia Risk Index zones were compared on CGM, sociodemographic, and clinical variables. Shapley value analysis examined the percentage of variation in GRI scores explained by different variables. Receiver operating characteristic curves examined GRI cutoffs for those more likely to have experienced ketoacidosis or severe hypoglycemia. Results: Mean glucose and variability, time in range, and percentage of time in high, and very high, glucose ranges differed across the five GRI zones ( P values < .001). Multiple sociodemographic indices also differed across zones, including education level, race/ethnicity, age, and insurance status. Sociodemographic and clinical variables collectively explained 62.2% of variance in GRI scores. A GRI score ≥84.5 reflected greater likelihood of ketoacidosis (area under the curve [AUC] = 0.848), and scores ≥58.2 reflected greater likelihood of severe hypoglycemia (AUC = 0.729) over the previous six months. Conclusions: Results support the use of the GRI, with GRI zones identifying those in need of clinical attention. Findings highlight the need to address health inequities. Treatment differences associated with the GRI also suggest behavioral and clinical interventions including starting individuals on CGM or automated insulin delivery systems.