Background: Managing T1D as a YA is challenging due to changing physiology, psychosocial demands, and increasing independence. Fewer than one-third of YA with T1D meet the ADA guidelines of quarterly diabetes visits and only one in seven attain the recommended hemoglobin A1c level of <7%. YA from disadvantaged ethnic, racial, and socioeconomic backgrounds face even greater T1D management obstacles. Methods: The CoYoT1 Care model was adapted for diverse, predominantly publicly insured, YA with T1D at a large urban hospital. A 15-month 4-arm randomized controlled trial collected data on 68 YA, ages 16-25. Participants received either CoYoT1 Care or Standard Care via in-person or Telehealth (TH) , prior to COVID-19; all in-person visits transitioned to TH in March 2020. CoYoT1 Care consists of patient-centered provider visits with bimonthly virtual T1D peer group sessions. Results: YA who attended >50% of study visits by TH attended more visits during the study period (3.4) than those who primarily attended in-person (2.6, p<0.0001) . Those who were seen more by TH also had stable levels of diabetes distress versus increased distress in those attending in-person visits (p=0.02) . A conjoint analysis conducted with YA found that not having to travel to clinic for visits was TH’s greatest benefit; technical problems and not always having private space were its biggest challenges. Participants also rated access to a clinic coordinator and TH visits as extremely valuable. Conclusions: TH was successfully adapted for diverse YA with T1D, resulting in increased attendance and stable diabetes distress compared to in-person care. Participants overwhelmingly indicated that the benefits associated with TH, such as saving time and money traveling and parking, outweighed any technical challenges. Larger studies with longer term follow-up, not occurring during a global pandemic, are needed to refine TH’s role in patient-centered care of YA with T1D. Disclosure J.Raymond: None. J.L.Fogel: None. M.W.Reid: None. E.Salcedo-rodriguez: None. D.Fox: None. E.Pyatak: Research Support; Abbott Diabetes. Funding Donaghue Foundation
Background: VPG have been shown to improve psychosocial well-being in AYA with T1D, but it is unknown what aspects of VPG are most or least valued. Methods: CoYoT1 to California is a 15 month randomized controlled trial for patients ages 16-25 with T1D. AYA received Usual Care (n=28) or CoYoT1 Care (n=40) , which consisted of patient-centered provider visits and bimonthly VPG led by a YA with T1D. VPG were AYA-driven discussions focused on topics pertinent to AYA with T1D, emphasizing problem-solving and emotional support. At study end, VPG participants responded to a survey about their preferences for intervention features. Results: CoYoT1 Care patients were 40% female, 53% Latinx, and 72% publicly insured; and they attended 1.9 VPG each on average. AYA who attended at least one VPG participated in 4.1 VPG on average. The average session had 4.5 AYA present; each topic was covered by 9.6 AYA on average. Most survey respondents (75%) reported VPG were extremely or very valuable in supporting their T1D care. Seeing peers use diabetes technology and being supported by same-aged peers with T1D increased VPG value the most. Larger group size and not feeling comfortable sharing decreased value the most. Conclusion: Peer interactions may support unmet needs of AYA with T1D from diverse backgrounds. Further work will help optimize the design of VPG based on patient preferences. Disclosure D.I.Bisno: None. E.Pyatak: Research Support; Abbott Diabetes. M.W.Reid: None. D.Fox: None. J.L.Fogel: None. E.Salcedo-rodriguez: None. J.J.Flores garcia: None. A.Torres sanchez: None. J.Raymond: None. Funding The Donaghue Foundation
Background: Historically disadvantaged, ethnically- and racially-diverse AYA experience significantly greater challenges with T1D management when compared to White peers. To address this inequity, the patient-centered CoYoT1 Care model was adapted and implemented at a T1D clinic serving primarily ethnically- and racially-diverse AYA. Methods: In a randomized controlled 2x2 trial, 68 AYA received either CoYoT1 Care or Standard Care via in-person or Telehealth (TH) . Hemoglobin A1c (A1c) and T1D-related distress were measured at baseline and after four quarterly clinic visits, and analyzed via linear mixed models adjusting for age, sex, and attendance. Results: At study end, participants in TH showed reduced A1c (p=0.01) and no changes in physician-related distress (p=0.04) , compared to increased A1c and distress in those randomized to in-person care. Secondary analyses revealed that these TH benefits were attributable to Latinx AYA subgroup. Compared to Latinx participants randomized to in-person care, those in TH showed significant reductions in A1c (p=0.003; Figure) and physician distress (p=0.008) . Among non-Latinx participants, no significant differences in A1c or distress were observed. Conclusion: The TH CoYoT1 Care model engages underserved, ethnically-diverse AYA and leads to improved outcomes. Next steps include collaborating with stakeholders to adapt and implement the model nationwide. Disclosure J.J.Flores garcia: None. M.W.Reid: None. E.Pyatak: Research Support; Abbott Diabetes. J.L.Fogel: None. D.Fox: None. E.Salcedo-rodriguez: None. J.Raymond: None.
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