Background: YAs with T1D have more complications and mental health challenges, and are less engaged in care, than other age groups. Few studies have examined factors predicting engagement in self-management interventions, which may support YAs’ T1D care and overall well-being. Methods: Using data from a T1D self-management RCT, we analyzed predictors of engagement among those randomized to the intervention who had reached the 6 month endpoint. Engagement was defined as the number of completed intervention sessions. Control variables were measured at baseline. Ordinary least-squares regression was used, entering categories of predictors in separate steps: 1) demographics: age, gender, race/ethnicity, insurance status, parental education; 2) clinical: A1c, duration of T1D, device use; 3) behavioral: medication adherence, diabetes self-management (DSMQ); 4) psychosocial: diabetes distress (DDS), self-efficacy (DES-SF), and autonomous motivation (TSRQ). Results: Participants (n=87) were 24 (±4) yrs old, 60% female, 49% Hispanic/Latinx and 43% White, and completed a mean of 9.5 intervention sessions (range: 0-24). In the final model (p=0.0003), engagement was associated with low parental education (parameter estimate -4.1 visits), being uninsured (+3.6 visits), and higher glucose monitoring (-1.1 visits) and physical activity (-0.6 visits) on the DSMQ. Discussion: Clinical and psychosocial variables were unrelated to OT visits; to an extent, poorer self-management predicted more visits. Indicators of SES were most predictive: low parental education decreased, and uninsured status increased, number of OT visits. Given that the factors most associated with engagement were indicators of SES, clinicians are encouraged to assess barriers and external factors that may impact access and participation as soon as possible in the therapeutic process, to facilitate engagement in services. Disclosure E.Pyatak: Research Support; Abbott Diabetes. J.Sideris: None. D.Fox: None. G.Granados: None. J.Diaz: None. J.Blanchard: None. A.R.Khurana: None. E.Salcedo-rodriguez: None. J.Raymond: None.
Introduction: Time limited eating (TLE) improves β-cell function, increases insulin sensitivity, lowers fasting glucose, and increases time in range in adults with T2D. Objectives: This study aims to evaluate TLE in pediatric new-onset T1D, at which time residual β-cell function may be preserved. Aim 1) Evaluate feasibility, acceptability, and safety of TLE. Aim 2) Test impact of TLE on β-cell function and insulin sensitivity. Aim 3) Assess effectiveness of TLE on glycemic control. Methods: A randomized controlled trial of youth aged 12-25 years diagnosed with T1D within 12 months; randomization to intervention (8-hour feed/16-hour fast) or control group (≥12-hour feed) for an 8-week period. Feasibility is evaluated using questionnaires and adherence. Safety is indicated by hypoglycemia frequency. β-cell function is evaluated by mixed meal tolerance test (MMTT) with area under C-peptide curve (AUC). Glycemic control is evaluated by time in range (TIR 70-180 mg/dL) on CGM and HbA1c. Results: Six youths have entered, three have completed (2 intervention, 1 control). Participants in intervention group adhered to TLE ~94% of time. Both reported TLE felt safe, noted improved stability of glucose, chose to continue TLE after study ended, and would recommend to others with T1D. No increased hypoglycemia frequency noted on CGM. Participant 2 (intervention) had increase in AUC from baseline (87.45 to 152.4) and decrease in HbA1c (-1.3 percentage points), although participant 1 (intervention) had decrease in AUC and no change in HbA1c. Participant 3 (control) had increase in AUC and decrease in HbA1c, both changes less than participant 2. No improvement in TIR on CGM was demonstrated in either group. Conclusion: This is the only known study evaluating TLE in youth with T1D and has the potential to advance management of T1D by introducing meal-timing early in diagnosis. Thus far the intervention appears feasible and safe, however more data is needed. Recruitment continues to be underway. Disclosure C.Berman: None. A.Vidmar: Advisory Panel; Rhythm Pharmaceuticals, Inc., Research Support; Dexcom, Inc. J.J.Flores garcia: None. J.Raymond: None.
Introduction: A subset of youth with T1D experience avoidable health problems, but it is unclear how specific social factors relate to these problems, particularly during the COVID-19 pandemic. We examined how systemic factors (caregiver, family, medical team) were related to medical outcomes in youth with elevated A1c from five academic medical centers during the pandemic. Methods: Youth 12-17 yrs with 1) T1D for ≥1 yr and 2) A1c≥10% in the past year were enrolled. Caregivers and youth completed measures of family conflict (Diabetes Family Conflict Scale-R); parent practices, stress, and health literacy (Alabama Parenting Questionnaire, Stress Index for Parents of Adolescents, BRIEF Health Literacy Scale); youth strengths and social support (Diabetes Strengths and Resilience, PROMIS); and family-medical team relationship (Quality of Healthcare Relationship) with EHR review including baseline A1c and acute complications (e.g., ED visits). Results: Participants were 157 youth with mean age 14.6 ± 1.6 years and mean A1c 11.0% ± 1.9%. 51% self-identified as Non-Hispanic White. Caregiver, family, and relational factors were significantly (p<.05) related to frequency of complications and A1c, with higher family conflict associated with higher A1c (r=.23) and more ED visits (r=.18). For caregivers, low health literacy (r=.17), inconsistent discipline practices (r=.20), and high parental stress related to low adolescent achievement (r=.26), were significantly (p<.05) associated with acute complications, as was youth report of low social support (r=-.20, p<.01). Positive family-medical team relationship was strongly related to lower A1c (r=-.30, p<.01). Discussion: Given these findings, screening and intervention efforts should emphasize targeting multiple systems and relationships with this population of youth, potentially with increased focus on the family-medical team relationship. Disclosure D.V.Wagner: None. L.Yglecias: None. J.Flores garcia: None. A.Torres sanchez: None. A.Bonilla ospina: None. J.Raymond: None. M.A.Harris: None. M.Perry: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. J.C.Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. D.Naranjo: None. A.Reed: None. C.Jenisch: None. C.Cruz: None. S.Mitchell: None. Funding JDRF
Background: The prevalence of type 1 diabetes (T1D) is increasing within racially and ethnically marginalized populations, highlighting the need for effective recruitment strategies that not only address healthcare disparities but also rebuild trust in medical research. Recently, the CoYoT1 to California (CTC) study evaluated a person-centered care model designed to support racially and ethnically diverse young adults (YA) who receive care at a hospital-based pediatric T1D clinic. In addition to treatment effectiveness, the study examined the success of recruitment strategies. Methods: Potential YA participants were approached in-person or remotely (by phone, email, or text). Those with clinic appointments during study recruitment were approached in-person, with recruiters focusing on cultural humility to connect with families; the concept and process of research was introduced, and families were allowed to ask questions as needed. Remote recruitment utilized multiple pre- and post-appointment messages with basic descriptions of the study or follow-up details as needed. Categorical data were compared using chi-squared tests. Results: The study approached 338 potential participants and recruited 68 (20%). Reflecting successful recruitment of diverse YA, study participants were representative of the clinic population in terms of racial and gender identities, and identified as Latinx (29, 43%) more often than those who declined (100, 37%; P=0.40). Recruitment strategy was significantly associated with participation, as most participants were recruited in-person (40, 59%), while most who declined did so remotely (200, 74%; P<0.0001). Conclusion: In-person recruitment is more effective for enrolling diverse YA and their families, as it allows recruiters to build rapport, and empowers families with information and choice. Internal and external barriers may prevent diverse YA from attending clinic appointments in-person, ultimately impacting research equity. Disclosure F.Gonzalez: None. M.W.Reid: None. E.Salcedo-rodriguez: None. J.Flores garcia: None. S.Hiyari: None. A.Torres sanchez: None. E.Pyatak: Research Support; Abbott Diabetes. D.Fox: None. J.Raymond: None. Funding Patrick and Catherine Weldon Donaghue Medical Research Foundation
Social determinants of health (SDOH) are recognized as drivers of health outcomes. In this pilot study, we explored SDOH in parents/guardians (PG) of youth with type 1 diabetes (T1D) and public insurance for differences across preferred language and ethnicity. PG of youth <12 years with T1D and public insurance were recruited to complete nine validated surveys in English or Spanish measuring perceived discrimination, childhood trauma, technology acceptance, and mental health. PG and child characteristics were gathered via self-report. Descriptive differences in survey responses were evaluated by three language and ethnicity groups: non-Hispanic English preferred (NHE), Hispanic English preferred (HE), and Hispanic Spanish preferred (HS). We recruited 28 PG (37±7 yrs, youth 8±2 yrs, 68% Hispanic, 54% Spanish preferred, 71% with income <$50K). Most children use sensors (93%) and, less frequently, pumps (54%). Compared to NHE and HS, HE PG score higher on discrimination scales, had lower technology acceptance, and poorer mental health (Table). Interestingly adverse childhood experiences were highest in the NHE group. Language may play a role in the experience of discrimination, technology acceptance, and mental health for Hispanic PG. Although only two surveys were statistically significant, mean survey differences between the groups are clinically meaningful and warrant further investigation. Disclosure A.Addala: None. R.Medina penaranda: None. S.Hanes: None. G.M.Shaw: None. L.Chamberlain: None. D.Naranjo: None. J.Raymond: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. K.K.Hood: Consultant; Cecelia Health. Funding Maternal & Child Health Research Institute; National Institute of Diabetes and Digestive and Kidney Diseases (K23DK13134201)
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