Introduction: The transition from pediatric to adult diabetes care is particularly risky for AYAs with T1D. We evaluate preliminary outcomes of a behavioral intervention targeting AYA health communication, T1D self-care, and transition readiness. Methods: 52 AYAs (48.1% male; 48.1% non-Hispanic White; M age=20.63±1.10 yrs) enrolled in Planning, Reflecting, and Engaging with Providers for Diabetes Care (PREP-DC) and were randomized to intervention (Int; n=26) or standard care (SC; n=26) groups. AYAs reported on communication, T1D self-care, and transition readiness at baseline and 4 mos (1 mo post-intervention); A1c was taken from medical records. AYAs rated satisfaction with PREP-DC participation (1-5; 5=extremely satisfied). T-tests examined change from baseline to follow-up and by group. Results: At follow-up, 51 AYAs (98%) completed questionnaires and 37 (71%) had A1c data. AYAs reported improvements in communication, T1D self-care, and transition readiness (Table 1), with few group differences. Both groups reported high satisfaction with participation (Int M=4.41±.59; SC M=4.45±.60). Discussion: AYAs were engaged in a behavioral trial promoting health communication; the Int group did not demonstrate significant improvements as compared to SC. Future analyses will evaluate final follow-up outcomes (8 mos post-intervention), including transfer to adult care. Disclosure M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. B.L.Bryant: None. C.H.Wang: None. J.E.Bost: None. R.Streisand: None. Funding American Diabetes Association (1-18-ACE-27 to M.M.)
Background: Managing T1D in a newly diagnosed young child significantly impacts family dynamics and is linked with elevated parental depressive symptoms. We examined the relationship among diabetes-related co-parenting cooperation and conflict soon after diagnosis with parent depressive symptoms 1 and 1.5 years later. Method: Participants were 157 primary caregivers (91.7% female, 76.4% married, 62.2% non-Hispanic White) of young children age 1-6 years (Mage=4.41.7 years; 54.8% female, 61.5% non-Hispanic White) in a behavioral intervention trial after child T1D diagnosis (M=29 days). Parents self-reported on Cooperation and Conflict subscales of the Diabetes-Specific Co-parenting Questionnaire (DCQ) and the Center for Epidemiological Studies Depression Scale (CES-D; ≥16=clinical elevation). Multiple logistic regressions were used with elevated depression score as outcome. Subjective socioeconomic status (SSES) and treatment condition were included as covariates. Results: Higher co-parenting conflict at baseline was associated with a 3.70 (OR=3.70, 95% CI=(1.68, 8.18) and 2.36 (OR=2.36, 95% CI=(1.13, 4.91)) higher odds of clinically elevated CES-D score risk at 1 and 1.5 years post-diagnosis, respectively. Higher co-parenting cooperation at baseline marginally reduced elevated CES-D odds by 0.58 (OR=0.58, 95% CI=(0.31, 1.10)) at 1.5 (but not 1) years post-diagnosis; higher SSES at baseline reduced depression odds by 0.97 (OR=0.97, 95% CI=(0.96, 1.00) at 1.5 (but not 1) years post-diagnosis. Discussion: Increased parental disagreements following T1D diagnosis may predict higher burden of managing T1D in a young child over time and possibly contribute to later depressive symptoms. Parental care strategies and interventions at T1D diagnosis that enhance supportive cooperation and communication among caregivers may help support parent psychosocial functioning over time. Disclosure L.Kang: None. C.H.Wang: None. M.E.Hilliard: None. C.Tully: None. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None. Funding National Institutes of Health (1R01DK102561-01A1)
Introduction: Minority youth are underrepresented in diabetes technology trials. An ongoing pilot study is recruiting 20 publicly insured, insulin pump naive youth ages 8-12 with T1D who identify as NHB or Latinx with recent HbA1c >8% to participate in a study using SMAs to improve T1D self-management and sustained CGM use. We aimed to identify the most successful recruitment strategies. Methods: Potentially eligible youth are identified through weekly review of diabetes appointments. Families are then contacted in-person at a clinic visit, by phone, or text-message. We reviewed the number of in-person, phone, and text-message attempts for all eligible participants, as well as the number of youth who enrolled, refused, or who have not yet been successfully contacted. Results:79 youth were identified as potentially eligible. 56% (n=44, 16±13 contact attempts) have been successfully contacted; 18% (n=14, 6±4 contact attempts) enrolled. 64% (n=9/14) of enrolled and 18% (n=12/65) of non-enrolled were approached at a clinic visit, 14% (n=2/14) of enrolled and 40% (n=26/65) of non-enrolled via phone, and 50% (n=7/14) of enrolled and 46% (n=30/65) of non-enrolled via text-message (p<0.001). 38% (n=6/16) of those who scheduled an enrollment visit after being contacted by phone/text attended the visit versus 63% (n=10/16) contacted at a clinic visit (p<0.001). 38% (n=30, 10±9 contact attempts) refused to participate; 27% (n=9) did not want to travel to the study site, 17% (n=5) refused CGM, and 53% (n=16) declined research participation. 46% (n=35, 12±5 contact attempts) have not yet been successfully contacted. Conclusions: Historically marginalized youth enrolling in this SMA study required an average of 6 contact attempts for study participation. Purposeful in-person recruitment strategies, being mindful of the low rates of technology use among this community and mistrust in the healthcare system, is needed to promote diversity and inclusion in T1D research. Disclosure J.Grundman: Research Support; American Diabetes Association, Dexcom, Inc. S.Majidi: None. A.G.Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc. R.Streisand: None. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. Funding American Diabetes Association (7-21-PDFHD-09 to J.G.)
Background: Non-Hispanic Black (NHB) youth with T1D are more likely to have suboptimal glycemic control and less likely to use HCL systems or to be included in clinical trials. We evaluated changes in glycemic control with use of Tandem t:slim X2 insulin pump with Control-IQ technology in this historically underrepresented population in T1D research. Methods: This prospective non-randomized pilot study enrolled 15 pump naïve, publicly insured, NHB youth (Mage 14.6 ± 3.7) with T1D and A1c ≥10% in a 6 month trial of HCL use. Changes in A1c (n=13) and CGM-measured glycemia at baseline versus the final 90 days of the study for those with <70% wear time (n=12) were assessed using paired t-tests and Wilcoxon signed rank tests. Results: Thirteen participants (87%) completed the study; one was removed after 2 episodes of diabetic ketoacidosis (DKA) and the other for protocol non-adherence. A1c decreased from 11.7±1.3% to 9.6±1.6% (p=0.001). Average sensor glucose decreased from 281±53 to 225±30 mg/dL and time in range (TIR) increased by 4.5±8.5 hours/day from 18.5±15.0% to 37.1±10.3% (p=0.007). Time above range (TAR) <180 mg/dL decreased by 4.6±4.5 hours/day from 81.3±15.4% to 62.0±10.3% (p=0.007). There were no changes in time below range <70 mg/dL (p=0.72). DKA did not increase (0.67 episodes/person-year pre-enrollment vs 0.58 episodes/person-year during study intervention). Conclusions: Tandem t:slim X2 insulin pump with Control-IQ technology use in NHB youth with suboptimal T1D control was associated with improvements in average glucose, TIR, and TAR. The theoretical risk for increased risk of DKA is frequently cited as a barrier to HCL use in this population, however there was no increase in rates of DKA during the study period. These glycemic improvements without increased risk emphasize the importance of supporting equitable access to diabetes technology among all people with T1D. Disclosure B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. J.Grundman: Research Support; American Diabetes Association, Dexcom, Inc. S.Meighan: Speaker's Bureau; Dexcom, Inc. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None. A.G.Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc. Funding National Institutes of Health (K23DK129827); Tandem Diabetes Care, Inc. (TDC20210226); Dexcom, Inc.
Background: Prior HCL studies enrolling participants with well-controlled T1D and limited financial, racial-ethnic, and socioeconomic diversity have shown limited success in improving patient-reported outcomes (PROs). We evaluated changes in PROs among marginalized youth with T1D and their parents after 6 months of Tandem t:slim X2 insulin pump with Control-IQ technology use. Methods: This non-randomized 6-month pilot study enrolled 15 publicly insured, non-Hispanic Black (NHB) youth with T1D and hemoglobin A1c (HbA1c) ≥10% (Mage 14.6 ± 3.7 yrs, MT1Dduration 8.5 ± 4.8 yrs, MA1c11.9±1.4%). Youth and parent PROs at baseline and 6-months were compared using paired t-tests. The following constructs were assessed using validated PROs: DRQL using T1D and Life (T1DAL), emotional distress using Problem Areas in Diabetes (PAID), positive expectancy of technology using INSPIRE, and self-management behaviors using Diabetes Management Questionnaire (DMQ). Results: Thirteen participants completed the study. HbA1c decreased from 11.7±1.3% to 9.6±1.6% over 6 months (p=0.001). TIDAL scores increased among parents and youth (p-T1DAL +7.1 to 70±13, p=0.01; y-T1DAL +8 to 69±12, p=0.03). PAID scores decreased among parents and youth (p-PAID -25 to 43±30, p=0.01; y-PAID -19.4 to 23±19, p=0.02). There were no changes in parent or child INSPIRE (p=0.23, p=0.88) or DMQ scores (p=0.44, p=0.16). Conclusions: Six months of Tandem t:slim X2 insulin pump with Control-IQ technology in marginalized youth with T1D improved HbA1c, DRQL, and diabetes-related distress among parents and youth despite no change in diabetes self-management behaviors or decrease in positive expectancy of HCL. Including diverse populations in T1D research and supporting equal access to HCL technology for all people with T1D may demonstrate psychosocial benefits with no additional burden for youth and their parents. Disclosure A.G.Perkins: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc. J.Grundman: Research Support; American Diabetes Association, Dexcom, Inc. S.Meighan: Speaker's Bureau; Dexcom, Inc. M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. R.Streisand: None. B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. Funding Tandem Diabetes Care, Inc. (TDC20210226); National Institutes of Health (K23DK129827); Dexcom, Inc.
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