147-LB: Visits in Pediatric vs. Adult Clinics for Young Adults (YA) with T1D—Prepandemic and Pandemic Care

Abstract

Aim: YA with T1D have high risk of rising A1c and loss to follow up. To understand factors associated with visit frequency, we compared characteristics of YA with T1D seen in pediatric vs adult diabetes clinics in the pre- and pandemic periods. Methods: EMR data included YA, aged 18-30 yrs, with T1D in pediatric and adult clinics during the pre- and pandemic (4/1/19 to 3/15/20 and 3/30/20 to 3/15/21, respectively), for both inperson and telehealth visits. Results: There were 1,762 YA (54% male), aged 24.0±3.6 yrs, with T1D duration 13.4±6.3 yrs and A1c 8.2±1.6%; 61% were pump treated; 64% used CGM. Pre-pandemic, almost all visits were inperson while most pandemic visits were virtual. During the pandemic, proportion of virtual visits was greater in pediatric vs adult care (99% vs 90%, p<.001). Overall, pre-pandemic visit frequency was 3.5±3.4, reduced to 3.1±4.1 (p<.0001) during pandemic. Pre-pandemic visit frequency was higher in those with higher A1c (r =.18, p<.001) in pediatric and adult care. During pandemic, YA visit frequency was preserved across A1c groups only for those in pediatric care (Figure 1). Pandemic visit frequency was lower in adult care regardless of sex, pump, CGM or A1c. Conclusion: Maintaining visit frequency may mitigate glycemic deterioration in YA with T1D. Pediatric care likely maintained visit frequency through use of telehealth, highlighting need for hybrid care to optimize outcomes. Disclosure A. Shapira: None. L. J. Tinsley: None. E. Toschi: Advisory Panel; Eli Lilly and Company. L. M. Laffel: Advisory Panel; Medtronic, Lilly Diabetes, Novo Nordisk, Vertex Pharmaceuticals Incorporated, Roche Diagnostics, Provention Bio, Inc., Consultant; Dexcom, Inc., Janssen Pharmaceuticals, Inc., Medscape. Funding Thomas J. Beatson, Jr. Foundation