A randomized pilot sleep and circadian behavior clinical trial to improve glycemic and psychological outcomes in young adults with type 1 diabetes (NCT04975230).

The complex treatment for diabetes type 1 (T1D) includes insulin dosing for every meal, which requires education and experience to achieve optimal outcomes. Advanced carbohydrate counting (ACC) is the recommended method. We studied ACC as part of a standard treatment with the aim to explore its associations with glycemic control and empowerment in adolescents and young adults. We used national registry data on glycemic outcomes, a study-specific questionnaire regarding the use of ACC and the Gothenburg Young Persons Empowerment Scale (GYPES) to measure empowerment. A total of 111 participants (10–28 years of age, diabetes duration >9 years, mean HbA1c of 55.4 mmol/mol) answered the questionnaire. We found that most participants (79.3%) who learn ACC, at onset or later, continue to use the method. A higher level of empowerment was associated with lower HbA1c (p = 0.021), making patient empowerment an important factor in achieving optimal glycemic outcomes. No associations were found between ACC and empowerment or glycemic outcomes. A mixed strategy, only using ACC sometimes when insulin dosing for meals, was associated with the lowest empowerment score and highest HbA1c and should warrant extra education and support from the diabetes team to reinforce a dosing strategy.

Patients with classical type 1 diabetes mellitus (T1DM) require lifelong dependence on exogenous insulin therapy due to pancreatic beta-cell destruction and absolute insulin deficiency. T1DM accounts for about 90% of children with diabetes in China, with a rapid increase in incidence and a younger-age trend. Epidemiological studies have shown that the overall glycated haemoglobin (HbA1c) and compliance rate are low in Chinese children with T1DM. Optimal glucose control is the key for diabetes treatment, and maintaining blood glucose within the target range can prevent or delay chronic vascular complications in patients with T1DM. Therefore, this study aims to investigate the glycemic control of children with T1DM from Hunan and Henan Province with flash glucose monitoring system (FGMS), and to explore factors associated with glycemic variability. A total of 215 children with T1DM under 14 years old were enrolled continuously in 16 hospitals from August 2017 to August 2020. All subjects wore a FGMS device to collect glucose data. Correlation of HbA1c, duration of diabetes, or glucose scan rates with glycemic variability was analyzed. Glucose variability was compared according to the duration of diabetes, HbA1c, glucose scan rates and insulin schema. HbA1c and duration of diabetes were positively correlated with mean blood glucose, standard deviation of glucose, mean amplitude of glucose excursions (MAGE), and coefficient of variation (CV) of glucose (all P<0.01). The glucose scan rates during FGMS wearing was significantly positively correlated with time in range (TIR) (P=0.001) and negatively correlated with MAGE and mean duration of hypoglycemia (all P<0.01). Children with duration ≤1 year had lower time below range (TBR) and MAGE when compared with those with duration >1 year (all P<0.05). TIR and TBR in patients with HbA1c ≤7.5% were higher (TIR: 65% vs 45%, TBR: 5% vs 4%, P<0.05), MAGE was lower (7.0 mmol/L vs 9.4 mmol/L, P<0.001) than those in HbA1c >7.5% group. Compared to the multiple daily insulin injections group, TIR was higher (60% vs 52%, P=0.006), MAGE was lower (P=0.006) in the continuous subcutaneous insulin infusion group. HbA1c was lower in the high scan rates (≥14 times/d) group (7.4% vs 8.0%, P=0.046), TIR was significantly higher (58% vs 47%, P<0.001), and MAGE was lower (P<0.001) than those in the low scan rate (<14 times/d) group. The overall glycemic control of T1DM patients under 14 years old in Hunan and Henan Province is under a high risk of hypoglycemia and great glycemic variability. Shorter duration of diabetes, targeted HbA1c, higher glucose scan rates, and CSII are associated with less glycemic variability.

Introduction &amp; Objective: Transfer from pediatric to adult care is challenging and YA with T1D are at risk for suboptimal outcomes. Protective factors are less studied during this vulnerable period. We aimed to explore associations between psychosocial factors and HbA1c as YA with T1D left pediatric care. Methods: At baseline of an RCT, n=100 YA (Mean age=19.9±1.3 yrs, HbA1c=8.8±2.0%, 56% pump, 76% CGM) self-reported demographic/clinical variables and completed measures of diabetes strengths and diabetes distress. HbA1c was from electronic health records or dried blood spot. Multiple regressions evaluated associations between diabetes strengths, diabetes distress, and HbA1c, controlling for covariates. Results: Domains of diabetes distress (management r=0.51; powerlessness r=0.19) and strengths (diabetes-related confidence r= -0.25) significantly correlated with HbA1c. The full regression model (Table) explained 39% of variance in HbA1c; public insurance, non-Hispanic ethnicity, no pump use, and higher diabetes distress significantly predicted higher HbA1c. Conclusion: When leaving pediatrics, diabetes distress appears particularly relevant to glycemic outcomes, outweighing diabetes strengths. Addressing diabetes distress and supporting device use in culturally-informed ways may help improve glycemic outcomes as YA with T1D transfer to adult care. Disclosure S. Camey: None. S.A. Carreon: None. C.G. Minard: None. S. Lyons: None. R. Streisand: None. T.S. Tang: None. S. Mckay: None. B.J. Anderson-Thomas: None. S. Devaraj: None. M.E. Hilliard: None. Funding National Institutes of Diabetes and Digestive and Kidney Disease (1R01DK119246); National Institute of Diabetes and Digestive and Kidney Disease (K26 DK138332)

Physical and Psychologic Rehabilitation Outcomes for Young Adults Burned as Children

Greater psychosocial risk in childhood and adolescence predicts poorer cardiometabolic outcomes in adulthood. We assessed whether the timing of psychosocial risk from infancy through adolescence predicts cardiometabolic outcomes in young adulthood. Young adults and their mothers participated in a longitudinal study beginning in infancy in Santiago, Chile (N = 1040). At infancy, 5 years, 10 years, and adolescence, mothers reported on depressive symptoms, stressful experiences, support for child development in the home, father absence, parental education, and socioeconomic status (SES) to create a psychosocial risk composite at each time point. Young adults (52.1% female; 21-27 years) provided fasting serum samples and participated in anthropometric and blood pressure (BP) assessments, including a dual-energy X-ray absorptiometry (DXA) scan for measuring body fat. Greater infant psychosocial risk was associated with a greater young adult metabolic syndrome score (β = 0.07, 95% confidence intervals (CI): 0.01 to 0.13, p = 0.02), a higher body mass index and waist circumference composite (β = 0.08, 95% CI: 0.03 to 0.13, p = 0.002), and a higher body fat (DXA) composite (β = 0.07, 95% CI: 0.01 to 0.12, p = 0.02). No psychosocial risk measure from any time point was associated with BP. Infant psychosocial risk predicted cardiometabolic outcomes in young adulthood better than psychosocial risk at 5 years, 10 years, or adolescence, mean of psychosocial risk from infancy through adolescence, and maximum of psychosocial risk at any one time. Consistent with the Developmental Origins of Health and Disease model, findings suggest that infancy is a sensitive period for psychosocial risk leading to poorer cardiometabolic outcomes in young adulthood.

OBJECTIVEUnderserved young adults (YA) with type 1 diabetes (T1D) experience the worst outcomes across the life span. We developed and integrated the Supporting Emerging Adults with Diabetes (SEAD) program into routine endocrinology care to address unmet social and medical challenges.RESEARCH DESIGN AND METHODSThis study was designed as a longitudinal cohort study, with prospective data collection over 4 years on YA in SEAD compared with usual endocrine care. We used propensity-weighted analysis to account for differences in baseline characteristics, and multivariate regression and Cox proportional hazard models to evaluate change in outcomes over time. Primary outcomes included incidence of hospitalizations, diabetes technology uptake, and annual change in HbA1c levels.RESULTSWe included 497 YA with T1D in SEAD (n = 332) and usual endocrine care (n = 165); mean age 25 years, 27% non-Hispanic Black, 46% Hispanic, 49% public insurance, mean HbA1c 9.2%. Comparing YA in SEAD versus usual care, 1) incidence of hospitalizations was reduced by 64% for baseline HbA1c >9% (HR 0.36 [0.13, 0.98]) and 74% for publicly insured (HR 0.26 [0.07, 0.90]); 2) automated insulin delivery uptake was 1.5-times higher (HR 1.51 [0.83, 2.77]); and 3) HbA1c improvement was greater (SEAD, −0.37% per year [−0.59, −0.15]; usual care, −0.26% per year [−0.58, 0.05]).CONCLUSIONSSEAD meaningfully improves clinical outcomes in underserved YA with T1D, especially for publicly insured and high baseline HbA1c levels. Early intervention for at-risk YA with T1D as they enter adult care could reduce inequity in short and long-term outcomes.

Background: There are significant and pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D). This review sought to examine 1) child and caregiver demographic and biopsychosocial variables associated with provider bias and outcomes (e.g., HbA1c; blood glucose values and range; diabetes technology use; burnout, stress, anxiety associated with T1D care); 2) evidence for associations between experiences of provider bias and patient physical and psychological outcomes; and 3) evidence for mediators or moderators (e.g., socioeconomic status, race/ethnicity) contributing to the association between provider bias and patient outcomes. Methods: A systematic review of the literature was conducted across five public electronic databases: PubMed, PsycINFO, CINAHL, Web of Science, Embase. Studies included youth/young adults with T1D with a mean age between 12-35 years that investigated the effects of provider bias on physical and psychological health outcomes. Results: Fourteen articles were included in the review. Results suggest experiences of provider bias (e.g., shaming, criticism) negatively affect individuals’ self-esteem, relationships with medical providers, and mood. Provider bias also impacts recommendations about diabetes technology use, insulin regimen intensity, and risk for life-threatening T1D complications. Conclusions: Evidence from the current review suggests that provider bias plays a role in adverse physical and mental health. Varying study methodology in definitions and assessment of provider bias signals a need for comprehensive measure development to account for diverse experiences and interpretations of bias in healthcare. More research is necessary to investigate intervening factors that may affect the association between provider bias and overall health outcomes in youth and young adults with T1D. Disclosure S.E.Wetter: None. A.C.Himelhoch: None. K.A.Driscoll: None.

AimsSelf‐management interventions effectively improve health outcomes in adults with Type 2 diabetes. Young adults living with Type 2 diabetes are at a higher risk of diabetes‐related complications, hospitalisation and reduced quality of life. While self‐management is key in diabetes care, its effectiveness in young adults with Type 2 diabetes remains unclear. This review assessed self‐management interventions' impact on health outcomes in young adults (18–45 years) with Type 2 diabetes.MethodsFive electronic databases were searched from inception to May 2024. Trials evaluating self‐management interventions versus usual care in young adults were included. Outcomes of interest were clinical, self‐care behaviour and psychological health. Meta‐analysis used a random effects model; study quality was assessed using the Cochrane risk of bias tool (RoB2) and the JBI checklist for quasi‐experimental studies. The review followed PRISMA guidelines and was registered on PROSPERO (CRD42024522979).ResultsTen studies were included, nine in the meta‐analysis, which reported no significant differences between the intervention and control groups in HbA1c, body mass index, weight, waist circumference, blood pressure, lipids, depression or self‐efficacy outcomes. Nevertheless, these findings are imprecise due to few studies, missing data and small sample sizes. Commonly used behaviour change techniques were goals and planning, shaping knowledge and feedback/monitoring.ConclusionsExisting self‐management interventions did not improve clinical and psychological outcomes among young adults (18–45 years) living with Type 2 diabetes. More effective strategies are needed for this priority population.

Introduction: Young adults (YA) with type 1 diabetes (T1D) are at risk of poor glycemic control. Use of continuous glucose monitoring (CGM) has been shown to improve glucose control. However, real-world data on the impact of CGM use on glucose control in YA is limited. Methods: We analyzed data from electronic medical records collected across 2018 from a tertiary adult clinic of YA patients age 18- 30 yrs with T1D. A1C and insulin administration methods defined as sliding scale (SS), multiple daily injection while carbohydrate counting (MDI), or via pump therapy (Pump) were collected along with CGM use. Results: Data from 891 patients (mean age 26±3, T1D duration 12±7 years, 52% female, average A1C 7.9%±1.5) were analyzed. Twelve % (n= 110) were on SS; 37% (n=331) on MDI, and 51% (n= 450) on pump therapy; mean age of all 3 groups was 26 ± 3yrs. Use of CGM was recorded in 32% of patients on SS, while use of CGM was recorded in 46% and 66% of patients using MDI and pump, respectively. A1C differed between CGM users and non-users in each subgroup. Conclusion: With increasing complexity of insulin regimen, CGM use rises. However, independent of insulin administration method, CGM use was associated with lower A1C. These findings highlight the potential benefit of CGM use, in YA with T1D in adult clinic settings. Disclosure E. Toschi: None. R.A. Gabbay: Advisory Panel; Self; FormHealth, Health Reveal, Lark, Onduo, Vida Health. A. Clift: None. M. Bennetti: None. A. Atakov-Castillo: None.

Longitudinal links between childhood family income and adult outcomes are well documented. However, research on childhood income volatility and young adult outcomes is limited. This study utilizes data from the NLSY ( N = 6,410) to examine how childhood family income and income volatility relate to socioeconomic outcomes and mental/behavioral health in emerging adulthood. Results show that lower childhood income was associated with young adult socioeconomic and behavioral health outcomes. Higher income volatility was associated with increased depression and teen parenthood during young adulthood. Additional analyses examining trajectories of income volatility illustrated that children in families with unstable income trajectories (i.e., frequent income losses and gains) showed higher depression scores than those with stable trajectories. These findings suggest that income volatility, not just income level or income loss, is important to consider when studying economic disparities in young adult outcomes. Implications for policies and programs for low-income, high-volatility households are discussed.

Behavioral infant sleep interventions: helping parents and clinicians make scientifically informed decisions

To investigate the relationship between the blood glucose variability and microalbuminuria (MAU) in type 2 diabetic patients with well-controlled glycosylated hemoglobin (HbA1c) and the influencing factors of blood glucose variability. One hundred and seventy-six type 2 diabetic patients with HbA1c under 6.5% and 48 subjects with normal glucose regulation were monitored using the continuous glucose monitoring system (CGMS). The mean blood glucose (MBG) and mean amplitude of glucose excursions (MAGE) were analyzed. (1) The MBG and MAGE levels of type 2 diabetic patients were (7.0+/-0.9) and (3.8+/-2.5) mmol/L respectively, both higher than those of the subjects with normal glucose regulation [(5.4+/-0.6) and (2.0+/-0.7) mmol/L respectively, both P<0.01]. (2) The incidence ratio of MAU of the patients with ascended MAGE level was 18.7%, significantly higher of those with normal MAGE (7.1%, P<0.05). (3) The MAGE level was positively correlated with age, duration of diabetes, and systolic blood pressure, and negatively correlated with glomerular filtration rate and the levels of fasting and postprandial C-peptide. Multivariant regression analyses indicated that duration of diabetes and the level of postprandial C-peptide 30 min after meal were the independent influential factors of MAGE. (4) In the type 2 diabetic patients, the MAGE of the MAU group was higher than that of the non-MAU group (P<0.05). Logistic regression analyses indicated that diastolic blood pressure and MAGE were the risk factors of MAU (OR=1.201 and 1.357, both P<0.05). In well-controlled patients with type 2 diabetes, blood glucose variability is one of the risk factors for MAU, duration of diabetes and early stage of insulin secretion function are the main factors influencing glycemic variability.

Clinical Characteristics and Outcomes of Young and Very Young Adults With Heart Failure: The CHARM Programme (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity)

Which is the Most Useful Patient Reported Outcome in Femoroacetabular Impingement? Test-retest Reliability of 6 Questionnaires in Young Active Adults

Characteristics and outcomes of young adults who suffered an out-of-hospital cardiac arrest (OHCA)