Adult Diabetes Clinic Research Articles

Diabetes visits in paediatric versus adult clinics for young adults (YA) with T1D: Pre-pandemic and pandemic care.

Young adults (YA) with type 1 diabetes mellitus (T1D) are at high risk of worsening glycated haemoglobin (HbA1c) with fewer follow-up visits. We examined the association of demographic and diabetes characteristics with care utilization, including in-person and telehealth visits, pre- (1 April 2019 to 15 March 2020) and during the COVID-19 pandemic (30 March 2020 to 15 March 2021) for YA (ages: 18-30) with T1D, comparing those seen in paediatric versus adult diabetes clinics at a single diabetes centre. Data were obtained from the electronic health record for YA with a pre-pandemic HbA1c. We performed descriptive statistics to describe the sample and paired t-tests to compare visits before and during the pandemic. Data from 1762 YA (54% male; age 24.0 ± 3.6 (M ± SD) years; HbA1c 66 ± 18 mmol/mol (8.2 ± 1.6%) revealed that in the full sample, mean pre-pandemic visit frequency was 3.5 ± 3.4 and mean pandemic visit frequency was 3.1 ± 4.1 (p < 0.0001). Furthermore, the pandemic visit frequency declined in the adult clinic regardless of sex, pump therapy, CGM use, and pre-pandemic HbA1c, whereas in the paediatric clinic, visit frequency was only reduced for those with HbA1c <53 mmol/mol (<7%) but was otherwise maintained. In this diabetes centre, the paediatric clinic maintained diabetes care delivery during the pandemic (30 March 2020 to 15 March 2021) to YA with glycaemic control above target, suggesting that preservation of remote care delivery should be considered in this high-risk group.

Low estimated glomerular filtration rate and proteinuria among adult diabetic patients in a tertiary hospital in Eastern Uganda - a cross-sectional study

BackgroundChronic kidney disease (CKD) is one of the most common complications of diabetes mellitus (DM). Diabetes mellitus contributes to about 66% of CKD cases globally. CKD results in increased morbidity and mortality and advanced stages often require kidney replacement therapy that is unaffordable for the majority of the patients. Developing countries have scanty data regarding CKD burden in diabetic patients.ObjectivesThis study aimed at determining the prevalence of low estimated glomerular filtration rate (eGFR) and proteinuria and associated clinical and socio-demographic factors among adult diabetic patients attending the diabetic clinic of Mbale Regional Referral Hospital (MRRH).MethodsA cross-sectional study was conducted at the adult diabetic clinic of MRRH in Eastern Uganda. A total of 374 adult diabetic patients were enrolled. A urine sample for urine albumin creatinine ratio (UACR) determination and a venous blood sample for measurement of serum creatinine were obtained from each participant. The eGFR was determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and CKD was staged according to the Kidney Disease Improving Global Outcomes (KDIGO) classification.ResultsA total of 318 (85%) participants had an eGFR of ≤ 60 mL/min/1.73m2, UACR of ≥ 30g/g, or both. Only 6.1% were aware. Age, duration of DM, hypertension, and dyslipidemia were associated with low eGFR and proteinuria.ConclusionThere is a high prevalence of low eGFR and proteinuria among DM patients, 85% of the participants had these markers of CKD and the majority of them were undiagnosed. Over half of the DM patients had an eGFR consistent with advanced CKD. Strengthening routine screening for CKD biomarkers and equipping DM clinics with more diagnostic resources is recommended.

A clinical audit exploring the relationship between HbA1c control and appointment adherence among young adult diabetes clinic patients

A clinical audit exploring the relationship between HbA1c control and appointment adherence among young adult diabetes clinic patients

Perceived comfort with weight, body shape and eating pattern of young adults with type 1 diabetes and associations with clinical and psychological parameters in a clinical setting

BackgroundHigher prevalence of disordered eating in young adults with type 1 diabetes (T1D) culminates in higher levels of morbidity and mortality. In addition to validated questionnaires for diabetes distress, depression/anxiety symptoms and emotional well-being, the Diabetes Psychosocial Assessment Tool (DPAT) includes three questions about comfort with weight, body shape and eating pattern (WSE), which were derived from literature and multidisciplinary team consensus. Recognising individuals with low comfort with WSE, is the first step towards identifying those who may be at risk of developing eating disorders.AimsObserve comfort with WSE, in young adults with T1D, and its associations with demographic/clinical characteristics and psychological parameters.Methods276 young adults, aged 15–26, who attended routine clinical care at a Young Adult Diabetes Clinic, completed the DPAT. The WSE questions were scored on a 5-point Likert scale (1 indicating lowest comfort). Linear regression analysed differences in comfort with weight and eating pattern by demographic and psychological parameters.Results1 in 3 young adults (29%) reported low comfort with WSE (scores 1 or 2). In females, 40%, 41% and 35% had low comfort with weight, shape and eating patterns respectively, in comparison to males in whom it was 18.5%, 16% and 21.5%. Females reported lower comfort with weight and eating pattern (mean 2.9 and 3.0 respectively) than Males (mean 3.7 and 3.6 respectively), each p < 0.001. Lower comfort with weight (p < 0.001) and eating pattern (p = 0.001) was associated with higher body mass index (BMI). Young adults with low comfort with weight and eating pattern experienced elevated diabetes distress and depressive/anxiety symptoms (each p < 0.001), also when adjusted for sex and BMI.ConclusionsThe study has shown that low comfort with WSE is common among young adults with T1D. Adding these questions into routine care, can allow for easy and early identification of low comfort, initiation of a therapeutic dialogue and implementation of focused management strategies.

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

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&amp;lt;.001). Overall, pre-pandemic visit frequency was 3.5±3.4, reduced to 3.1±4.1 (p&amp;lt;.0001) during pandemic. Pre-pandemic visit frequency was higher in those with higher A1c (r =.18, p&amp;lt;.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

701-P: Psychological Resources of Young Adults with Type 1 Diabetes Mellitus during Transition from a Pediatric to Adult Diabetes Clinic—A Multicenter Cross-Sectional Study

Introduction: The period of transition of patients with type 1 diabetes from pediatric to adult-oriented health care is very vulnerable time, as it is associated with poorer glycemic control and less frequent clinic attendance. Aim: The purpose of this study was to evaluate psychological parameters of transitioning young patients with type 1 diabetes during the 1st visit in adult outpatient clinic. Methods: We examined 50 consecutive patients (56% females) transitioning from 03.2021 - 11.2022 into adult care (3 diabetes centers from 3 regions in southern Poland (A=16; B=21; C= 13)) and their basic demographic information. All patients fulfilled the following psychological questionnaires: STAI, GSES, PSS-10, SWLS, AIS, MHLC and CECS. Furthermore, we made comparison of data obtained in the study with data for general healthy population and general population with persons with diabetes. Results: During the first adult outpatients visit patients mean age was 19.2±1.4 yrs. with 9.8±4.3 yrs. of diabetes duration and BMI 23.5±3.1 kg/m2. Considering the therapy type: 67% of patients were treated with insulin pump therapy while 33% with multiple daily injections. There was no difference regarding the level of life satisfaction, perceived level of stress and state anxiety between studied population and general/diabetes population. Studied patients had similar locus of health control and negative emotions control in comparison to general population of diabetes. Patients had higher level of suppression of negative emotions: anger, depression, and anxiety than age matched general population. In addition, our population was characterized by higher acceptance of illness and higher level of self-efficacy compared to general/diabetes population. Conclusions: This study indicated good psychological resources and coping mechanisms of young patients transitioning to adult outpatient clinic. Disclosure B.Matejko: Consultant; Medtronic, Roche Diagnostics, BIOTON S.A. K.M.Cyranka: Other Relationship; Ascensia Diabetes Care, Roche Diabetes Care, Abbott, Research Support; Medtronic. A.Juza: None. K.Nabrdalik: Research Support; BIOTON S.A., Speaker's Bureau; Novo Nordisk, Abbott, Boehringer-Ingelheim, Lilly Diabetes, AstraZeneca. H.Kwiendacz: Speaker's Bureau; Sanofi, Novo Nordisk. J.Gumprecht: Advisory Panel; Abbott, Medtronic, Speaker's Bureau; Novo Nordisk A/S, Lilly, AstraZeneca, Merck &amp; Co., Inc., Sanofi, Bayer Inc., KRKA, Ascensia Diabetes Care. M.Malecki: Advisory Panel; Abbott Diabetes, Novo Nordisk, Lilly, Sanofi, Dexcom, Inc., Bayer Inc., Research Support; Medtronic, Speaker's Bureau; AstraZeneca, AlfaSigma, Merck &amp; Co., Inc., BIOTON S.A., Servier Laboratories, KRKA. T.Klupa: Advisory Panel; Abbott Diabetes, Ascensia Diabetes Care, Sanofi, BIOTON S.A., Speaker's Bureau; Medtronic, Abbott Diabetes, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Servier Laboratories.

643-P: Engagement of Young Adults with Type 1 Diabetes (T1D) in a Virtual Young Adult Diabetes Clinic as a Component of Transition from Pediatric to Adult Diabetes Care

Objectives: Young adults with Type 1 Diabetes (T1D) face unique challenges with engaging in care as they transition from the pediatric to the adult setting. The Young Adult Diabetes Clinic (YADC) is a multidisciplinary clinic that includes a group clinic, combining endocrinology, diabetes education, and behavioral health. Due to the COVID-19 pandemic, the need for a virtual YADC group clinic arose. We sought to understand how this virtual setting could impact engagement as compared with the in-person model. Methods: We conducted a retrospective cohort study comparing in-person to virtual engagement, characterized by three central measures: rates of scheduled group visits after referral, rates of attended group visits after scheduling, and rates of follow-up after attending a group visit. A z-test was used to compare proportions of no-shows and lost-to-follow-ups between the in-person and virtual attendees. Results: Two hundred and seventy-one patients were referred to the YADC between December 2017 and December 2022. Out of those, 149 (54%) scheduled a group visit. Subsequently, 112 scheduled patients attended a group visit. Sixty-one (54%) attended a virtual group visit, compared to 51 (46%) in-person. Out of these attendees, 45 (62%) in-person attendees followed-up subsequently with a member of the care team, and 28 (38%) virtual attendees. No-show rates were significantly higher in the virtual population at 35% vs. 4% in-person (P=.002). Lost-to-follow-up rate was 27% in the virtual population and 12% in-person, (P=.07). Conclusions: Young adults with T1D face significant barriers to engagement that virtual medicine may help overcome. This data illustrates the continued challenges with engaging young adults in the virtual setting, and need for further understanding of what other factors may influence follow-up in this patient population. Disclosure T.H.Pandharpurkar: None. R.D.Tweet: None. J.J.Park: None. T.Heyerman: None. K.O'neil: None. I.Guttmann-bauman: None. F.Joarder: None.

692-P: Characteristics of Young Adults with Type 1 Diabetes (T1D) Attending a Virtual Young Adult Diabetes Clinic (YADC) as a Component of Transition from Pediatric to Adult Diabetes Care

Objectives: Young adults (18-25) living with T1D are at high risk of acute and chronic complications and poor glycemic control in part because of difficulties seen in transitioning from pediatric to adult care. In 2017 an in-person YADC was created to help engage and support new patients transitioning from pediatric to adult care. In 2021, in response to the COVID-19 pandemic, the YADC was adapted to a virtual model. This study characterizes the participants of the virtual YADC. Methods: The YADC is a comprehensive virtual clinic that includes a group welcome, orientation to adult diabetes care, peer-to-peer interaction, group discussion about pediatric-to-adult transition of care (facilitated by a behavioral health clinician), a diabetes education visit and a medical provider visit. Young adult attendees were self-select; those who were referred to an adult endocrinologist were given the option to join the YADC. Descriptive statistics were utilized to summarize the characteristics of patients attending the virtual YADC. Results: Of 89 patients scheduled, 61 patients attended the virtual YADC between January 2021 and December 2022. Attendees ranged in age from 18 to 25, with a mean age of 21. Forty-one attendees (67%) had private insurance and 20 had state insurance. The mean HbA1c of virtual YADC participants was 8.61%. In comparison, the mean HbA1c of those who did not attend was 9.84%. Among young adult patients who did not attend, 19 (67%) attendees had state insurance, whereas 9 attendees had private insurance. Conclusions: Characterization of virtual YADC attendees reveals a higher proportion with private insurance vs state insurance. This finding implies potential differences in access to care. Future studies will focus on understanding the differences between those who do and do not attend virtual YADC and how to increase patient engagement. Disclosure F.Joarder: None. T.H.Pandharpurkar: None. R.D.Tweet: None. T.Heyerman: None. K.O'neil: None. J.J.Park: None. I.Guttmann-bauman: None.

Evaluation of Psychological Resources of Young Adults With Type 1 Diabetes Mellitus During the Transition From Pediatric to Adult Diabetes Clinics: Multicenter Cross-sectional Study.

The transition period of patients with type 1 diabetes from pediatric to adult-oriented health care is associated with poorer glycemic control and less frequent clinic attendance. Fears and anxiety about the unknown, care approach differences in adult settings, and sadness about leaving the pediatric provider all contribute to a patient's reluctance to transition. This study aimed to evaluate the psychological parameters of young patients with type 1 diabetes transitioning to an adult outpatient clinic during the first visit. We examined 50 consecutive patients (n=28, 56% female) transitioning from March 2, 2021, to November 21, 2022, into adult care (3 diabetes centers from 3 regions in southern Poland: A, n=16; B, n=21; and C, n=13) and their basic demographic information. They completed the following psychological questionnaires: State-Trait Anxiety Inventory (STAI), Generalized Self-Efficacy Scale, Perceived Stress Scale, Satisfaction with Life Scale, Acceptance of Illness Scale, Multidimensional Health Locus of Control Scale Form C, Courtauld Emotional Control Scale, and Quality of Life Questionnaire Diabetes. We compared their data with those for the general healthy population and patients with diabetes from Polish Test Laboratory validation studies. During the first adult outpatient visit, patients' mean age was 19.2 (SD 1.4) years, with a diabetes duration of 9.8 (SD 4.3) years and BMI of 23.5 (SD 3.1) kg/m2. Patients came from diverse socioeconomic backgrounds: 36% (n=18) live in villages, 26% (n=13) live in towns with ≤100,000 inhabitants, and 38% (n=19) live in bigger cities. Regarding therapy type, 68% (n=34) were treated with insulin pump therapy, whereas 32% (n=16) were treated with multiple daily injections. Patients from center A had a mean glycated hemoglobin level of 7.5% (SD 1.2%). There was no difference regarding the level of life satisfaction, perceived level of stress, and state anxiety between the patients and reference populations. Patients had similar health locus of control and negative emotions control to the general population of patients with diabetes. Most patients (n=31, 62%) believe that control over their health depends on themselves, whereas 52% (n=26) believe that it depends mostly on others. Patients had higher levels of suppression of negative emotions-anger, depression, and anxiety-than the age-matched general population. Additionally, the patients were characterized by a higher acceptance of illness and higher level of self-efficacy compared to the reference populations: 64% (n=32) had a high level of self-efficacy and 26% (n=13) had a high level of life satisfaction. This study indicated that young patients transitioning to adult outpatient clinics have good psychological resources and coping mechanisms, which might result in adequate adaptation and adult life satisfaction including future metabolic control. These result also disprove the stereotypes that young people with chronic disease have worse life perspectives when entering adulthood.

Seroprevalence of hepatitis C virus infection in patients with type 2 diabetes mellitus is associated with increased age in sub-Saharan Africa: Results from a cross-sectional comparative analysis

BackgroundSeveral epidemiological studies have established the association between hepatitis C virus (HCV) infection and type 2 diabetes mellitus (T2DM). However, the determinants and reasons for the high prevalence of HCV infection in people with T2DM are not well understood especially in sub-Saharan African populations. In this study, we aimed to assess determinants of the association between HCV infection and T2DM.MethodsWe performed a cross-sectional study amongst 442 T2DM patients recruited from an out-patient adult diabetes clinic in a tertiary hospital and 442 non-diabetic controls recruited from the general population. Serological testing for HCV antibody was performed using standard ELISA technique. Anti-HCV antibody prevalence was reported by age group in participants with diabetes and the non-diabetic controls. Logistic regression was used to examine for factors associated with the HCV infection in patients with diabetes.ResultsWe reported an overall HCV prevalence of 11.5% [95% CI: 9.4-13.6] irrespective of diabetes status in this study. The seroprevalence of HCV infection in diabetics patients was 17.6% [95% CI: 14.0-21.2] compared to 5.5% [95% CI: 3.4-7.6] in non-diabetics (p&amp;lt; 0.001). We did not find a significant HCV seropositivity difference in diabetic patients with common risk factors of HCV infection. When investigating the HCV seroprevalence by age group in diabetic and non-diabetic patients, no case of HCV infection was found in patients less than 30 years old while the highest HCV seropositivity was reported in patients older than 60 years (36.7% T2DM and 11.1% for non-diabetics) followed by the patients belonging to 50-59 years age group (16% in T2DM and 5.8% in non-diabetics) and those in 40-49 years age group (4.4% in diabetic, 0.8% in non-diabetic). To support this finding, in a multivariate logistic regression, only diabetic patients belonging to age group &amp;gt; 65 years had a significant risk (OR: 16.7 [95% CI: 1.7-160.0]) to acquire HCV infection.ConclusionThe seroprevalence of HCV infection is higher among T2DM adult patients than in non-diabetic patients, and is associated with increased age. This age-dependent association may suggest a generational exposure that may no longer exist overtime.

Sustained Improvement in Glycemic Control in Emerging Adults with Type1 Diabetes 2Years After the Start of the COVID-19 Pandemic.

Although there were initial concerns that the public health response to the COVID-19 pandemic would adversely affect glycemic control in people with type1 diabetes, several early continuous glucose monitor (CGM) studies reported an unexpected slight improvement in glucose metrics. Early emerging adulthood (roughly spanning the ages of 18-24years) is often a vulnerable time in the life of a person with type1 diabetes. Here, we set out to determine how the care and glucose management of emerging adults with type1 diabetes changed over a period of approximately 2years from the start of the COVID-19 pandemic. This was a retrospective study of a tertiary referral, multidisciplinary young adult diabetes clinic, spanning before and after the 777-day state of emergency in the City of Toronto. Of 130 emerging adults with type1 diabetes (80 male, 50 female; mean age 21.0 ± 2.1years), baseline pre-pandemic HbA1c values were available for 120 individuals. During 24.9 ± 5.4months of follow-up before and after the start of the COVID-19 pandemic, HbA1c fell from 8.5 ± 1.7% (69.3 ± 18.8mmol/mol) to 8.1 ± 1.9% (65.2 ± 20.5mmol/mol) (P < 0.05), with change in HbA1c from pre-lockdown levels being sustained throughout the second year of the pandemic. Over the same period, CGM use rose from 43% to 83%, primarily through increased uptake of intermittently scanned CGM, which is covered through the Ontario Drug Benefit program. Change in HbA1c was most evident in DexcomG6 real-time CGM users -0.7 ± 1.2% (-9.8 ± 17.1mmol/mol) (P < 0.01 vs. self-monitoring of blood glucose). Among emerging adults with type1 diabetes attending a multidisciplinary clinic in a high-income country, glycated hemoglobin levels are on average 0.4% (4.1mmol/mol) lower than they were before the pandemic. This reduction in HbA1c is unlikely to be a consequence of early strict lockdowns given the length of time of follow-up. Rather, improved glycemic control coincided with increased utilization of wearable diabetes devices.

Prolonged lapses between pediatric and adult care are associated with rise in HbA1c and inpatient days among patients with type 1 diabetes

AimTo quantify the association between the duration of the pediatric-to-adult care transfer with glycemic control among patients with type 1 diabetes (T1D). MethodsThis retrospective cohort study included patients with T1D who completed transfer between pediatric and adult diabetes clinics at a single academic medical center between 2004 and 2020. The primary exposure was time from the last pediatric to first adult diabetes care encounter. The primary outcome was the average HbA1c in the first year after entry into adult care. ResultsA total of 449 patients (mean age at transfer 19.8yrs, 51.7 % male) were included for analysis. Transfer required a median of nearly 5 months (196 days; IQR:93–251) and in adjusted and unadjusted models was strongly associated with increased HbA1c within 1 year of transfer (0.19 %, 2 mmol/mol; 95 %CI:0.04 %-0.33 %) for each 6 months of latency. In secondary analyses, transfer latency also exhibited a significant association with days spent hospitalized (IRR 1.23 per 6 months; 95 %CI:1.08–1.33). ConclusionsOur findings isolate and quantify the impact of prolonged lapses in care associated with the pediatric-to-adult care transfer. These findings underscore the need for providers and healthcare systems to improve this care transition in order to improve outcomes for this vulnerable patient population.

Use of continuous subcutaneous insulin infusion versus multiple daily injections in emerging adults with type 1 diabetes is associated with better clinical engagement but not glycaemic control.

Limited studies have compared outcomes between emerging adults with type 1 diabetes mellitus (T1D) attending a diabetes transition support programme using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). To assess glycaemic control and service utilisation in emerging adults with T1D on MDI or CSII attending a young adult diabetes clinic (YAC). A retrospective cohort analysis was conducted from January 2013 to December 2015. Data collected included clinic visits per year, after-hours mobile telephone use, diabetic ketoacidosis (DKA) admissions and all HbA1c levels. Independent t-test was used to compare continuous variables whilst Pearson's Chi-squared test was used for categorical variables. Linear mixed effects models explored mean changes in HbA1c levels over time. Over 3 years, 318 youth with T1D (176 MDI, 121 CSII, 21 switched from MDI to CSII) attended our YAC. Aggregated mean HbA1c levels remained similar between modalities (CSII 9.1% vs MDI 9.3%; P = 0.23); however, mean change in HbA1c at 3 years was significantly increased in CSII users at 0.55% (95% CI 0.15-0.95; P < 0.01) compared with no significant change in MDI users. Clinic visits per year were improved in CSII users (CSII 2.8 vs MDI 2.5; P = 0.02), while DKA admissions remained similar between MDI and CSII users (3.6 admissions per 100 patient-years). In our YAC cohort, glycaemic control in CSII and MDI users was similar but well below recommended international glycaemic targets (HbA1c level < 7.0%). Despite increased clinical engagement occurring in CSII users, glycaemic deterioration was observed over the 3 years.

The impact of COVID-19 lockdown on glycaemic control in young adults with type 1 diabetes mellitus.

BackgroundIn December 2019, a novel coronavirus strain, COVID-19, was identified in Wuhan, China. The first case was reported in the Republic of Ireland that month. Since then, along with many other countries worldwide, Ireland has imposed intermittent strict lockdowns to mitigate the spread of the virus.AimsTo investigate the impact of lockdown on glycaemic control in young adult patients with type 1 diabetes mellitus.MethodsPre- and post-lockdown HbA1c levels were recorded for 118 patients attending the Young Adult Diabetes clinic in Beaumont Hospital, Dublin, and the results were compared. Changes in weight, insulin requirements and incidence of DKA/severe hypoglycaemia were also assessed.ResultsHbA1c results were 3.81 mmol/mol lower post-lockdown. Weight increased by 1.8 kg. Both of these results were statistically significant.ConclusionsLockdown was associated with improved glycaemic control in young adult diabetic patients, and also with an increase in body weight. Changes in lifestyle factors associated with lockdown may explain this finding.

943-P: Impact of Culturally Appropriate Diabetes Care amongst Asian Americans with Type 2 Diabetes during the COVID Pandemic

Even as patients with T2D have been shown to have increased COVID-related morbidity and mortality, little is known on the impact of COVID on appointment adherence. This report reviews the impact of culturally-relevant diabetes clinics on adherence to clinical appointments, (pre-and during COVID) . This is a retrospective observational study using EMR data of adult patients with T2D managed at Joslin Diabetes Center before the COVID pandemic (April 20to Dec. 2019) and during the COVID pandemic (April 2020 to Dec. 2020) . Demographic and clinical visit data were extracted from patients seen at least once in both time periods. Clinical appointment adherence and outcomes were compared to patients in the general adult diabetes clinic (GADC) versus the Asian American Diabetes Initiative clinic (AADI) . 297 adult patients with T2D were seen in the AADI clinic and 4,655 patients were seen in the GADC clinics. The AADI clinic catered to a significantly larger proportion of patients who were non-native English speaking (46.1% vs. 8.7%, p&amp;lt;0.001) and on Medicaid (8.4% vs. 4.6%, p&amp;lt;0.001) . Early in the pandemic, virtual appointments were the major source of kept visits, with in-person kept appointments adherence returning in late 2020 (Oct-Dec.) . While the AADI clinic saw no significant changes in kept appointment rates, the GADC clinic had significantly fewer kept appointments overall compared to a similar time frame pre-COVID (pre: 71.7% vs. during: 63.5%, p=0.03) . Both clinics had significantly higher no-show rates during the pandemic. Comparing clinical outcomes, while GADC clinic patients saw a decline in their eGFR during the pandemic (80 vs. 75; p-value=0.04) , the AADI clinic did not observe a significant change in their patient’s renal status (82 vs. 83; p-value=0.93) . Our study shows that culturally oriented clinics like the AADI can successfully allow lower-incomes and older adults to acclimatize to telehealth services while also ensuring ongoing clinical wellbeing Disclosure A.Adam: None. K.Lau: None. H.Shah: None. M.Yu: None. G.L.King: Advisory Panel; Medtronic, Research Support; Janssen Pharmaceuticals, Inc.

Impact of continuous glucose monitoring in youth with type 1 diabetes aged 15-21 years.

People with type 1 diabetes (T1D) aged <21 years are eligible for subsidised continuous glucose monitoring (CGM) products under the Australian National Diabetes Services Scheme. There are few real-world published studies to evaluate the benefits of CGM in young adults. To perform a real-world observation study among youth with T1D to evaluate CGM use and benefits of CGM. Patients at the Westmead Hospital Young Adult Diabetes Clinic aged 15-21 years who commenced CGM before July 2018 were followed for 6 months post commencement of CGM. Differences in HbA1c and glucose metrics at baseline and follow up are compared between those commencing CGM and those that did not. Forty-four (38%) of 115 eligible patients commenced CGM. Demographic characteristics and baseline HbA1c did not differ significantly between those started on CGM and those that did not. At 6 months, 18 (41%) of 44 patients still used CGM, with discomfort and inconvenience the most common reasons for dropout. In CGM continuers, at 6 months compared with baseline, there was no change in HbA1c (8.2% vs 8.0%; P = 0.8), coefficient of variation of glucose (38% vs 39%; P = 0.5) or percentage time in range (52% vs 58%; P = 0.3). Six-month follow-up HbA1c in CGM non-users deteriorated significantly compared with users. Mean hypoglycaemia fear scores (worry scale) were significantly decreased from baseline at 6 months (33 vs 18; P < 0.01). There are high rates of discontinuation in CGM use among youth with T1D. At 6 months of CGM use, there was no significant change in glycaemic control, although HbA1c in non-users deteriorated significantly. Worry of hypoglycaemia was significantly decreased among those who continued CGM.

Prevalence of coeliac disease in children and adolescents with type 1 diabetes mellitus in a tertiary hospital in South Africa

Background. International literature has shown the prevalence of coeliac disease (CD) in children and adolescents with diabetes to range from 1 - 10%. Prevalence rates in African countries are limited or unknown. Objective. The objective was to describe the prevalence of CD in all children and adolescents with type 1 diabetes mellitus presenting to the paediatric and adult diabetic clinic at Steve Biko Academic Hospital, Pretoria, South Africa. Method. A retrospective review of the files of all children and adolescents in the paediatric and adult diabetic clinic with type 1 diabetes mellitus between August 2016 and June 2019 was conducted. Children requiring screening and/or intestinal biopsies were also prospectively included during this period. The setting of this study was Steve Biko Academic Hospital, a tertiary referral centre, in Pretoria, South Africa. Coeliac screening included anti-deaminated gliadin antibodies and anti-tissue transglutaminase antibodies (both IgA and IgG). All biopsies were obtained by a paediatric gastroenterologist or an experienced paediatric surgeon. Results. A total of 184 files were screened; 132 met inclusion criteria but only 108 patients in total had coeliac screening. Positive antibody screening for CD was found in 11 out of 108 patients (10.2%). Nine of the 11 serology-positive patients had biopsies performed. Out of the nine biopsies, two (22.2%) were positive for CD based on the Marsh-Oberhuber classification. Conclusion. This study found a prevalence of serology-positive CD in our local population of South African children with type 1 diabetes mellitus of 10.2%, while the prevalence of biopsy-confirmed CD was found to be 1.9%.

The Impact of Integrated Behavioral Healthcare on Glycemic Control.

Integrated behavioral healthcare (IBH) is the "standard of care" to address psychosocial factors impacting diabetes outcomes; it is not standard in practice. This longitudinal, retrospective, chart-review examines IBH impact on glycemic control in an adult diabetes clinic. Adults (n = 374) with ≥ 1 behavioral health encounter, ≥ 2 hemoglobin A1c (HbA1c) values, and HbA1c value > 8% at initial IBH visit were included. Mixed effects linear piecewise models examined differences in slope trajectories for 365days pre- and post-IBH intervention. Pre-intervention slope was not significant (z = -1.09, p = 0.28). The post-intervention slope was significant (z = -6.44, p < 0.001), indicating a significant linear decrease in HbA1c values. Results demonstrated that prior to engaging with behavioral health, there was no change in HbA1c. After initial IBH visit, there was a predicted reduction of > 1% in HbA1c over the following year. These results suggest that IBH significantly improves patients' metabolic status. Next steps for IBH research are offered.

839-P: Impact of Culturally Specific Care Teams on Mitigation of Racial Disparities in Diabetes Care: A Five-Year EHR-Based Study

Cultural and language barriers are known to reduce the likelihood of Asian-American patients (AA) with diabetes achieving recommended goals for HbA1c, blood pressure, and LDL, known as ‘ABCs of DM.’ Our previous study of an integrated Asian clinic for AA (AAC) at Joslin Diabetes Center, showed more AA patients achieving ABC goals 1-year after their initial visit, than whites in the Adult Diabetes clinic (WDC). AAC staff, including MDs, dietitians, educators, and patient coordinators, are all multi-lingual AAs who offer culturally-tailored management approaches. In a 5-year follow-up study between 2014 to 2019, we examined the clinical performance of new patients with T2D, comparing the following groups: AAC (n=166), AA in Adult Diabetes Clinic (ADC) (n=186), and WDC (n=2993). Compared to WDC and ADC, AAC patients were older (P=0.06), had lower BMI (P&amp;lt;0.001), lower education levels (P&amp;lt;0.001), more likely to be on Medicare (P&amp;lt;0.001), more likely to be non-native English speakers, and had significantly more educator sessions (P&amp;lt;0.001). At the initial visit, AAC patients had similar metabolic profiles as ADC and WDC (P=0.50). At the end of 5 years, 32.0% of AAC patients achieved the ABC goals, compared to 23.7% in WDC and 34.6% in ADC. Across all patients, the odds of meeting ABC goals are significantly higher (P&amp;lt;0.01) by having English as a primary language (OR:1.51; 95% CI: 1.19 - 1.26) and not being on Medicare (OR:1.24; 95% CI: 1.09 - 1.41). After adjusting for these factors, over 5-years of follow-up, the odds of AAC patients meeting ABC goals are similar to WDC patients (OR:0.58; 95% CI:0.25- 2.31, P=0.11) and better than ADC patients (OR:1.30, 95% CI:0.98- 3.22; P=0.06). Despite the financial, language, and educational disadvantages, AAC patients have achieved similar ABC targets as WDC and ADC patients. These findings suggest that culturally-specific care for AA can mitigate healthcare disparity in T2D management and can be maintained over prolonged periods of time. Disclosure A. Adam: None. K. Lau: None. H. Shah: None. M. Yu: None. G. L. King: Consultant; Self; Agios, Inc., Medtronic, Other Relationship; Self; Janssen Pharmaceuticals, Inc.

Experiences and perspectives of the parents of emerging adults living with type 1 diabetes.

IntroductionWhereas it is widely recognized that emerging adulthood can be a difficult time in the life of an individual living with type 1 diabetes, relatively little is known about the experiences of their parents or guardians. These individuals once shouldered much of the burden for their child’s diabetes ‘self’-management, yet their contribution is often overlooked by the adult healthcare system. Here, we set out to gain an understanding of the perspectives of parents of emerging adults living with type 1 diabetes.Research design and methodsSemi-structured interviews were performed with a purposeful sample of parents of emerging adults with type 1 diabetes recruited from two urban young adult diabetes clinics and through a national diabetes charity. Thematic coding was derived using a constant comparative approach.ResultsAnalysis of interviews with 16 parents of emerging adults with type 1 diabetes identified three themes: parental experiences of the transition to adult care; negotiating parent–child roles, responsibilities and relationships; and new and evolving fears. Parents spoke in detail about the time surrounding their child’s diagnosis of type 1 diabetes to emphasize the complexity of diabetes care and the need to establish a ‘new normal’ for the family. In turn, adolescence and emerging adulthood required a renegotiation of roles and responsibilities, with many parents continuing to play a role in high-level diabetes management. Several parents of emerging adults with type 1 diabetes (particularly those of young men) vocalized worries about their child’s readiness to assume responsibility for their self-care, and some expressed frustration with the apparent dichotomy in the role expectations of parents between the pediatric and adult care settings.ConclusionsAdult healthcare providers should recognize both the ongoing involvement of parents in the ‘self’-management of emerging adults with type 1 diabetes and the unique aspects of the caregiver burden that they experience.