Advanced Diabetes Technologies Research Articles

How Can Diabetes Technologies Reduce the Burden of Cost?

The ever-increasing transformation of people to a sedentary lifestyle paved the way for a steep increase in diabetes. It is well-documented that advanced diabetes technologies can reduce disease burden and improve the quality of life. However, several reasons are entangled with the lesser acceptance of diabetes technologies. Some of these include inaccessibility, lack of skill, unawareness, fear of being with devices, overall treatment cost, and cost associated with technologies. Among these, the cost of technologies intensifies peoples' unwillingness in using diabetes technologies. Majority of the patients with diabetes, especially in developing countries, are unaware of diabetes-related complications which eventually impose a huge economic burden on them. Diabetes awareness should start from the primary care centers and primary care physicians should encourage using technologies that are proven to be cost-effective in preventing the costly complications of diabetes. Policy-makers and government should take the initiative to provide financial support to people with diabetes in availing technologies. The review provides insights into how diabetes technologies help people with diabetes to reduce the cost burden in the long term. The data were collected from relevant studies based on the cost-effectiveness of diabetes technologies which were published in electronic databases such as PubMed and Google Scholar using the keywords diabetes, cost-effectiveness, economic burden, incremental cost-effectiveness ratio, smartpens, insulin devices, diabetes technologies, and continuous glucose monitoring (CGM). The review discusses studies that highlight the cost effectiveness of telemedicine, smart insulin pens CGM, and insulin pumps.

Inequity in Adoption of Advanced Diabetes Technologies Among Medicare Fee-for-service Beneficiaries.

Health inequity is often associated with race-ethnicity. To determine the prevalence of insulin pump therapy and continuous glucose monitoring (CGM) among Medicare beneficiaries with type 1 diabetes (T1D) by race-ethnicity, and to compare diabetes-related technology users with nonusers. The prevalence of technology use (pump, CGM) was determined by race-ethnicity for enrollees in coverage years (CY) 2017-2019 in the Medicare fee-for-service database. Using CY2019 data, technology users were compared with nonusers by race-ethnicity, sex, average age, Medicare eligibility criteria, and visit to an endocrinologist. Community. Beneficiaries with T1D and at least 1 inpatient or 2 outpatient claims in a CY. Pump or CGM therapy, visit to an endocrinologist. Diabetes-related technology use by race-ethnicity groups. Between 2017 and 2019, CGM and insulin pump use increased among all groups. Prevalence of insulin pump use was < 5% for Black and Other beneficiaries yet increased from 14% to 18% among White beneficiaries. In CY2019, 57% of White patients used a pump compared with 33.1% of Black and 30.3% of Other patients (P < 0.001). Black patients were more likely than White patients to be eligible because of disability/end-stage renal disease or to be Medicare/Medicaid eligible (both P < 0.001), whether using technology or not. Significant race-ethnicity differences (P < 0.001) existed between technology users and nonusers for all evaluated factors except visiting an endocrinologist. Significant race-ethnicity associated differences existed in T1D management. The gap in diabetic technology adoption between Black and White beneficiaries grew between 2017 and 2019.

Practical aspects of diabetes technology use: Continuous glucose monitors, insulin pumps, and automated insulin delivery systems

There have been tremendous advances in diabetes technology in the last decade. Continuous glucose monitors (CGM), insulin pumps, and automated insulin delivery (AID) systems aim to improve glycemic control while simultaneously decreasing the burden of diabetes management. Although diabetes technologies have been shown to decrease both hypoglycemia and hyperglycemia and to improve health-related quality of life in individuals with type 1 diabetes, the impact of these devices in individuals with cystic fibrosis-related diabetes (CFRD) is less clear. There are unique aspects of CFRD, including the different underlying pathophysiology and unique lived health care experience and comorbidities, that likely affect the use, efficacy, and uptake of diabetes technology in this population. Small studies suggest that CGM is accurate and may be helpful in guiding insulin therapy for individuals with CFRD. Insulin pump use has been linked to improvements in lean body mass and hemoglobin A1c among adults with CFRD. A recent pilot study highlighted the promise of AID systems in this population. This article provides an overview of practical aspects of diabetes technology use and device limitations that clinicians must be aware of in caring for individuals with CF and CFRD. Cost and limited insurance coverage remain significant barriers to wider implementation of diabetes technology use among patients with CFRD. Future studies exploring strategies to improve patient and CF provider education about these devices and studies showing the effectiveness of these technologies on health and patient-reported outcomes may lead to improved insurance coverage and increased rates of uptake and sustained use of these technologies in the CFRD community.

Advanced Diabetes Technology Remains Underutilized in Underserved Populations: Early Hybrid Closed-Loop System Experience at an Academic Safety Net Hospital.

We retrospectively evaluated outcomes of the Minimed Medtronic 670G system in an academic urban safety-net population of adults with type 1 diabetes, between September 2016 and January 2020. Among 32 patients prescribed the 670G, the majority were female (69%), white (69%), achieved advanced degrees (56%), were commercially insured (94%), and were experienced pump users (84%). Patients who initiated auto-mode demonstrated significant improvement in A1c after 1 year. However, 31% of patients never initiated auto-mode. Black and Hispanic patients comprised 50% of this group, despite similar insurance coverage, diabetes duration, educational level, and prior pump use. Hence, traditional barriers to technology use do not explain these racial/ethnic disparities. Of 22 patients who initiated auto-mode, 5 discontinued within 1 year. The most common reason for discontinuation was frustration with pump-sensor interactions. Future studies identifying barriers to and strategies for increasing use of advanced insulin delivery systems in underserved populations are needed.

Newest Diabetes-Related Technologies for Pediatric Type 1 Diabetes and Its Impact on Routine Care: a Narrative Synthesis of the Literature.

Purpose of ReviewThis review aims to address the actual state of the most advanced diabetes devices, as follows: continuous subcutaneous insulin infusions (CSII), continuous glucose monitoring systems (CGM), hybrid-closed loop (HCL) systems, and “Do-it-yourself” Artificial Pancreas Systems (DIYAPS) in children, adolescents, and young adults. This review has also the objective to assess the use of telemedicine for diabetes care across three different areas: education, social media, and daily care.Recent FindingsRecent advances in diabetes technology after integration of CSII with CGM have increased the popularity of this treatment modality in pediatric age and shifted the standard diabetes management in many countries. We found an impressive transition from the use of CSII and/or CGM only to integrative devices with automated delivery systems. Although much has changed over the past 5 years, including a pandemic period that precipitated a broader use of telemedicine in diabetes care, some advances in technology may still be an additional burden of care for providers, patients, and caregivers. The extent of a higher rate of “auto-mode” use in diabetes devices while using the HCL/DIYAPS is essential to reduce the burden of diabetes treatment.SummaryMore studies including higher-risk populations are needed, and efforts should be taken to ensure proper access to cost-effective advanced technology on diabetes care.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40124-021-00248-7.

Determining the Perception and Willingness of Primary Care Providers to Prescribe Advanced Diabetes Technologies.

Advanced diabetes technologies have produced increasingly favorable outcomes compared to older treatments. Disparities in practice resources have led to a treatment disparity by clinical setting, where endocrinologists typically prescribe far more such technologies than primary care providers (PCPs). Fully automated artificial pancreas systems (APS), which combine technologies to deliver and adjust insulin dosing continuously in response to automatic and continuous glucose monitoring, may be more straightforward for PCPs to prescribe and manage, therefore extending their benefit to more patients. We aimed to assess willingness of PCPs to prescribe advanced diabetes technologies through a cross-sectional survey of PCPs from 4 geographically diverse centers. While respondents were uncomfortable initiating (63 of 72, 88%) or adjusting (64 of 72, 89%) traditional insulin pumps, their views on APS were quite different: 71 of 76 (93%) saw advantages to prescribing APS by PCPs rather than only endocrinologists. Most would consider prescribing APS for type 1 diabetes (58 of 76, 76%) and type 2 diabetes (52 of 76, 68%). No differences were seen among attendings, residents, or nurse practitioners. APS were much more acceptable than traditional insulin pumps among this primary care sample. If successful, primary care management of closed-loop APS would greatly increase access to such therapies and reduce disparities among those patients who face more difficulty accessing subspecialty care than they do primary care.

707-P: Use of Advanced Insulin Delivery Systems Is Not Associated with Fear of Hypoglycemia or Diabetes Treatment Satisfaction in Children and Their Caregivers with Type 1 Diabetes

Hypoglycemia occurs frequently in children with type 1 diabetes (T1D). However, the relationship between fear of hypoglycemia (FOH) and use of diabetes technology with different insulin delivery systems has not been well studied. Similarly, little is known about the relationship of diabetes treatment satisfaction with advances in diabetes technology in the pediatric population. Caregivers of children 6-17 years with T1D (n=104, 84% female caregivers, median T1D duration 5.3 years, mean GMI 7.5 ± 0.7%, 93% insulin pump users, 92% CGM users) using any insulin delivery system (8% MDI, 0.05% pump alone, 31% sensor augmented pump, 23% predictive low glucose suspend, 38% hybrid closed loop) completed the Hypoglycemia Fear Survey - Parent (HFS-P) and the Diabetes Treatment Satisfaction Questionnaire - Parent (DTSQ-P). Youth 13-17 years (n=35, 56% males) also completed the HFS - Child (HFS-C) and DTSQ - Child (DTSQ-C). Linear regression was used to look for associations between HFS and DTSQ scores and clinical factors, and paired t-tests were used to compare scores between caregivers and youth. Female caregivers had higher mean HFS Worry and Behavior scores than male caregivers (Worry 1.4 ± 0.18 vs. 0.88 ± 0.16, p=0.004; Behavior 4.9 ± 0.39 vs. 3.9 ± 0.3, p=0.008). Longer duration of diabetes, duration of pump use, and duration of CGM use were all associated with higher mean HFS-C Worry scores, but not with HFS-P Worry scores. The use of different insulin delivery systems was not associated with any HFS scores. Caregivers had a higher mean HFS Behavior score (4.8 ± 0.29) than youth (2.2 ± 0.078) (p &amp;lt;0.0001). The only clinical factor that was associated with a lower DTSQ-P score was higher GMI (β-coefficient -0.22 ± 0.11, p=0.05). These data suggest that despite recent advancements in diabetes technology, FOH and diabetes treatment satisfaction still remain significant concerns and need to be addressed in clinical contexts. Disclosure F. Abdulhussein: None. J. C. Wong: Advisory Panel; Self; Provention Bio, Inc., Research Support; Self; Dexcom, Inc., Tandem Diabetes Care.

833-P: HbA1c Trends in the T1D Exchange Quality Improvement Collaborative (T1DX-QI), 2017-2020

Background: The T1DX-QI was launched in 2016 with 10 participating centers and now has over 30 U.S. endocrinology centers that share data and best practices to improve healthcare delivery and outcomes for people with T1D through the application of QI. This study aims to compare trends in A1c levels among people with T1D in the T1DX-QI registry in 2017 and 2020 across all ages. Methods: The analysis includes all T1D patients in the T1DX-QI database for whom electronic medical record data were available from clinic visits (in-person or virtual) in 2017 (N=16,683) and 2020 (N=11,575) with at least one HbA1c in each of those years. Patients aged Results: Mean A1c in 2017, the start of the T1DX-QI data sharing and practice-wide improvements, was higher in comparison with A1c trends in 2020 (mean [SD]: 8.9[1.6] vs. 8.6[1.7]) (p 25 years of age. Conclusion: This study demonstrates the early success of the T1DX-QI population-based trends in HbA1c outcomes over time. While there are many contributing factors including advances in diabetes technology during this interval, improvement in A1c for sites participating in QI initiatives is encouraging. Disclosure O. Ebekozien: None. P. Prahalad: None. O. Odugbesan: None. M. K. Kamboj: None. D. M. Maahs: Advisory Panel; Self; Abbott Diabetes, Dompe, Eli Lilly and Company, Medtronic, Novo Nordisk, Consultant; Self; aditxt. M. A. Clements: Consultant; Self; Eli Lilly and Company, Employee; Self; Glooko, Inc., Research Support; Self; Abbott Diabetes, Dexcom, Inc. T1dx-qi collaborative: n/a. N. Noor: Research Support; Self; Dexcom, Inc. N. Jones: Consultant; Self; Companion Medical, Medtronic. G. T. Alonso: None. M. Desimone: None. R. Izquierdo: None. S. Corathers: None. D. Desalvo: Consultant; Self; Insulet Corporation, Research Support; Self; Insulet Corporation, Speaker’s Bureau; Self; Dexcom, Inc. N. Rioles: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

937-P: Mealtime Insulin in New-Onset Type 1 Diabetes Mellitus: Fixed Dose vs. Insulin:Carbohydrate Ratio

Over the past 20 years, advances in diabetes technology and along with carbohydrate counting (CC) to determine insulin dose, has provided an opportunity for improvement in glycemic control and quality of life for children and adolescents with type 1 diabetes (T1D). These advances, however, have not translated into improved outcomes. This may be due to the stress and anxiety the child and family experience with the large amount of information taught during diabetes education sessions at diagnosis. A simplified teaching approach may reduce stress for the child and family. This study assessed the effects of two approaches to mealtime insulin delivery on parental stress. In the fixed dose (FD) regimen, the same dose of insulin is delivered for a set range of carbohydrates. In the insulin:carbohydrate ratio (ICR) regimen, insulin delivery varies based on the exact number of carbohydrates. Twenty-four subjects (8-15-yrs) with new-onset T1D were randomized to the FD or ICR group. The primary endpoint was parental stress using the Parental Stress Survey, at 1-month and 4-months after diagnosis. Secondary endpoints included glycemic variability (% of values within target range) and HbA1C (%), at 1-month and 4-months after diagnosis. The FD group experienced less stress than the ICR group at 1-month (27 ± 2.29 vs. 37.28 ± 2.57)and 4-months (27.62 ± 2.34vs. 35.14 ± 2.57) (interactive p = 0.04). The FD group had similar glycemic variability and HbA1C levels as the ICR group at 1-month (67.5% vs. 63.2% and 9.76 ± 0.53vs. 9.2 ± 0.58) and 4-months (63.3% vs. 69.0% and 7.27 ± 0.55 vs. 7.71 ± 0.58). Complications (severe hypoglycemia or DKA) did not occur in either group during the study. The additional stress associated with learning CC at the onset of T1D education may be reduced with a simple mealtime insulin and carbohydrate regimen. A simple insulin regimen that does not adversely affect glycemic control may alleviate the stress that many patients and families experience when a child is diagnosed with new-onset T1D. Disclosure J. V. Reyes diaz: None. E. Felner: None.

Diabetes technologies in people with type 1 diabetes mellitus and disordered eating: A systematic review on continuous subcutaneous insulin infusion, continuous glucose monitoring and automated insulin delivery.

In this systematic review, we aimed (1) to identify and describe research investigating the use of advanced diabetes technologies (continuous subcutaneous insulin infusion, CSII; continuous glucose monitoring, CGM; automated insulin delivery, AID) in people with type 1 diabetes (T1DM) and disordered eating and (2) to discuss potential (dis)advantages of diabetes technology use in this population, derived from previous research. We conducted a systematic literature search in two electronic databases for English articles published between 2000 and 2020 addressing eating disorders and/or dysfunctional eating behaviours and diabetes technology use in children, adolescents and adults with T1DM (PROSPERO ID CRD42020160244). Of 70 publications initially identified, 17 were included. Overall, evidence on the use of diabetes technologies in people with T1DM and disordered eating is scarce. The majority of the studies reports findings on CSII in people with T1DM and dysfunctional eating behaviours or eating disorders. Findings predominantly stem from observational data and are, in most cases, secondary findings of the respective studies. Providing the greatest flexibility in diabetes management, CSII may have benefits in disordered eating. CGM data may complement the diagnostic process of disordered eating with a physiological indicator of insulin restriction (i.e. time spent in hyperglycaemia). Results on possible (dis)advantages of diabetes technology use in people with T1DM and disordered eating are based on observational data, small pilot trials and anecdotical evidence from case reports. Prospective data from larger samples are needed to reliably determine potential effects of diabetes technology on disordered eating in T1DM.

Benefits and Challenges of Current Closed-Loop Technologies in Children and Young People With Type 1 Diabetes.

Recent advances in diabetes technology have led to the development of closed-loop insulin delivery systems for the management of type 1 diabetes. Several such systems are now commercially available for children and young people. While all available systems have been shown to improve glycaemic control and quality of life in this population, qualitative data also highlights the challenges in using closed-loop systems, which vary among different pediatric age-groups. Very young children require systems that are able to cope with low insulin doses and significant glycaemic variability due to their high insulin sensitivity and unpredictable eating and exercise patterns. Adolescents' compliance is often related to size and number of devices, usability of the systems, need for calibrations, and their ability to interact with the system. Given the speed of innovations, understanding the capabilities and key similarities and differences of current systems can be challenging for healthcare professionals, caregivers and young people with type 1 diabetes alike. The aim of this review is to summarize the key evidence on currently available closed-loop systems for children and young people with type 1 diabetes, as well as commenting on user experience, where real-world data are available. We present findings on a system-basis, as well as identifying specific challenges in different pediatric age-groups and commenting on how current systems might address these. Finally, we identify areas for future research with regards to closed-loop technology tailored for pediatric use and how these might inform reimbursement and alleviate disease burden.

The Evolution of Hemoglobin A1c Targets for Youth With Type 1 Diabetes: Rationale and Supporting Evidence.

The American Diabetes Association 2020 Standards of Medical Care in Diabetes (Standards of Care) recommends a hemoglobin A1c (A1C) of <7% (53 mmol/mol) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness and for those who do not have access to analog insulins or advanced diabetes technologies or who cannot monitor blood glucose regularly. Even less stringent A1C targets (e.g., <8%) may be warranted for children with a history of severe hypoglycemia, severe morbidities, or short life expectancy. During the “honeymoon” period and in situations where lower mean glycemia is achievable without excessive hypoglycemia or reduced quality of life, an A1C <6.5% may be safe and effective. Here, we provide a historical perspective of A1C targets in pediatrics and highlight evidence demonstrating detrimental effects of hyperglycemia in children and adolescents, including increased likelihood of brain structure and neurocognitive abnormalities, microvascular and macrovascular complications, long-term effects, and increased mortality. We also review data supporting a decrease over time in overall severe hypoglycemia risk for youth with T1D, partly associated with the use of newer insulins and devices, and weakened association between lower A1C and severe hypoglycemia risk. We present common barriers to achieving glycemic targets in pediatric diabetes and discuss some strategies to address them. We aim to raise awareness within the community on Standards of Care updates that impact this crucial goal in pediatric diabetes management.

Overcoming Therapeutic Inertia in the Age of Advanced Diabetes Medication Therapy and Technology

Overcoming Therapeutic Inertia in the Age of Advanced Diabetes Medication Therapy and Technology

Glycemic Outcomes in Adults With Type 2 Diabetes Participating in a Continuous Glucose Monitor-Driven Virtual Diabetes Clinic: Prospective Trial.

BackgroundThe Onduo virtual diabetes clinic (VDC) for people with type 2 diabetes (T2D) combines a mobile app, remote personalized lifestyle coaching, connected devices, and live video consultations with board-certified endocrinologists for medication management and prescription of real-time continuous glucose monitoring (RT-CGM) devices for intermittent use.ObjectiveThis prospective single-arm study evaluated glycemic outcomes associated with participation in the Onduo VDC for 4 months.MethodsAdults aged ≥18 years with T2D and a baseline glycated hemoglobin (HbA1c) of ≥8% to ≤12% were enrolled from 2 primary care centers from February 2019 to October 2019. Participants were asked to engage at ≥1 time per week with their care team and to participate in a telemedicine consultation with a clinic endocrinologist for diabetes medication review. Participants were asked to use a RT-CGM device and wear six 10-day sensors (total 60 days of sensor wear) intermittently over the course of 4 months. The primary outcome was change in HbA1c at 4 months from baseline. Other endpoints included change in weight and in RT-CGM glycemic metrics, including percent time <70, 70-180, 181-250, and >250 mg/dL. Changes in blood pressure and serum lipids at 4 months were also evaluated.ResultsParticipants (n=55) were 57.3 (SD 11.6) years of age, body mass index 33.7 (SD 7.2), and 40% (22/55) female. HbA1c decreased significantly by 1.6% (SD 1%; P<.001). When stratified by baseline HbA1c of 8.0% to 9.0% (n=36) and >9.0% (n=19), HbA1c decreased by 1.2% (SD 0.6%; P<.001) and 2.4% (SD 1.3%; P<.001), respectively. Continuous glucose monitoring–measured (n=43) percent time in range (TIR) 70-180 mg/dL increased by 10.2% (SD 20.5%; P=.002), from 65.4% (SD 23.2%) to 75.5% (SD 22.7%), which was equivalent to a mean increase of 2.4 hours TIR per day. Percent time 181-250 mg/dL and >250 mg/dL decreased by 7.2% (SD 15.4; P=.005) and 3.0% (SD 9.4; P=.01), respectively. There was no change in percent time <70 mg/dL. Mean weight decreased by 9.0 lb (SD 10.4; P<.001). Significant improvements were also observed in systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and triglycerides (P=.04 to P=<.001).ConclusionsParticipants in the Onduo VDC experienced significant improvement in HbA1c, increased TIR, decreased time in hyperglycemia, and no increase in hypoglycemia at 4 months. Improvements in other metabolic health parameters including weight and blood pressure were also observed. In conclusion, the Onduo VDC has potential to support people with T2D and their clinicians between office visits by increasing access to specialty care and advanced diabetes technology including RT-CGM.Trial RegistrationClinicalTrials.gov NCT03865381; https://clinicaltrials.gov/ct2/show/NCT03865381

1281-P: Pilot Study on the Feasibility of Weekly CGM Data Review in Youth with New-Onset Type 1 Diabetes

Despite advances in diabetes technology and treatment, many youth with type 1 diabetes (T1D) continue to have hemoglobin A1c (HbA1c) above target. Consistent use of continuous glucose monitors (CGM) improves HbA1c and time in range (TIR 70-180 mg/dl) glucose, while minimizing hypoglycemia in youth with T1D. A previous study suggested that long-term HbA1c outcomes may be determined early in the course of T1D. Thus, increased awareness of glucose trends and frequent insulin dose adjustments early in the course of T1D is hypothesized to improve long-term HbA1c and health outcomes. We have initiated CGM in the first month of T1D diagnosis. In March 2019, we added weekly remote review of CGM data by a pediatric endocrinologist or certified diabetes educator to provide dose adjustments. Data sharing is facilitated by using a custom platform including Apple HealthKit to transmit data from the Dexcom G6 mobile app to Epic MyChart. Inclusion criteria were diagnosis of T1D within the past 30 days and intention to follow in our clinic. During the initial 8 months of this study, we enrolled 43 youth (age at diagnosis 9.2±4.2 years, 57% male, 78% on private insurance, 42.5% non-Hispanic White, initial HbA1c 12.0±2.0%). Twenty-eight youth had at least 1 documented data review with an average of 15.8±8.1 reviews/patient and 5.4 dose adjustments/youth (∼1 dose adjustment every 3 weeks) via phone calls or secure MyChart messages. Based on CGM downloads, users had a high percentage of time of CGM wear (88±11% of time over 2-week periods), high percentage of TIR glucose (72.2±18.4%), and low incidence of hypoglycemia (32±54 min/day, 2.2±3.8%). This pilot study demonstrates that implementing routine data review as part of a new onset program increases the frequency of insulin dose adjustments. Tools should be developed to allow for efficient data review for population health management. Further follow up is needed to determine long-term outcomes, scalability, and sustainability of this new onset program. Disclosure M. Lee: None. J. Leverenz: None. B. Leverenz: None. N.M. Pageler: None. D. Scheinker: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. P. Prahalad: None. Funding Stanford Diabetes Research Center (P30DK116074)

630-P: Targeting Workload Experienced by Diabetes Camp Medical Staff: A Novel Training Curriculum

More than 5700 children with diabetes attend American Diabetes Association (ADA) camps each year. Training volunteer medical staff has become more challenging given the rapid advances in diabetes technology. Through a prospective, multi-site pilot study at 4 ADA camps, we assessed the efficacy of an educational bundle of online interactive cases with in-situ simulation in preparing medical volunteers for management of type 1 diabetes (T1D). We hypothesized that our curriculum would reduce the workload necessary to manage children with T1D as measured by the NASA-Task load index (TLX), a validated workload assessment tool comprised of 6 self-rated scales; mental, physical, and temporal demand, performance, effort, and frustration. No statistical difference in change in workload was observed between the intervention and control groups (Table 1). However, both groups were small and had different experiences prior to camp. The reduction in temporal demand reported by the intervention group by the end of camp may signal an impact among medical providers. Future interventions, with larger, more balanced groups, could evaluate timing of TLX change and the effect on medical staff’s camp experience and patient care. Disclosure E.S. Atwood: Research Support; Self; American Diabetes Association. N.M. Sheanon: Research Support; Self; American Diabetes Association. S. Amanat: None. J.C. Khoury: None. M. Klein: None.

741-P: Racial/Ethnic Disparity in Advanced Diabetes Technology Use in Type 1 Diabetes (T1D): Minority Young Adult (YA) Perspectives on Perceived Access

Previous research has documented racial/ethnic disparity in continuous glucose monitor and insulin pump use in people with T1D. It remains unknown whether disparities result from socioeconomic status or other factors. We recruited 17 YA with T1D from an underserved area (mean age 22, 5 non-Hispanic Black, 12 Hispanic, 88% Medicaid, duration 11 yrs, median HbA1c 9.6%) and conducted semi-structured individual interviews in English or Spanish. We asked questions about how YA were introduced to diabetes technology and what helped them make decisions for use. We developed a standard codebook to direct content analysis and achieved thematic saturation. Our results revealed 3 main themes surrounding information and decisions on technology use: 1) providers were the gateway for information and access; 2) patients were not typically included in decision-making, but were more likely to accept use when they were; and 3) cost was not an issue. Half of participants reported they were never offered or told about diabetes technology in the past despite long diabetes duration. For those with whom technology was discussed, most stated they were not included in the decision process to receive such technology. Some participants reported that providers refused prescription of technology due to lack of demonstration of self-management skills. Still, no alternative options or goal-setting to obtain technology were offered. Some participants desired to learn more about technology but refused to ever start because of perceived extra burden, skepticism of new equipment, or attachment concerns. Very few participants stated they could not afford the technology. Our results suggest that racial/ethnic disparity in technology use may originate at the patient-provider level. Deeper examination of implicit bias in prescribing practices is needed, as well as understanding of minority YA preferences and promotion of shared decision-making. Disclosure G. Crespo-Ramos: None. V. Miller: None. J.S. Gonzalez: None. A. Jang: None. S. Agarwal: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)

70-OR: Change in A1C with and without Intermittent Use of CGM in Adults with Type 2 Diabetes Participating in the Onduo Virtual Diabetes Clinic

The Onduo Virtual Diabetes Clinic (VDC) for people with T2D combines a mobile app, remote personalized lifestyle coaching and connected devices. Differentiating features are live video consultations with board-certified endocrinologists for medication management and prescription of real-time CGM devices for intermittent use as clinically indicated. This analysis examined change in A1c from enrollment to follow-up at 6 mo in CGM vs. non-CGM user groups. Characteristics of CGM (n=213) and non-CGM (n=399) groups were similar. Overall, participants (n=612) were 53.5±8.7 yr, 61.1% female and 26.5% lived in a rural geography. Baseline A1c was 7.8%±1.7, 33.0% were on insulin and 23.5% on a sulfonylurea. A1c decreased significantly in CGM and non-CGM groups by 0.9%±1.7 and 0.4%±1.3, respectively (both p&amp;lt;0.001). Change in A1c stratified by CGM use and baseline A1c categories of &amp;gt;9.0%, 8.0-9.0%, 7.0-&amp;lt;8.0%, &amp;lt;7.0% are presented in the Table. These real-world data suggest that participation in the Onduo VDC was associated with significant improvement in A1c for participants not meeting ADA treatment targets. There was an approximately two-fold greater improvement in A1c with intermittent CGM use. In conclusion, the VDC has potential to support people with T2D and their clinicians between office visits by increasing access to specialist care and advanced diabetes technology. Disclosure J.E. Layne: Employee; Self; Onduo. H. Zisser: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. R.M. Bergenstal: Consultant; Self; Ascensia Diabetes Care, Johnson &amp; Johnson. Other Relationship; Self; Abbott, Dexcom, Inc., Hygieia, Lilly Diabetes, Medtronic, Novo Nordisk A/S, Onduo, Roche Diabetes Care, Sanofi, UnitedHealth Group. R.A. Gabbay: Advisory Panel; Self; FormHealth, Health Reveal, Lark, Onduo, Vida Health. N.A. Barleen: Employee; Self; Onduo. D.P. Miller: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. R.F. Dixon: Employee; Self; Onduo.

756-P: Socioeconomic and Self-Management Factors Do Not Explain Racial/Ethnic Disparities in Advanced Diabetes Technology Use among Young Adults (YA) with Type 1 Diabetes (T1D)

Recent studies demonstrate wide racial/ethnic disparity in insulin pump and continuous glucose monitor (CGM) use in people with T1D. It remains unknown whether socioeconomic status (SES) or other factors drive disparities. We recruited 300 diverse YA with T1D from 6 diabetes centers across the U.S. (ages 18-28; 33% non-Hispanic White, 32% non-Hispanic Black, 34% Hispanic; 52% public/no insurance; median A1c 9.2%). We used logistic regression to examine how patient-reported and chart-extracted variables, including multiple socioeconomic and individual-level factors, accounted for racial/ethnic disparity in current pump or ever CGM use. Compared with White YA (71/72%), both Black (18/28%) and Hispanic (37/39%) YA had significantly lower pump and CGM use, respectively (p&amp;lt;0.001). Pump and CGM users were more likely to have lower A1c levels, higher attained education, greater household income, lower neighborhood poverty, private insurance, higher diabetes numeracy and literacy, and receive care in a pediatric or combined pediatric-adult center (p&amp;lt;0.001). They were also more likely to report frequent self-monitoring of blood glucose and diabetes medical visit attendance (p&amp;lt;0.001). Full adjustment for these multiple SES, self-management, and care factors did little to explain racial/ethnic disparity. Compared with White YA, Black and Hispanic YA had persistent 50-80% lower odds of insulin pump use and Black YA had 70% lower odds of CGM use (OR (95% CI) Pump: Black 0.125 (0.050, 0.313), Hispanic 0.427 (0.176, 1.035); CGM: Black 0.291 (0.121, 0.702)). In contrast, these variables accounted for more of the CGM disparity between White and Hispanic YA (OR (95% CI) 1.007 (0.409, 2.483)). Exploration of factors other than SES and self-management is needed to examine disparity in diabetes technology use, especially in Black YA. Black and Hispanic YA preferences for technology and provider factors should be considered. Disclosure S. Agarwal: None. C. Schechter: None. J.S. Gonzalez: None. J.A. Long: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896)

77-LB: Improved A1C and TIR in Adults with T2D Participating in a CGM-Driven Virtual Diabetes Clinic

The Onduo Virtual Diabetes Clinic (VDC) for people with T2D combines a mobile app, remote personalized lifestyle coaching, connected devices and live video consultations with board-certified endocrinologists for medication management and prescription of real-time CGM devices for intermittent use. This prospective single-arm study enrolled adults with a baseline A1c of ≥8.0% to ≤12.0% from 2 primary care centers to participate in the VDC program. The primary outcome was change in A1c from baseline at 4 mo. Secondary outcomes included change in CGM-based (Dexcom G6) glycemic parameters. Participants (n=55) were: 57.3±11.6 yr, 40.0% female and BMI 33.7±7.2. A1c decreased significantly by -1.6%±1.0 (p&amp;lt;0.001) from 8.9%±1.0 to 7.3%±0.9 at 4 mo. Stratified by baseline A1c 8.0% to 9.0% (n=36) and &amp;gt;9.0% (n=19), A1c decreased by -1.2%±0.6 and -2.4%±1.3 (both p&amp;lt;0.001). CGM metrics (n=43) are presented in the Table. Percent time in range (TIR) increased significantly from below target to target levels at follow-up. The results indicate that participation in the VDC for 4 mo was associated with significant improvement in A1c, increased TIR, decreased time in hyperglycemia and no increase in hypoglycemia. In conclusion, the VDC has potential to support people with T2D and their clinicians between office visits by increasing access to specialty care and advanced diabetes technology including CGM. Disclosure A.R. Majithia: Consultant; Self; Onduo. C. Kusiak: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. A. Armento Lee: None. F.R. Colangelo: None. R. Romanelli: Advisory Panel; Self; Novo Nordisk Inc. S. Robertson: Other Relationship; Self; Verily Life Sciences LLC. D.P. Miller: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC. D.M. Erani: None. R.F. Dixon: Employee; Self; Onduo. H. Zisser: Employee; Self; Verily Life Sciences LLC. Stock/Shareholder; Self; Verily Life Sciences LLC.