Introduction: Carbohydrate counting is an important part of diabetes management, but it is difficult and can negatively impact quality of life. To address this challenge, a novel mobile application (app) called iSpy that uses computer vision and artificial intelligence to identify foods, estimate their carbohydrate content, and provide real-time feedback to users, was developed. Objective: To evaluate iSpy’s functionality among youth aged 10 to 17 years (mean age = 14 years) with type 1 diabetes mellitus (T1DM). Design/Methods: A pilot study among 44 youth (22 each randomized to intervention (iSpy) or control) was conducted to assess: (1) whether iSpy leads to improved carbohydrate counting ability (accuracy and speed) measured using standardized meal plates at baseline and at the end of the 12-week study; and (2) implementation outcomes such as app acceptability and technical problems. Results: Compared to the control group, the intervention group improved its carbohydrate counting accuracy (total grams per meal) over the 12-week study period (p=0.007). Moreover, the percentage of times the carbohydrate estimate of a particular item was off by more than 10g from the true value was reduced by 9.9% (p=0.047). There was no statistically significant difference in total time to count carbohydrates. Qualitative interviews and app acceptability scale scores across 7 domains were primarily positive. 43% of iSpy participants were still using the app and logged at least once per 2 weeks at the end of the study. No major technical challenges were identified. Conclusion(s): Participants using iSpy demonstrated improved carbohydrate counting accuracy and positive acceptability. iSpy has the potential to improve diabetes management, which should be further tested in a formal randomized controlled trial. Disclosure E. Choi: Other Relationship; Self; Inner Analytics Inc. J. Alfonsi: Other Relationship; Self; Inner Analytics Inc. T. Arshad: None. S. Sammott: None. V. Pais: None. J. Stinson: None. M. Palmert: None. Funding Physician Services Incorporated Foundation