High Diabetes Distress Research Articles

832-P: Resilience Outstrips the Negative Impact of Diabetes Distress on Glycemic Control and Self-Management among Youth with Type 1 Diabetes

Background: Adolescent with type 1 diabetes (T1D) experience increased diabetes distress, which is linked to poor self-management and glycemic control. Resilience might be able to decrease distress and facilitate disease management. Objective: To determine whether resilience buffers the deleterious consequences of distress on glycemic control and self-management. Methods: A convenience sample of 203 eligible adolescents (mean age 14.60 years) was recruited from a national endocrine center. Data were collected on social clinical characteristics, diabetes distress, resilience, self-management and glycemic. We preformed the simple slope and Johnson-Neyman statistical technique to probe moderating effects of resilience. Results: A total of 42.4% of adolescents reported high diabetes distress. Our results indicated that resilience moderated the association that hazards of severe diabetes distress for higher HbA1c (β = 0.148, t = 4.156, p = 0.000) and worse self-management (β = -0.010, t = -3.000, p = 0.003) were only apparent in the context of low resilience. Conclusions: We highlight the interactive relationship between diabetes distress and resilience in relation to glycemic control and self-management. It suggest that resilience is promising intervention target for distressed T1D adolescents with unsatisfactory glycemic control and self-management behavior. Disclosure D. Luo: None. J. Xu: None. M. Zhu: None. H. Wang: None. Y. Wang: None. Y. Shi: None. M. Zhang: None.

738-P: Social Support Moderates the Association between Diabetes Distress and Diabetes Self-Care in Adults with Diabetes in Appalachian Ohio

Background: Social support is associated with better physical and mental health in people with diabetes. Social support may buffer the negative effects of diabetes distress on health outcomes. The purpose of this study was to assess the moderating role of social support in the relationship between diabetes distress and self-care in adults with type 1 (T1D) and type 2 (T2D) diabetes in Appalachian Ohio. Methods: Participants completed the Diabetes Distress Scale for T2D or T1D, the Medical Outcomes Study Social Support Survey, and the Self-Care Inventory Revised. We conducted hierarchical multiple regression models using SPSS version 26.0. To avoid multicollinearity with the interaction terms, variables were centered. Results: A total of 325 adults (age=41.6±19.2 years, 62.2% female, 86.5% white; A1C=7.5±1.6%; duration=12.4±9.6 years) participated. Of the 131 participants with T1D, 30.5% reported high diabetes distress. For the 194 T2D participants, 27.7% reported high diabetes distress. In the T1D model, diabetes distress and social support were significantly associated with diabetes self-care: R2 .15, F(2, 103)=8.81, p<.001. However, the interaction term did not account for the variance in T1D self-care (b= -.032, t= -.349, p=.728). In the T2D model, diabetes distress and social support were significantly associated with diabetes self-care: R2 .17, F(2, 182)=18.58, p<.001. The interaction term between diabetes distress and social support accounted for a significant proportion of the variance in T2D self-care: ΔR2=.03, ΔF(1, 296)=6.82, p=.01, b= -.185, t= -2.61, p=.01. Conclusions: Social support moderated the relationship between diabetes distress and self-care in adults with T2D but not T1D. Further explorations of social support in adults with T1D is warranted. Given the importance of kinship in Appalachian culture, engaging family members and the community in diabetes management may buffer the negative effect of diabetes distress. Disclosure E.A. Beverly: None. M.D. Ritholz: None. Funding American Osteopathic Association (1291708718)

833-P: Standardized Assessment of Diabetes Distress in Routine Type 1 Diabetes Care

Background: Diabetes distress (DD) refers to the feelings of stress, worry, and fear related to living with diabetes, and is a commonly unrecognized experience. Although greater DD is modestly associated with higher hemoglobin A1c, DD is common even among patients with A1c at goal. Despite its prevalence, regular assessment for DD in clinical care is not standard. This study evaluates the implementation of standardized DD assessment into a routine clinic visit. Methods: As part of a quality improvement initiative within an academic diabetes clinic, a multi-disciplinary team of endocrinologists, psychologist, and clinic administrators introduced a validated diabetes distress scale for adults with type 1 diabetes (T1-DDS) into the clinic check-in process. Patients were coached by medical assistants to complete the T1-DDS. DD scores were calculated and provided to patient and provider. Clinicians were trained to discuss DD and deliver focused counseling interventions to patients within the scheduled visit. Implementation outcomes were assessed by interview and querying the electronic health record. Results: Surveyed providers had positive perceptions of conducting the assessment (acceptability). Clinic staff and providers believed it was feasible to incorporate DD assessment and counseling into a preexisting scheduled visit. Since inception of this program, 95% of eligible patients seen in clinic were assessed for diabetes distress. Of those assessed, 100% discussed the results with the provider. Prevalence of clinically significant DD in all patients screened was 90.4%. Even in patients with A1c less than 7.0%, 88% reported high DD. Of those with DD, 52.6% scored highest in the subcategory of powerlessness. Conclusions: Implementation of DD assessment into routine clinical care is feasible and acceptable by providers. Even in patients with optimal glycemic control, DD is highly prevalent. Screening for DD should be incorporated into standard comprehensive diabetes care. Disclosure T. Kompala: None. P. Fu: None. A.K. Folick: None. M. Babey: None. E. Koh: None. P. Mehta: None. L. Fisher: None. U. Masharani: None. A.B. Neinstein: Consultant; Self; Steady Health.

Psychological correlates of disordered eating in youth with type 1 diabetes: Results from diabetes MILES Youth-Australia.

This study examined the relationship between disordered eating (DE), body dissatisfaction (BD), and psychological variables; and identified correlates of DE in youth with type 1 diabetes. Data were from the Diabetes Management and Impact for Long-Term Empowerment and Success Youth Study-Australia, an online survey assessing the psychosocial impact of type 1 diabetes. Adolescents (N = 477; mean age 16 ± 2 years) with type 1 diabetes for at least 1 year, completed the Diabetes Eating Problem Survey-Revised, measures of BD, quality of life, well-being, depressive and anxiety symptoms, diabetes distress, and resilience. DE correlated positively (moderate-large) with depressive and anxiety symptoms, diabetes distress, and BD; and negatively (moderate-large) with well-being, quality of life, and resilience. In contrast, BD correlated (moderately) with all psychological variables in females only. In the stepwise regression, high diabetes distress and BD were the strongest predictors of DE. While the magnitude of BD was almost five times higher in females, the level of DE risk across genders did not differ when BD was added into the model, which overall explained 71% of the variance. This study explored potential risk and protective factors associated with DE. The novel finding that diabetes distress is a strong indicator of DE provides preliminary support for its inclusion into future risk models and potential target for intervention. Longitudinal studies are required to map how these factors predict changes over time with greater emphasis needed into understanding the gender-specific risks associated with BD, particularly during more difficult developmental phases, such as adolescence to young adulthood.

Higher patient assessed quality of chronic care is associated with lower diabetes distress among adults with early-onset type 2 diabetes: Cross-sectional survey results from the Danish DD2-study

AimAmong adults aged 20–45 years with type 2 diabetes mellitus, we examined the perceived quality of chronic care, and its associations with (i) sociodemographic and clinical characteristics, and (ii) diabetes distress. MethodsIn total, 216/460 (47%) completed a self-administered survey assessing sociodemographic characteristics, patient assessed chronic illness care (PACIC-20, scale of 1–5) and diabetes distress (PAID-20, scale of 0–100), and 197 had full quality of care data for assessment. We obtained clinical data from national registers and used linear and logistic regression models to examine associations. ResultsThe mean (SD) PACIC score was 2.6 (0.9) (score range 1–5). Lower PACIC scores were associated with female sex and current unemployment, and with receiving diabetes care in general practice compared with hospital outpatient clinics [mean difference: −0.4 (95% confidence interval (CI) (−0.7 to −0.2)]. People with upper quartile PACIC scores were less likely to report high diabetes distress compared with people with lower quartile PACIC scores [odds Ratio 0.3 95%CI (0.1–0.8)]. ConclusionHigher quality of care was associated with lower diabetes distress among adults with early onset type 2 diabetes mellitus, but respondents reported less than optimal quality in several core areas of chronic care.

When patient-reported experience does not match change in clinical outcomes: A perplexing view from the inside of a diabetes distress intervention

AimsTo assess between-group differences in participant experiences in a two-arm diabetes distress (DD) reduction RCT and to determine their relationship to clinical outcomes (reductions in DD and HbA1C). MethodsFor high DD adults with Type 1 diabetes and HbA1c ≥7.5% participating in T1-REDEEM, we evaluated post intervention 5-point ratings of overall program “helpfulness” and program component “helpfulness,” along with open-ended feedback statements using 10 qualitative codes. We compared responses of those in OnTrack, a distressed-focused intervention, with KnowIt, an education/management intervention. ResultsThose in OnTrack reported significantly higher levels of overall program helpfulness and greater helpfulness of each component of the program, greater group support, far fewer negative experiences, and more active and meaningful group engagement than those who participated in KnowIt. Ratings of helpfulness were unrelated to reductions in DD and HbA1C in both study arms. As previously reported, these findings occurred despite significant reductions in both DD and HbA1C in both arms with no between-group differences. ConclusionsFindings highlight the importance of addressing the personal experience of diabetes interventions in clinical care as separate, distinct outcomes. Personal experience may not always be related to changes in traditional clinical indicators.

Identifying the Burden and Predictors of Diabetes Distress among Adult Type 2 Diabetes Mellitus Patients.

Background:Diabetes is a psychologically challenging medical condition. Diabetes distress (DD) refers to the unique, often hidden emotional burdens and worries that the patient experiences when managing diabetes.Objective:The objective of the study was to find the burden and identify the predictors of DD in adult Type 2 diabetes mellitus (T2DM) patients.Materials and Methods:Two hundred and fifty T2DM patients were recruited for this study from the endocrine outpatient department from February to April 2019. DD was measured using the Diabetic Distress Scale.Results:The prevalence of DD was 19.6%. The risk of DD was 4.25 times more in those aged ≤45 years as compared to those aged >45 years. Patients with hemoglobin A1c (HbA1c) >8% had 8.8 times more DD. Patients on insulin had more DD (5.4 times) as compared to patients who were on oral antidiabetic drugs. Patients with a history of treatment interruption had 11 times more risk of DD as compared to patients who did not.Conclusions:DD was found to be high among patients aged ≤45 years, illiterates, patients on insulin, patients with a history of treatment interruption, and those with HbA1c >8%. Patients with high DD were found to have higher HbA1c levels.

Relatively young T1D adults using fixed doses of insulin have higher diabetes distress levels in a sample of patients from a Brazilian tertiary hospital

BackgroundElevated rates of anxiety and depressive symptoms in Type 1 Diabetes patients (T1D) and high rates of diabetes-specific distress (DD) have been shown. Several factors may be responsible for increase the DD levels such as age, life changes, lack of familiar support, education, insulin regimens (IRs) and chronic complications. The goals of this study were: 1—to compare DD levels, anxiety and depressive symptoms according to age (< and ≥ 25 years old), 2—to evaluate the association between DD levels, anxiety and depressive symptoms and IRs, and 3—to evaluate the association between DD levels, anxiety and depressive symptoms and chronic complications.MethodsIn a cross-sectional study, T1D patients receiving outpatient care at Unicamp tertiary hospital were included. Inclusion criteria were age at least 18 years old and diagnosis of T1D for 6 months. Exclusion criteria were cognitive impairment, major psychiatric disorders, severe diabetes-related complications, and pregnancy. Depressive symptoms were evaluated by the depression subscale of the Hospital Anxiety and Depression Scale (HAD-D) and the anxiety symptoms by the anxiety subscale of the same instrument (HAD-A). DDS scale assessed DD. Glycemic control was evaluated by HbA1C. The latest lipid panel results were recorded and IRs and chronic complications were obtained through chart review.ResultsOf all 70 patients, 70% were younger than 25 years old. No differences were found between two groups according to gender, education, and income (p = 0.39, p = 0.87, and p = 0.52, respectively). HbA1c mean was 10% in both groups (p = 0.15). Older patients had higher levels of total DD and physician DD than younger (p = 0.0048 and p = 0.0413; respectively).Total DD and DD on subscales 1 and 2 were higher in patients using fixed doses of insulin compared to variable doses according to carbohydrates count (p = 0.0392, p = 0.0383 and p = 0.0043, respectively). No differences were found between anxiety and depressive symptoms and age and IRs. Similarly, no differences were found among DD levels, anxiety and depressive symptoms in patients with and without chronic complications.ConclusionsWhen providing education and care for T1D patients, health providers should consider age, patient’s developmental stage, with its related demands and the burden of insulin regimen.

ILLNESS PERCEPTION AS A DETERMINANT OF SELF-RATED HEALTH AMONG OLDER CHINESE AMERICANS WITH TYPE 2 DIABETES

Self-Rated Health (SRH) has been used as a proxy to evaluate individuals’ quality of life, overall well-being, and mortality. However, little is known about how illness perception influences SRH in Chinese American patients with type 2 diabetes (T2DM). This study, guided by Leventhal’s Self-Regulatory Model, explored the association between illness perception and SRH beyond socioeconomic and health factors. A cross-sectional survey from 109 community-dwelling foreign-born Chinese Americans with T2DM (60-95 years old; 51.4% females; Mean age= 74.17, SD=6.83). In addition to descriptive and correlation analysis, hierarchical regression models of SRH was estimated by subsequently entering the following set of predictors: (1) demographics (age, gender, marital status, education, financial status, and acculturation), (2) health factors (insulin usage, length of diabetes, number of chronic condition, depression, and diabetes distress) and (3) illness perception (timeline, disease consequence, personal and treatment control). SRH was measured by asking “How would you rate your overall health?” with a likert response scale: 1 (poor) to 4 (very good). Only 50.5 % of participants rated their health as good or very good. Participants with lower acculturation, higher number of chronic health conditions, higher diabetes distress, and a belief that illness will have more negative consequences were highly correlated with worse SRH. The total amount of variance explained by the entire model was 56% (F = 6.07, p < .001). These findings suggest that the modifiable factors such as acculturation, diabetes distress, and the belief of diabetes consequences should be incorporated into integrative health promotion efforts for this population.

Adult attachment insecurity and associations with diabetes distress, daily stressful events and self-management in type 1 diabetes.

Anxious and avoidant attachment may be detrimental for diabetes distress and management. Additionally, individuals' perceptions of their partner's involvement may affect these associations. The study explored cross-sectionally and at the daily level whether anxious and avoidant attachment associated with diabetes distress or stressors and diabetes management, and whether higher perceived collaboration and support (C&S) moderated associations between attachment and diabetes management. Individuals with type 1 diabetes (N = 199; M age = 46.82; 52.3% women) completed measures of diabetes distress, diabetes-related C&S, self-care, average blood glucose (hemoglobin A1c), and attachment insecurity, and daily diary measures of diabetes-related C&S, diabetes stressors, mean blood glucose, and self-care. Higher anxious and avoidant attachment associated with higher diabetes distress. Higher anxious attachment associated with more daily stressors. Anxious attachment associated with lower self-care. C&S did not moderate any associations. Findings highlight the need to consider attachment when designing interventions to reduce diabetes-related distress.

High Prevalence of Diabetes Distress in a University Population.

Diabetes distress is an affective condition that addresses an individual's frustrations, worries, and concerns about living with diabetes. It is associated with fewer self-care behaviors, suboptimal glycemic control, and lower quality of life (QOL). For these reasons, diabetes care guidelines recommend routine assessment of diabetes distress. To assess diabetes distress in a university population. This study was conducted using a descriptive, cross-sectional design. Researchers assessed diabetes distress and other psychosocial factors via an electronic anonymous survey among students, faculty, and staff at a large university in the Midwest. A total of 173 participants completed the survey (mean [SD] age, 35.1 [16.7] years), with 108 [62.4%] female and 142 [82.1%] white participants). Eighty-five participants had type 1 diabetes mellitus (T1DM), and 88 had type 2 diabetes mellitus (T2DM). Of the 85 T1DM participants, 23 (27.4%) reported high diabetes distress, and 27 (30.7%) T2DM participants reported high diabetes distress. Sixteen T1DM (18.8%) and 15 T2DM (17.0%) participants screened positive for severe depression. Severe depression was associated with high distress for both T1DM and T2DM participants (T1DM: χ2=28.845, P<.001; T2DM: χ2=20.679, P<.001). Participants with T1DM reported more frequent self-care behaviors (mean [SD], 62.3 [17.1] vs 52.2 [19.2]; P<.001), but lower diabetes QOL (63.3 [14.1] vs 68.5 [15.5]; P=.021) compared with T2DM participants. No differences were observed in depressive symptoms, diabetes self-efficacy, and coping styles. Linear regression models showed that high diabetes distress scores (standardized β=.323, P=.025; standardized β=.604, P<.001) were independently associated with higher hemoglobin A1C levels and lower diabetes QOL after controlling for depressive symptoms, age, and gender in T1DM participants. Similarly, high diabetes distress scores (standardized β=.434, P<.001) were associated with lower diabetes QOL in T2DM participants after controlling for the same variables. High diabetes distress levels were associated with lower diabetes QOL for both T1DM and T2DM participants. These findings suggest that attending or working at a university may be associated with high diabetes distress scores and lower diabetes QOL. Additional research with a larger, more diverse sample from multiple universities is needed to confirm these findings.

Prevalence and correlates of diabetes distress, perceived stress and depressive symptoms among adults with early-onset Type 2 diabetes: cross-sectional survey results from the Danish DD2 study.

To establish the prevalence of diabetes distress, perceived stress and depressive symptoms among adults with early-onset Type 2 diabetes, and to examine their association with socio-demographic and clinical characteristics. A cross-sectional survey was performed among individuals with Type 2 diabetes aged 20-45 years who were included in the Danish nationwide Danish Center for Strategic Research in Type 2 Diabetes cohort between 2010 and 2016. The survey assessed diabetes distress (20-item Problem Areas in Diabetes Scale), perceived stress (10-item Perceived Stress Scale) and depressive symptoms (10-item short form of the Center for Epidemiological Studies Depression Scale Revised), as well as socio-demographic characteristics. Clinical data were collected from national health registers. In total, 216/460 (47%) individuals (48% women) with Type 2 diabetes completed the survey. The median (IQR) age was 42 (38-44) years and the diabetes duration was 5 (3-7) years. In total, 24% of respondents reported high diabetes distress (Problem Areas in Diabetes Scale ≥ 40), 46% reported high perceived stress (Perceived Stress Scale ≥ 18) and 41% reported elevated symptoms of depression (Center for Epidemiological Studies Depression Scale Revised ≥ 10). The prevalence of emotional problems was higher among women than men. Diabetes distress was higher among those prescribed non-insulin glucose-lowering drugs (vs. no glucose-lowering drugs), but was not associated with other clinical or socio-demographic characteristics. High perceived stress was associated with being unemployed and using antidepressant medication, and elevated depressive symptoms were associated with low education level, unemployment, living alone, having a psychiatric disorder and using antidepressant medication. We found a high prevalence of emotional problems among adults with early-onset Type 2 diabetes in Denmark. Health care for this group should focus on both physical health and psychosocial circumstances and should also address general as well as diabetes-specific emotional problems.

Diabetes distress is associated with adverse pregnancy outcomes in women with gestational diabetes: a prospective cohort study

BackgroundAround 12% of pregnant women develop gestational diabetes mellitus (GDM), which is associated with increased health risks for both mother and child and pre- and postpartum depression. Little is known about the relationship of GDM with diabetes-specific emotional distress (diabetes distress). The aims of this study are to assess the prevalence of diabetes distress in GDM and its association with adverse pregnancy outcomes.MethodsA prospective cohort study was carried out in an Amsterdam based teaching hospital with an ethnic diverse population. Women diagnosed with GDM completed a set of questionnaires at three time points. Questionnaires consisted of Problem Areas in Diabetes Scale 5 (PAID-5) for diabetes distress (T0-T1), Patient Health Questionnaire 9 (PHQ-9) for depressive symptoms (T0-T2), and questions to assess adverse pregnancy outcomes (T2). Adverse pregnancy outcomes (collected via self-report and if feasible from the medical records) were defined as hypertension, pre-eclampsia, caesarean section, severe perineal tearing, postpartum hemorrhage, postpartum depression, shoulder dystocia, neonatal hospitalization, macrosomia, jaundice, hypoglycemia and other (among which low heart rate, fever, hypoxia). Adverse pregnancy outcomes were dichotomized into none and 1 or more. Additional information was collected from the medical charts. Missing data were imputed via predictive mean matching and a multivariable logistic regression analysis was performed with diabetes distress, depressive symptoms, socioeconomic status, parity and ethnicity as predictors and age, HbA1c, and BMI as covariates.ResultsA total of 100 women were included, mean age 32.5 (4.1), mean BMI 26.7 (4.8), 71% were of non-Dutch ethnic background. Elevated diabetes distress (PAID score ≥ 8) was reported by 36% of the women. Multivariable logistic regression analyses revealed that both high diabetes distress (OR 4.70, p = .02) and parity (OR 0.21, p = .02) but not antepartum depressive symptoms were related to adverse pregnancy outcomes.ConclusionsDiabetes distress is likely in women with GDM and our findings suggest an association between both diabetes distress, parity and adverse pregnancy outcomes in women with GDM. This warrants replication and further research into the underlying mechanisms explaining the impact of diabetes distress in GDM and potential interventions to reduce distress.

875-P: To Treat High Diabetes Distress or Not: Determining the Clinical Impact of Targeted Interventions with Type 1 Adults

A recent study (T1-REDEEM) reported the relative effectiveness of two interventions to reduce high diabetes distress (DD) among adults with type 1 diabetes (T1). While these results show promise regarding the efficacy of DD-targeted interventions, there is little evidence to support their use when compared to non-treatment controls. We leveraged two recent studies to examine differences between the effect of targeted interventions on high DD T1 adults and a comparable sample of untreated participants, as well as to document the stability of untreated DD over time. T1 adults with elevated baseline DD (mean ≥ 2.0) and HbA1c (≥ 7.5), identified from a longitudinal, non-intervention, observational study (non-INT) (N = 51, age = 40.4 [SD = 16.8], 72.5% female, baseline DD = 2.5 [SD = 0.4], baseline HbA1c = 8.4 [SD = 1.3]), were compared to a matched sample of T1 adults who participated in T1-REDEEM (INT) (N=51, age = 48.8 [SD = 15.3], 74.5% female, baseline DD = 2.6 [SD = 0.4], baseline HbA1c = 8.7 [SD = 1.0]). Both groups completed the T1-DDS questionnaire at baseline and 9 months. Large reductions in DD (mean ∆ ± SD) were reported in the INT group (-0.6 ± 0.6), while minimal change was reported in the non-INT group (-0.2 ± 0.6), yielding a statistically and clinically meaningful difference (-0.4±0.6, p = 0.002; effect size d=.67) between groups. Additional analyses using the established MCID (0.19) for the T1-DDS showed that DD increased significantly (≥ 1 MCID) or persisted at high levels for 51% of non-INT participants, compared to 23.5% in the INT group. Targeted interventions lead to dramatic reductions in DD when compared to untreated individuals. Furthermore, high DD does not resolve over time when left unaddressed; in fact, DD remains high or worsens in more than half of non-INT participants. These data suggest that interventions targeting DD are clinically effective in T1 adults with high DD relative to non-treatment controls, and that high DD can become chronic if left untreated. Disclosure J. Parra: Employee; Self; Behavioral Diabetes Institute. D.M. Hessler: Consultant; Self; Eli Lilly and Company. L. Fisher: Consultant; Self; Abbott, Eli Lilly and Company. W. Polonsky: Consultant; Self; Abbott, Bigfoot Biomedical, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Johnson &amp; Johnson Diabetes Institute, Merck &amp; Co., Inc., Novo Nordisk Inc., Sanofi, Servier. L.A. Strycker: None. V. Bowyer: None. M. Dedhia: None. U. Masharani: Research Support; Self; Clementia Pharmaceuticals. Funding National Institutes of Health

Factors Predicting Adherence to an Integrative Model of Care Intervention in Hispanic/Latino Patients with Type II Diabetes (P04-118-19)

ObjectivesThis study aimed to identify factors relating to adherence to an integrative model of care intervention for Hispanic/Latino patients with type 2 diabetes (T2D). MethodsBaseline characteristics and 12-month intervention data from 225 Hispanic/Latino patients with T2D who were randomized to the intervention arm of the Latinos Understanding the Need for Adherence in Diabetes (LUNA-D) trial were analyzed. Linear regressions were conducted to determine which factors (sex, age, BMI, place of birth, family diabetes history, annual household income, employment, education, current smoking, marital status, controlled or uncontrolled glycated hemoglobin [HbA1c, ≤ 7% or > 7%, respectively], depression, anxiety, or diabetes distress) predicted adherence to three intervention components: group health education classes (GHEC), behavior health consultations (BHC), and medical examinations (ME). Logistic regression was conducted to identify factors that predicted poor (≤50%) or adequate (> 50%) adherence to the total intervention. ResultsResults of linear regressions are means ± standard error. Controlled HbA1c status predicted poorer GHEC (β = −1.9 ± 4.7, P < 0.001) and BHC adherence (β = −1.7 ± 0.3, P < 0.001). Higher diabetes distress also predicted poorer BHC attendance (β = −0.99 ± 0.30). Adherence to ME visits was worse for participants with controlled HbA1c (β = −1.77 ± 0.29, P < 0.001) and higher diabetes distress (β = −1.00 ± 0.30) but was better for those with increased anxiety (β = 0.10 ± 0.05, P = 0.043). No other factors predicted adherence.Factors significantly predicting > 50% adherence to all intervention components were: poorly controlled HbA1c (OR = 6.2, 95% CI: 3.0, 12.6, P < 0.001), higher anxiety (OR = 1.2, 95% CI: 1.0, 1.3, P = 0.024), higher diabetes distress (OR = 0.45, 95% CI: 0.22, 0.92, P = 0.29), and higher age (OR = 1.1, 95% CI: 1.0, 1.1, P = 0.014). ConclusionsHaving uncontrolled T2D predicts better adherence to GHEC, BHC, and ME in Hispanics/Latinos with T2D. However, different factors appear to influence specific adherence to medical examinations and behavioral health consultations. T2D interventionists should target specific factors to improve adherence to multi-component interventions for Hispanic/Latino patients. Funding SourcesNIH/NINR.

831-P: Comparing Experience and Satisfaction of Adults with Type 1 Diabetes Participating in Interventions to Reduce Diabetes Distress

Diabetes distress (DD) refers to the emotional burdens that arise from living with a demanding chronic disease like diabetes. T1REDEEM was a randomized-controlled trial comparing two group interventions to reduce DD among adults with type 1 diabetes (T1D): KnowIt (KI), a comprehensive education program, and OnTrack (OT), a program focused on identifying and addressing diabetes-related emotions. Both programs included a group workshop and 4 online group meetings over 3 months. Both programs were equally effective in reducing high DD. The aim of this report is to compare participant satisfaction between programs, and to identify key themes related to participation. 267 of 293 (91.1%) participants completed surveys following the 3-month intervention program to rate satisfaction and experience. T-tests compared group mean scores. A thematic analysis of open-ended survey questions identified overarching experiential themes. Participants in OT were significantly more satisfied than those in KI on multiple measures: they rated OT as more helpful (3.62 (1.1) vs. 3.13 (1.1)), had a more positive group workshop experience (4.22 (.9) vs. 3.68 (1.1)), and reported profiting more from group discussion (3.98 (1.0) vs. 3.58 (1.1)) and group support (3.72 (1.2) vs. 3.19 (1.3), all p&amp;lt;.05). Main themes related to satisfaction and experience differed by group. KI participants reported higher levels of disappointment, especially concerning lack of novelty of program content. OT participants reported greater exploration of new health behaviors, gaining a new perspective on their diabetes, and finding the experience of meeting other adults with T1D to be more assuring. Feeling support from and connection with other group participants was a more common theme in OT than KI. Findings suggest that high DD T1D adults participating in an emotion-focused intervention were more satisfied than those attending an education-focused program to address high DD. Disclosure V. Bowyer: None. L. Fisher: Consultant; Self; Abbott, Eli Lilly and Company. D.M. Hessler: Consultant; Self; Eli Lilly and Company. W. Polonsky: Consultant; Self; Abbott, Bigfoot Biomedical, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Johnson &amp; Johnson Diabetes Institute, Merck &amp; Co., Inc., Novo Nordisk Inc., Sanofi, Servier. U. Masharani: Research Support; Self; Clementia Pharmaceuticals. J. Parra: Employee; Self; Behavioral Diabetes Institute. M. Dedhia: None. Funding National Institutes of Health

812-P: High Diabetes Distress Associated with Lower Diabetes Quality of Life in College Students

College is an exciting, challenging, and anxiety-provoking time that introduces new barriers to diabetes, such as inconsistent schedules, changes to diet and exercise routines, and social support issues. For students with diabetes, these barriers may contribute to new or existing psychosocial difficulties. The purpose of this study was to assess diabetes distress, depression, and diabetes quality of life (QoL) in a university population with type 1 diabetes (T1D). Using a descriptive, cross-sectional design, students completed the Type 1 Diabetes Distress Scale, Patient Health Questionnaire-9, Self-care Inventory-R, and Diabetes Quality of Life Scale. Linear regression analyses were conducted to assess the relationship between diabetes distress and 1) glycemic control, 2) self-care, 3) diabetes QoL. A total of 56 college students with T1D (age=21.5±5.2 years, 80.4% (n=45) female, 89.3% (n=50) white; A1C=8.2±1.6%; duration 10.3±5.4 years; BMI=25.3±4.2 kg/m2) participated in the study. Of the 56 students, 35.7% (n=20) reported high diabetes distress. The subscales with the highest distress scores included: Powerlessness (57.1%, n=32), Management Distress (50.0%, n=28), and Eating Distress (42.9%, n=24). Further, 23.2% (n=13) of T1D participants also screened positive for severe depression; Fisher’s exact tests showed severe depression was associated with high distress (p&amp;lt;0.001). Linear regression models found high scores of diabetes distress (standardized b= 0.718, p&amp;lt;0.001) were independently associated with lower diabetes QoL after controlling for depressive symptoms, age, and gender; this model accounted for 67% of the variation in diabetes QoL. Using the same model, diabetes distress was not associated with A1C levels or self-care. Participating students experienced high levels of diabetes distress at this university in the Midwest. Additional research is needed to establish potential causal effects of the college setting on diabetes distress levels and diabetes QoL. Disclosure E.A. Beverly: None. E.H. Guseman: None. R.G. Rennie: None. A.M. Healy: None. Funding American Osteopathic Association (1291708718)

51-LB: The Impact of Digital Health Coaching on the Diabetes Distress Scale (DDS)

The ADA’s recent release of the Standards of Medical Care in Diabetes recommends including technology-based methods for the delivery of effective diabetes self-management education and support. Self-management of diabetes involves meal planning, taking medications, blood glucose monitoring, physical activity, coordinating care, and others. The program developed by Pack Health addresses all of the tasks above and more through a structured 12-week program, evidence-based tools, and a non-prescriptive Health Advisor. The program has over 60 proactive outbound touchpoints that originate from the Health Advisor (via text messages, emails, and/or phone calls). The Pack Health program collects and utilizes patient-reported outcomes (PROs) along with clinical measures, self-reported by patients. All data is used for coaching sessions and evaluation purposes. This study examines the impact of Digital Health Coaching on a national diabetes population (n=198) and an African American sub-population (n=57) enrolled in the South (AL, GA, FL, MS) upon completion of the initial 12-weeks of engagement. The DDS is a 17-item scale that captures four critical dimensions of distress: emotional burden, regimen distress, interpersonal distress and physical distress. DDS score benchmarks are established at little to no diabetes distress (&amp;lt;2.0), moderate diabetes distress (2.0-2.9), high diabetes distress (≥3.0). Health coaching demonstrates the following impact: National Diabetes Population: Baseline: 3.0; Post: 2.2; Improvement: 0.8 African Americans in the South: Baseline: 3.0; Post: 2.1; Improvement: 0.9 The data above emphasizes that digital coaching program can have a significant impact on Diabetes Distress for a general population and African American population in the South. Disclosure M. Allison: None. U. Srivastava: None. S.B. Burton: None. M. Rasulnia: None. D. Patel: None.

859-P: Social Support and Diabetes Distress among Adults with Alabama Medicaid

Background: Diabetes distress affects up to 45% of adults with diabetes and is associated with reduced treatment adherence and poor glycemic control. We evaluated diabetes distress and the relationship between social support and diabetes distress in adults with Medicaid. Methods: We surveyed a population-based sample of adults, aged 19 to 64 years old, covered by Alabama Medicaid, and diagnosed with type 2 diabetes. Diabetes distress was measured with the 17-item Diabetes Distress Scale (DDS) assessing emotional burden, physician-related distress, regimen-related distress, and interpersonal distress. A score of &amp;lt;2 indicates little/no distress, 2-2.9 moderate distress, and ≥3 high distress. Social support was assessed by the question “How much support do you get for dealing with your diabetes?” and responses were categorized as low, moderate, or high social support. We performed multivariate logistic regression of diabetes distress by social support, adjusting for demographics, disease severity, self-efficacy, and depressive symptoms. Results: In total, 541 individuals participated; 72% were female, 40% white, 58% black, and 3% Hispanic. Mean diabetes distress score was 1.7 (SD 0.88); 72.8% of participants had little/no diabetes distress, 16.8% moderate distress, and 10.4% high distress. Most participants (56.9%) reported high social support, but 13.5% reported low and 29.6% moderate social support. Participants who reported low and moderate social support were significantly more likely to have high diabetes distress (≥3) than those who reported high social support, adjusted odds ratio 14.3 (95% CI 5.2, 39.1) and 4.2 (95% CI 1.6, 10.7), respectively. This relationship was present for each diabetes distress domain, with particularly strong relationships between low social support and high interpersonal and regimen-related distress. Conclusions: Interventions seeking to reduce diabetes distress in adults with type 2 diabetes may benefit from a focus on improving social support. Disclosure C.A. Presley: None. F.L. Mondesir: None. A.A. Agne: None. K.R. Riggs: None. M. Pisu: None. E.B. Levitan: Consultant; Self; Novartis Pharmaceuticals Corporation. Research Support; Self; Amgen Inc. J.M. Bronstein: None. A. Cherrington: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases

10-LB: Factors Associated with Fear of Hypoglycemia among the T1D Exchange Glu Population

Fear of hypoglycemia (FoH) has been associated with suboptimal diabetes management and health outcomes. The American Diabetes Association recommends further mental health evaluation and treatment if a person with diabetes has a positive screen for FoH. This study investigated factors associated with behavioral and emotional aspects of FoH among adults living with T1D. The study included 494 participants from T1D Exchange Glu (mean [SD] age 43.9 ± 12.2 years, duration of T1D 16.6 ± 16.8 years, self-reported A1c 6.9 ± 0.8%), 63% male, 89% on insulin pump, 25% experienced a severe hypoglycemic event in the last six months. The Hypoglycemia Fear Scale (HFS-II) short form and the Hypoglycemia Attitudes and Behavior Scale (HABS) were used to assess FoH. Multivariable regression analyses showed that higher anxiety, higher depression, and higher diabetes distress were associated with FoH (Table 1). Longer duration of diabetes was associated with lower FoH. Ever experienced severe low blood glucose was associated with higher worry of hypoglycemia but not avoidance behavior. Higher avoidance behavior but not worry/anxiety of hypoglycemia was associated with higher A1c or more diabetes-related comorbidities. These results highlighted the multifaceted nature of FoH and suggest that positive screen for anxiety, depression, or diabetes distress warrants further discussion on FoH between providers and patients with T1D. Disclosure J. Liu: None. B. Mitchell: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J. Bispham: None. L. Fan: Employee; Self; Lilly Diabetes. Stock/Shareholder; Self; Lilly Diabetes. A. Hughes: None. A. McAuliffe-Fogarty: None.