Pediatric Diabetes Research Articles

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

693-P: Diabetes Distress Is Common in Newly Diagnosed Families in the 4T Study and Families Are Receptive to Psychological Services

Psychosocial states significantly impact T1D care and management for youth and their families. As part of a clinical pragmatic study, we report the number of elevated Patient Reported Outcomes (PROs) in newly diagnosed families and track their progress to psychological care. Parents/guardians (PG, n=125/133 4T Study 1 participants) and youth ≥11 years (n=60) were eligible to complete baseline, 3-, and 6-month PROs. PG completed Diabetes Distress Scale - Parent (DDS-P) and youth completed Diabetes Distress Scale (DDS-2) and PROMIS Pediatric Global Health Scale (PGH). Elevated PROs were based on published guidelines and were referred to the clinic's psychological services. Survey completeness was verified by staff to identify false flags. Staff reapproached the participant's psychologist for re-flagged PROs >3 months after the last visit. Over the three study time periods, a total of 99 PROs flags were evaluated (Table). At baseline, there were 32% flagged PROs, which decreased to 27% and 23% at 3 and 6 months, respectively. Elevated DDS-P was the most common reason for referral (75%). Early psychological intervention may explain the reduction in elevated PROs over the study period. With the implementation of systematic PROs in this new onset population, we observed it was common to have diabetes distress and families were receptive to psychological services. Disclosure A.Schneider-utaka: None. F.K.Bishop: None. D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. P.Prahalad: None. M.Desai: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. K.K.Hood: Consultant; Cecelia Health. A.Addala: None. E.Pang: None. A.L.Cortes-navarro: None. I.Balistreri: None. A.Loyola: None. N.Arrizon-ruiz: None. S.A.Alamarie: None. V.Ritter: None. B.Shaw: None. Funding National Institutes of Health (R18DK122422)

168-LB: A Randomized Crossover Trial Comparing Glucose Control between Different Exercise Types in Adolescents with Type 1 Diabetes Using a Hybrid Closed-Loop System

Background: Hybrid closed loop (HCL) systems may mitigate the glycemic impact of different exercise types in youth with type 1 Diabetes. Aims: Glucose was compared during and following moderate intensity exercise (MIE), high intensity interval exercise (HIE) and resistance exercise (RE) in adolescents using HCL insulin delivery. Methods: Adolescents using HCL (Medtronic Minimed 670G) undertook 40 min of MIE, HIE and RE in random order. A temporary glucose target was set 2 hours prior and during exercise with 15g carbohydrate given pre-exercise if glucose level was <126mg/dL. A standardized dinner was eaten 4 hours after exercise. The primary outcome was sensor glucose percentage time in range 70-180mg/dL (TIR) for 12 hours from exercise onset. Results: Twenty-eight participants (50% female); age [mean (SD)] 16.3(2.1) years; diabetes duration 9.4(4) years; HbA1c 7.3(0.6)% [56(7)mmol/mol], completed the study. In the 12 hrs following exercise onset the TIR for MIE was [median (IQR)] 76(60-92)%, HIE 87(78-96)% and RE 85(69-94)% (MIE v HIE; (p=0.015). Time >180mg/dL (TAR) was greater for MIE v HIE (18[3-25]% v 7[0-15]%; p=0.041). Time <70mg/dL (TBR) did not differ between MIE, HIE and RE [0 (0-7)%; 2(0-9)%; and 2(0-10)% respectively]. After the post-exercise meal (280-715mins), TIR for MIE was lower than HIE [86(76-96) v 67(49-87)%; p=0.003] and TAR was higher for MIE than HIE [5(0-19) v 28(0-41)%; p=0.012]. There was no significant difference between exercise types in TIR, TAR and TBR during exercise (0-40min) and before dinner (40-280mins). There was a total of 8 episodes of hypoglycemia (15mins <54mg/dL) each for MIE and RE and 5 for HIE. Conclusion: Glucose control in the post meal period following exercise differed between HIE and MIE but not RE. Hypoglycemia occurred across all exercise types. Disclosure R. Seckold: None. D. Morrison: None. J. Rafferty: None. S. R. Valkenborghs: None. B. Paldus: None. D. P. Zaharieva: Speaker's Bureau; American Diabetes Association. Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation. Advisory Panel; Dexcom, Inc. Speaker's Bureau; Ascensia Diabetes Care, Medtronic. M. C. Riddell: Stock/Shareholder; Supersapiens. Advisory Panel; Zealand Pharma A/S. Speaker's Bureau; Dexcom, Inc. Consultant; Lilly Diabetes. Speaker's Bureau; Novo Nordisk, Sanofi. Stock/Shareholder; Zucara Therapeutics. Advisory Panel; Zucara Therapeutics, Indigo Diabetes. Consultant; Eli Lilly and Company, Jaeb Center for Health Research. C. E. Smart: None. D. N. O'Neal: None. B. R. King: None. Funding JDRF (3-SRA-2018-532-M-B)

1146-P: Changes in Parent/Guardian and Youth Patient Reported Outcomes (PROs) after T1D Diagnosis for Families in the 4T Study 1

The 4T Study 1 is a clinical pragmatic research trial that starts continuous glucose monitoring (CGM) within 30 days of T1D diagnosis and monitors PROs. We report the longitudinal relationship of PROs between newly diagnosed youth and parents/guardians (PG). PROs surveys were administered to youth and PG at baseline, 3, and 6 months. PG PROs included the 20-item parent Diabetes Distress Scale (DDS-P) and youth PROs were the 2-item Diabetes Distress Scale (DDS-2) and the 7-item PROMIS Pediatric Global Health Scale (PGH-7). Pearson correlations evaluated the relationship between scores on the PG and youth PROs. Youth (n=60 who were aged ≥11 years) with new onset T1D and their PG (n=125) were eligible to complete PROs, yet response rates varied (at baseline, 3-, 6-months: Youth 59%, 53%, and 50% vs PG 74%, 70%, and 66%). Correlations showed that PG diabetes distress was positively correlated with child diabetes distress at baseline (r=0.48, p=0.003) and at 3 months (r= 0.35, p=0.058). However, by 6 months, this association decreased in strength and significance (r=0.16, p=0.42). Youth global health was inversely correlated with PG diabetes distress at baseline (r=-0.36, p=0.029) and 3 months (r=-0.53, p=0.002) and this correlation was not significant at 6 months (r =-0.049, p=0.81). These data suggest that the relationship between PG diabetes distress and youth psychosocial states are dynamic. PG and youth psychosocial states are strongly associated after diagnosis and decrease over time. Utilization of CGM, age, T1D duration, response rate, and changes in the PG-youth relationship (such as decreased adult involvement or increased independence of youth) may contribute to our findings. Further investigation of longitudinal relationships between PG and youth PROs may provide additional insight into PG and youth psychosocial states and diabetes outcomes and indicate optimal timing for assessment and treatment referral. Disclosure S.A.Alamarie: None. F.K.Bishop: None. D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. P.Prahalad: None. M.Desai: None. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. K.K.Hood: Consultant; Cecelia Health. A.Addala: None. E.Pang: None. A.L.Cortes-navarro: None. N.Arrizon-ruiz: None. I.Balistreri: None. A.Loyola: None. A.Schneider-utaka: None. V.Ritter: None. B.Shaw: None. Funding National Institutes of Health (R18DK122422)

577-P: A Novel Program to Help Teens Manage Type 1 Diabetes during Physical Activity—Diabetes Training Camp Teen Boot Camp

Introduction: Physical activity (PA) has many health benefits in people with type 1 diabetes (T1D), yet adolescents with T1D engage in less PA than their peers and may struggle to employ strategies that allow them to participate fully and maintain glucose levels in target range. Diabetes Training Camp Teen Boot Camp (DTC-TBC) is an intensive 3-day program that includes education and workouts geared for teens with T1D and their parents/guardians. We aimed to determine if indicators of psychosocial (confidence in glucose management during PA, positive experience, barriers to PA) and health (HbA1c) changed after attending DTC-TBC in summer 2022. Methods: DTC-TBC participants included 16 adolescents aged 13-18 years (HbA1c=7.3±1.4%; 25% female). Most used a continuous glucose monitor (93%) and insulin pump (69%) to manage T1D. Participants completed questionnaires on the first day of camp (baseline), last day of camp and 1 month after camp. Paired t-tests were used to compare 1) mean 7-point Likert scale scores for confidence in managing T1D (1 = not confident, 7= very confident) before and immediately post camp and 2) mean scores on the Barriers to PA in T1D and reported HbA1c before and 1-month post camp (n=11). Results: Both parents and teens reported high satisfaction with the DTC-TBC experience; 100% of participants said they would recommend DTC-TBC. Confidence in managing T1D significantly increased (baseline 4.9±1.2 vs post-camp 6.0±0.6; p<0.0001). Teens reported lower barriers to PA 1-month post-camp (baseline 25.0±14.3, 1 month 21.5±8.0; p=0.170). HbA1c decreased by 0.26% 1 month after camp (95% CI −0.18, 0.70; p=0.106). Conclusions: Barriers to PA and HbA1c both trended towards significant reductions even with a small sample size, whereas confidence significantly increased. Follow-up at regular intervals and inclusion of future camp participants will help determine if DTC-TBC has a statistically significant positive impact on psychosocial and health outcomes. Disclosure K.M.Simmons: Advisory Panel; Provention Bio, Inc., Consultant; Dexcom, Inc., Provention Bio, Inc., Research Support; Novartis. J.D.Hall: None. H.K.O'donnell: None. J.P.Deblois: None. B.Tanner: None. C.Ferri: None. D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. R.Powell: None. M.H.Corcoran: Speaker's Bureau; Boehringer Ingelheim and Eli Lilly Alliance, Novo Nordisk.

1156-P: Diabetes Technology in the Pediatric Inpatient Setting

Introduction: Continuous subcutaneous insulin infusion (CSII) pumps and continuous glucose monitors (CGMs) improve glycemic control and quality of life for children with diabetes. This study assessed the existence and content of pediatric inpatient diabetes technology policies in U.S. hospitals. Methods: A cross-sectional survey was distributed to the Pediatric Pharmacy Association listserv. The survey had multiple-choice and open-ended items related to hospital practices on insulin pump and CGM use in the pediatric inpatient setting. Results: Only 17 of the 31 responding hospitals (54.8%) allowed CGM use in the pediatric inpatient setting with 13 (76.5%) of those having written CGM policies. Primary barriers to allowing CGM use were lack of policy (n=11, 78.6%), limited policy knowledge (n=9, 64.3%), and lack of EMR integration (n=6, 42.9%). Most hospitals reported not utilizing CGM high and low blood sugar alarms (n=10, 58.8%). Hospitals typically used finger stick blood glucose testing while patients used a CGM (n=13, 76.5%). More hospitals (n=29, 93.5%) reported an option for insulin pump use in the pediatric inpatient setting with 96.6% (n=28) having a written policy. Overall, hospitals’ reported policies did not differ for pump use in children admitted for diabetes complications versus nondiabetes diagnoses (n=24, 85.7%). Less than half had specific policies for suspected pump site failure (n=13, 46.4%). Verification of pump doses varied greatly with hospitals reporting nursing verification (n=17, 58.6%), patient report (n=10, 34.5%) and no verification policy (n=2, 6.9%). Conclusion: Most hospital respondents had policies for inpatient insulin pump use while fewer had policies allowing CGM use. Best practice standards support having written guidelines to ensure patient safety and to guide the pediatric care team. Policy repositories may be a helpful resource for hospitals that lack written guidelines. Disclosure N. Rajagopal: None. A. Bailey: None. C. Ngo: None. A.D. Hendrix-Dicken: Stock/Shareholder; Catalyst Pharmaceuticals, Johnson & Johnson, AstraZeneca. S. Mercer: None. M. Condren: Consultant; Wolters Kluwer Health.

1144-P: Racial/Ethnic Disparities in Accessing the Latest Automated Insulin Delivery (AID) System

Background: AID systems improve glycemic control in youth with type 1 diabetes (T1D). There was a full market release of the OmniPod 5 (OP5) AID system in the United States on 8/1/2022 and it was FDA approved for ages ≥2 on 8/22/22. OP5 is available through pharmacy benefits and requires users to have a smartphone. We hypothesized that disparities exist in OP5 access. Methods: We assessed OP5 use at two pediatric diabetes centers among youth with T1D ages 2-21 who were using any version of an OmniPod (OP) insulin pump 3-months after the full market release. Differences in demographic characteristics of OP5 users compared to other OP pump users were assessed using Chi-squared and student’s independent two-sample t tests. Results: Of 1037 youth (mean age 12.8±4.4 years, 49.5% female, mean T1D duration 5.3±3.7 years), 510 (49.2%) were using OP5. Rates of OP5 use were higher among non-Hispanic White youth than among youth of all other racial/ethnic identities (53.2% vs 38.0%, p<0.0001). Youth using OP5 were more likely to be younger (12.3±4.0 years vs 13.2±4.7 years, p=0.0001) and to have a shorter T1D duration (4.9±3.5 vs 5.8±3.9 years, p=0.0002). There was a trend towards lower rates of uptake among publicly versus privately insured youth (43.1% vs 50.7%, p=0.054). There was no difference in OP5 use by sex (48.2% female vs 51.8% males, p=0.43). Conclusions: Minority youth were less likely to access the OP5 AID system 3-months after full-market release. Given the glycemic improvements associated with AID systems, it is important to promote equitable access to the latest diabetes technologies. Improving insurance coverage of technologies and supporting AID access without the need for a smartphone may support these goals. Disclosure B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. S.Meighan: Speaker's Bureau; Dexcom, Inc. E.A.Brown: None. A.Zehra: None. R.Suresh: None. J.L.Douvas: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. Funding National Institutes of Health (K23DK129827)

192-LB: Temporal Relationship of New Pediatric Diabetes Diagnoses and COVID-19

SARS-CoV-2 infection may increase the incidence of diabetes mellitus (DM) in children.1-3 Mechanisms are incompletely understood and likely vary between type 1 and type 2 DM. All children may be at greater risk regardless of infection due to pandemic control measures increasing sedentary time and disrupting primary care.4,5 This cross sectional analysis examined the percentage of new DM diagnoses in children across 60-day calendar-time intervals relative to SARS-CoV-2 infection in a nationwide database, the National COVID Cohort Collaborative. The percentage of new type 1 and 2 DM diagnoses was highest in the acute period, within 60 days of infection. After acute infection, the percentage of new diagnoses appears lower than pre-infection percentages. Further study of this nuanced relationship is needed to inform screening and treatment. Disclosure N. Reddy: None. J. Harper: None. S. Johnson: None. R. A. Moffitt: None. M. Evans: None. H. Yeh: None. J. E. B. Reusch: Advisory Panel; Medtronic. R. Wong: None. J. B. Buse: Consultant; Alkahest, Anji Pharmaceuticals, AstraZeneca, Bayer Inc., Biomea Fusion, Inc., Boehringer Ingelheim International GmbH, CeQur SA, Cirius Therapeutics, Inc., Corcept Therapeutics, Eli Lilly and Company, GentiBio, Glycadia, Glyscend Inc., Janssen Pharmaceuticals, Inc., Mellitus Health, Pendulum Therapeutics, Praetego, LLC, Stability Health, Terns, Inc, Valo, Other Relationship; Novo Nordisk, Research Support; Dexcom, Inc., Novo Nordisk, vTv Therapeutics, Stock/Shareholder; Glyscend Inc., Mellitus Health, Pendulum Therapeutics, PhaseBio Pharmaceuticals, Inc., Praetego, LLC, Stability Health. C. Bramante: None. Funding National Center for Advancing Translational Sciences (U24TR002306); Clinical and Translational Science Institute, University of Minnesota (UL1TR002494); National Institute of Diabetes and Digestive and Kidney Diseases (K23DK124654); National Institutes of Health (3R01DK130351-02S1)

1118-P: Accuracy of Dexcom G6 Continuous Glucose Monitor in Pediatric Diabetic Ketoacidosis Admissions

Continuous glucose monitors (CGMs) are an integral part of care for youth with type 1 diabetes (T1D) though lack FDA labeling for inpatient use. While some adult data on CGM use in inpatient settings is available, pediatric data are minimal. This retrospective chart review evaluated the accuracy of Dexcom G6 CGM versus point of care (POC, Nova Biomedical StatStrip [MARD 6%])) blood glucose values from pediatric inpatient encounters. Blood glucose data, diagnosis codes, and initial labs were collected from the medical record. CGM values were obtained from Dexcom Clarity CSV files. Paired glucose values (N=1191) from 83 patients with T1D (median age 12 yrs, 54% male, 69% non-Hispanic White) were used to calculate mean absolute relative difference (MARD) and Clarke Error Grid. Data from DKA admissions (N=665) had a MARD of 11.1% with 97.8% of values within A&B zones, compared to 11.4% and 98.5% for non-DKA admissions (N=526). Values from severe DKA admissions (N= 307) (pH <7.15 and/or bicarbonate <5 mmol/L) had a lower MARD compared to non-severe admissions (N=358) (8.4% vs 13.4%, p=0.01). In summary, CGM accuracy is comparable between DKA and non-DKA admissions. The accuracy of CGMs, even in severe DKA, suggests potential usability during pediatric hospital encounters. Further analysis will differentiate POC versus lab glucose and the effect of medications, including IV insulin infusions. Disclosure L.A.Waterman: None. L.Pyle: None. L.Towers: None. E.Jost: Other Relationship; Tandem Diabetes Care, Inc. A.J.Karami: None. C.Berget: Consultant; Insulet Corporation, Dexcom, Inc., Other Relationship; Tandem Diabetes Care, Inc. G.P.Forlenza: Advisory Panel; Medtronic, Consultant; Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., Lilly Diabetes, Research Support; Medtronic, Abbott, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc. R.Wadwa: Consultant; Eli Lilly and Company, Other Relationship; Dexcom, Inc., Eli Lilly and Company, Research Support; Dexcom, Inc., Eli Lilly and Company, Beta Bionics, Inc., Tandem Diabetes Care, Inc. E.C.Cobry: None. Funding National Institutes of Health (5T32DK063687)

1100-P: Real-World Use of GLP-1 Agonists in Youth with Type 2 Diabetes Is Associated with Improvements in Hemoglobin A1c—A Multicenter Analysis

Background: Despite the high risk of diabetes complications at an early age in youth with type 2 diabetes (T2D), there are limited pharmacologic options to manage T2D in youth. The first Glucagon-like-peptide-1 agonist (GLP-1a) was approved for pediatric T2D treatment in 2019. However, little is known on the real-world use and effectiveness of GLP-1a for management of T2D in the pediatric population. Objectives: To assess the real-world use and effectiveness of GLP-1a (exenatide, dulaglutide, liraglutide, semaglutide) in managing T2D in a diverse cohort of youth. Methods: This multicenter retrospective analysis included adolescents and young adults (ages 11-25y) from two academic pediatric diabetes centers who were prescribed a GLP-1a for management of T2D. Patient HbA1c, weight, and BMI within 12 months of follow-up after GLP-1a prescription were compared to baseline using Signed Rank tests. Secondary outcomes included insulin and metformin use after GLP-1a initiation and were compared using McNemar's test. Results: A total of 153 patients (median age 16.1 years (IQR 13.9-17.8), 57% female, 59% non-Hispanic Black, 23% Hispanic or Latino, 76% with public insurance) were prescribed GLP-1a and 36 patients discontinued the GLP-1a. At a median follow-up of 8.2 months, 117 patients were taking GLP-1a and were included in pre-post analyses. From baseline to follow-up, HbA1c decreased from 8.3% to 7.5% (p<0.007), while weight and BMI remained stable. At baseline, 48% of patients were taking prandial insulin, compared to 36% at follow-up (p=0.001), 71% were taking basal insulin compared to 62% at follow-up (p = 0.025), and 85% were prescribed metformin at baseline compared to 74% at follow-up (p=0.005). Conclusion: Real-world use of GLP-1a in youth with T2D is associated with decreased HbA1c levels. GLP-1a treatment may reduce doses of insulin and other medications for diabetes in youth, which can mitigate the burden of daily diabetes management. Disclosure S.Samuels: None. A.Chajecki: None. P.Hu: None. M.Kayser: None. K.Weyman: None. B.Pan: None. E.A.Brown: None. M.A.Van name: Research Support; Provention Bio, Inc. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. Funding American Diabetes Association (7-22-JDFN-03 to S.S.); National Institutes of Health (R01DK134955)

1068-P: Correleations of HbA1c, Continuous Glucose Monitor (CGM) Use, Insurance Type, and Language in a Large Pediatric Diabetes Practice in Phoenix, Arizona

Background: Inequities among technology use in pediatric type 1 diabetes (T1D) patients remains prevalent. These disparities contribute to poor glycemic control. Method: This study was a retrospective chart review of HbA1C and CGM use by type of insurance, ethnicity and language spoken at home in 2022. Results: In a cohort of nearly 2000 T1D pediatric patients, differences were found in HbA1c levels between ethnicities (mean of 8.6% Hispanics and 8.1% non-Hispanics). However, when stratified by insurance type (Private vs Medicaid), the relationship of ethnicity to HbA1C levels was no longer present, suggesting insurance drives differences in HbA1C levels rather than ethnicity. The effects of insurance may in part be related to technology use. An average of 45% of patients with private insurance use CGMs, in comparison with 32% of those with Medicaid. The use of CGMs compared with non-use of CGMs had a positive effect on HbA1C (8.3% vs 9.0%). Conclusions: CGM use is associated with lower HbA1C levels in our practice. Patients on Medicaid had higher HbA1C levels and less use of CGM. Hispanic and non-English speaking patients were more likely to be on Medicaid, and to have higher HbA1C levels and lower use of CGMs. These findings highlight the need to reduce health inequities among these populations. Our clinic will aim to develop interventions to improve technology use and access in Medicaid, Hispanic, and non-English speaking populations. Disclosure L.Holzmeister: None. S.Chmelnik: None.

1139-P: Use of Degludec to Reduce DKA Recurrence—A QI Initiative

Background: As part of a larger QI initiative to decrease rate of recurrent DKA events, a large pediatric diabetes center initiated a QI project to switch 80% of youth with established T1D on treatment with glargine admitted with DKA to longer acting degludec (iDeg) during 2017 to 2020. Methods: A series of PDSA cycles were implemented: training physicians, nurses, diabetes educators and patients/families; adding iDeg to electronic order set; and developing an insurance approval process. DKA event rate pre-iDeg and post-iDeg with predictors including race/ethnicity (R/E), HbA1c, gender and insurance type were explored. Results: iDeg prescriptions increased from 5.6% in 2017 to 63% by the end of 2020. Of the 255 patients admitted with DKA in 2017 - 2020, 97 patients not previously on iDeg were prescribed iDeg within 21 days of hospitalization. The mean age of the iDeg group was 14.2 years (SD=3.4), 62.9% on public insurance, 40% African American (AA), 30% Hispanic (H) and 29% non-Hispanic White (NHW). The median (IQR) DKA event rates were 0.5 (0.3, 1) pre-iDeg and 0.4 (0, 1) events per year post-iDeg. The median change from pre-iDeg to post-iDeg was -0.2 (-0.5, 0.4) (Wilcoxon sign-rank p=0.25). Racial/ethnic (p=0.02) and insurance (p=0.01) were associated with change in DKA event rates in a multiple regression model. Hispanic patients taking iDeg had a decrease in DKA of -1.29 events per year compared with increases of -0.29 for AA and -0.52 for NHW (adj P=0.032 and 0.026, respectively). Patients with private insurance had a mean decrease in DKA event rates of -0.63 events per year compared to those on public insurance (mean increase of 0.66, p=0.01). Conclusion: iDeg was not associated with a decrease in DKA rate in the full population. Risk factors for DKA recurrences are multi-factorial including R/E and insurance types. The association of iDeg and decreased rate of repeat DKA in H patients' needs to be explored in a larger cohort. Disclosure M.Vakharia: None. X.C.Huang: None. C.G.Minard: None. S.Lyons: None. S.Mckay: None.

162-LB: ¡Más Fresco! More Fresh—Impact of a Fruit and Vegetable Prescription Program in a Pediatric Type 2 Diabetes Clinic

Fruit and vegetable prescription (FVRx) programs have shown to improve fruit and vegetable intake and glycemic control in adults with diabetes; however, pediatric data is lacking. The aim of this study was to assess if a FVRx program improved fresh fruit and vegetable intake and health outcomes of children with type 2 diabetes mellitus (T2D). Families with a child with T2D and enrolled in Medi-Cal were recruited from our pediatric diabetes clinic. Families were randomized to either receive vouchers immediately (intervention group) or after a 6-month waiting period (delayed-control group). Monthly vouchers were given for 1 year to purchase fresh fruits and vegetables. Families completed surveys including the Dietary Screening Questionnaire and U.S. Household Food Security Survey every 6 months. Physiologic data and standardized laboratory tests were also collected. Of the 57 families with baseline surveys, the majority identified as Latino/Hispanic (84%) and the mean age of children was 14.3 years. Of the 49 parents who completed the baseline U.S. Household Food Security Survey, 46.9% reported low household food security and 16.3% reported very low food security. There were 29 families who completed our baseline and 6-month surveys. For the intervention group (n=14), there was an increase in parent-reported fruit and vegetable intake from baseline to 6-months for parents (2.4 vs 3.6 cups per day, p=0.0034) and children (2.6 vs 4.4 cups per day, p=0.0264). Children self-reported increased fresh vegetable intake between baseline and 6-months (0.17 vs 0.53 cups per day, p=0.014). There was no statistically significant difference in these measures for the delayed-control group (n=15). There was no significant change in BMI Z-score or hemoglobin A1c for the two groups after 6 months. A FVRx program is a viable intervention to improve fruit and vegetable intake for families with a child with T2D. Further research is needed to assess its impact on BMI and glycemic control. Disclosure K. Chan: None. S. P. Hiller-venegas: None. J. J. Kim: None. K. O. Klein: Consultant; AbbVie Inc., Tolmar Pharm, Azurity. K. Rhee: None. Funding U.S. Department of Agriculture-National Institute of Food and Agriculture (2021-06512)

Diabetes in School Health (DiSH): Telementoring Collaboration Between Pediatric Diabetes Specialists and School Nurses to Improve Care of Children With Diabetes.

Rates of diabetes in youth are rising and more than 1 million children have diabetes. School nurses are central to a school-aged child's diabetes care and they must make important moment-to-moment decisions requiring understanding of and comfort with diabetes care and technology. The rapid changes in diabetes care and technology make ongoing education essential, yet access to up-to-date and practical education is limited for many school nurses. Integrating needs data and stakeholders' input, this group developed Diabetes in School Health (DiSH) to address this gap. We adapted a well-established, innovative, and easily-accessible telementoring educational model, Project ECHO, to create a collaborative learning community. In the first year, 9 diabetes experts and >150 school nurses joined live DiSH sessions. DiSH has been well-received by the school community and next steps include expansion of DiSH to other states and study of impact of DiSH on health disparities.

Standards of Specialized Diabetes Care / Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 11th Edition

Dear Colleagues!We are glad to present the 11th Edition of the Standards of Specialized Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation.The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO), International Diabetes Federation (IDF), European Association for the Study of Diabetes (EASD), American Diabetes Association (ADA), American Association of Clinical Endocrinologists (AACE), International Society for Pediatric and Adolescent Diabetes (ISPAD) and Russian Association of Endocrinologists (RAE). Current edition of the “Standards” also integrates results of completed randomized clinical trials, as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals.Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 537 million patients by the end of 2021. According to the current estimation by the International Diabetes Federation, 643 million patients will be suffering from DM by 2030 and 783 million by 2045.Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 962 762 patients with DM in this country on 01.01.2023 (3,42% of population) with 92,3% (4 581 990) – Type 2 DM, 5,6% (277 092) – Type 1 DM and 2,1% (103 680) – other types of DM, including 8 758 women with gestational DM. However, these results underestimate real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) confirmed that 54% of patients with Type 2 DM are undiagnosed. So real number of patients with DM in Russia is 11-12 million patients (about 7% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don’t receive any treatment and have high risk of vascular complications.Severe consequences of the global pandemic of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death.In accordance with the Federal Law № 489-FZ of 25.12.2018 medical care should be provided on the basis of the clinical recommendations. Therefore, clinical recommendations posted in the rubricator of the Ministry of Health of the Russian Federation (https://cr.minzdrav.gov.ru) being the priority.This edition of the Algorithms for Specialized Care for Patients with Diabetes Mellitus contains the main information from the clinical guidelines for the management of diabetes mellitus in adults and children (“Type 1 Diabetes in Children (2022)”, “Type 1 Diabetes in Adults (2022)”, “Type 2 diabetes mellitus in children (2021)”, “Type 2 diabetes mellitus in adults (2022)”), as well as the updated data.New information has been added about indications for using of antihyperglycemic drugs and their instructional restrictions; algorithm of treatment of type 2 diabetes mellitus has been updated; clarifications have been made on the range of glycemic control in pregnant women; information on the treatment of diabetic complications and the management of pediatric patients has been added. In 2023, Russian diabetology suffered an unbearable loss - Alexander Yuryevich Mayorov, who was the executive editor of the previous issues and an active participant of the work on all the previous editions of “Algorithms” from the moment they were founded, passed away. This publication is dedicated to the memory of Alexander Yuryevich, who was an example of the service to patients and medicine, a friend, teacher, mentor, generously sharing his knowledge and the sample of the execution of the medical duty to all of us. On behalf of the Working Group

Plasma amino acid signatures define types of pediatric diabetes

Metabolic biomarkers with pathophysiological relevance is lacking in pediatric diabetes. We aimed to identify novel metabolic biomarkers in pediatric type 1 (T1D) and type 2 diabetes (T2D). We hypothesized that (1) targeted plasma metabolomics, focused on plasma amino acid concentrations, could identify distinctively altered patterns in children with T1D or T2D, and (2) there are specific changes in concentrations of metabolites related to branch chain amino acids (BCAA) and arginine metabolism in children with T2D. In a pilot study, we enrolled children with T1D (n=15) and T2D (n=13), and healthy controls (n=15). Fasting plasma amino acid concentrations were measured by ultra-performance liquid chromatography, and compared between the groups after adjustment for confounding factors. The mean age (SD) of participants was 16.4 (0.9) years. There were no group differences in age, gender, race/ethnicity, or 24-h protein intake. Mean BMI percentile was higher in the T2D than the T1D group or controls (p<0.001). The T2D group had lower arginine, citrulline, glutamine, glycine, phenylalanine, methionine, threonine, asparagine and symmetric dimethylarginine (SDMA) but higher aspartate than controls, after adjusting for BMI percentiles (all p<0.05). Children with T2D also had lower glycine but higher ornithine, proline, leucine, isoleucine, valine, total BCAA, lysine and tyrosine than those with T1D after adjusting for confounding factors (all p<0.05). Children with T1D had lower phenylalanine, methionine, threonine, glutamine, tyrosine, asymmetric dimethylarginine (ADMA) and SDMA than controls (all p<0.05). Children with T2D and T1D have distinct fasting plasma amino acid signatures that suggest varying pathogenic mechanisms and could serve as biomarkers for these conditions.

Importance of residual insulin secretion in type 1 diabetes

Finland has the highest incidence of type 1 diabetes in the world, which has led to many important studies of type 1 diabetes in the Finnish population and to the formation of several study groups. In The Lancet Diabetes & Endocrinology, Minna Harsunen and colleagues 1 Harsunen M Haukka J Harjutsalo V et al. Residual insulin secretion in individuals with type 1 diabetes in Finland: longitudinal and cross-sectional analyses. Lancet Diabetes Endocrinol. 2023; (published online June 5.)https://doi.org/10.1016/S2213-8587(23)00123-7 Google Scholar present longitudinal and cross-sectional analyses of random C-peptide (an index of insulin secretion and β-cell function) measurements in three Finnish cohorts: 957 newly diagnosed patients seen at Helsinki University Hospital, in collaboration with the Finnish Pediatric Diabetes Registry (FPDR), for the longitudinal analysis; and 3984 study participants from the FinnDiane study group and 645 from the DIREVA regional diabetes registry in western Finland for the cross-sectional analysis. Data from these studies were used to examine which parameters were associated with residual insulin secretion. Residual insulin secretion in individuals with type 1 diabetes in Finland: longitudinal and cross-sectional analysesAlthough children with multiple autoantibodies and HLA risk genotypes progressed to absolute insulin deficiency rapidly, many adolescents and adults had residual random serum C-peptide decades after the diagnosis. Polygenic risk of type 1 and type 2 diabetes affected residual random serum C-peptide. Even low residual random serum C-peptide concentrations seemed to be associated with a beneficial complications profile. Full-Text PDF

Psychological Care for Children and Adolescents with Diabetes and Patient Outcomes: Results from the International Pediatric Registry SWEET

Background. Easy accessibility of psychosocial care is recommended for children and adolescents with type 1 diabetes (T1D) and their families. Objective. The study aimed to evaluate the availability of psychological care and its associations with glycemic control in centers from the multinational SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) registry. Subjects. Centers participating in SWEET (n = 112) were invited to complete a structured online survey, designed for the study, regarding their psychology service. Methods. Linear/logistic regression models adjusted for several confounders were used to determine the patient’s HbA1c (mmol/mol) and odds ratios (ORs) for diabetic ketoacidosis (DKA) and severe hypoglycemia (SH) related to survey responses. Results. 76 (68%) centers with relevant data in the SWEET database responded to the survey. Psychological services were provided in 89% of the centers. The availability of psychological service in centers was associated with a slightly lower HbA1c of the patients (72 (62–82) vs. 67 (57–78) mmol/mol, p = 0.004 ) and significantly lower odds for DKA (1.8 (1.1–2.9), p = 0.027 ). Conclusions. Most centers from the SWEET registry offered some form of structured psychological care, consistent with the recommendations of easy access to psychosocial care for children and adolescents with T1D and their families. The main benefit of this psychological care appears to be in the incidence of DKA between centers. The study data also continues to emphasize the importance of treatment targets in shaping the outcomes of pediatric diabetes care. These findings should inform health-service planners and the diabetes community of the importance of mental healthcare in multidisciplinary diabetes teams.

PCR201 Digital Health Literacy of Parents and Health-Related Quality of Life of Their Children with Type 1 Diabetes Mellitus

The increased use of digital medical devices in pediatric diabetes management puts increased digital health literacy expectations on parents. We aimed to assess parents’ digital health literacy, the health status of their children with Type 1 diabetes mellitus (T1DM) and explore the determinants of children’s glucose control status.

Trends &amp; Technology

Trends & Technology| June 2023 Trends & Technology ASA Monitor June 2023, Vol. 87, 16–17. https://doi.org/10.1097/01.ASM.0000938808.42211.e6 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Cite Icon Cite Get Permissions Search Site Citation Trends & Technology. ASA Monitor 2023; 87:16–17 doi: https://doi.org/10.1097/01.ASM.0000938808.42211.e6 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: trend In the NIH-funded Pediatric Artificial Pancreas (PEDAP) Trial, artificial pancreas technology improved blood glucose control in young children between ages 2 and 5 with type 1 diabetes. The study was a 13-week randomized, controlled trial that enrolled 102 participants between ages 2 and 5 at three pediatric diabetes centers across the U.S. The participants were randomly assigned to either the artificial pancreas group or the standard care comparison group. The artificial pancreas, also known as closed-loop control, is a diabetes management system that tracks blood glucose levels using a continuous glucose monitor (CGM) and automatically delivers the insulin when needed using an insulin pump. The system replaces reliance on testing by fingerstick or CGM with delivery of insulin by multiple daily injections or a pump controlled by the patient or caregiver. Participants in the artificial pancreas group spent 12% more time within their target blood glucose range compared to the... You do not currently have access to this content.