Pump Users Research Articles

Catheter dysfunction in long-term intrathecal baclofen pump users and when to evaluate integrity: A case series

Catheter dysfunction in long-term intrathecal baclofen pump users and when to evaluate integrity: A case series

Assessment and Technical Constraint Identification of Smallholder Irrigation Pump in Arsi and East Shewa Zone, Oromia

Efficient irrigation begins with properly installed and maintained pumps, motors, and engines. For this, the study was conducted on potential irrigation pump users of the Arsi and East Shewa zones with the objective of identifying the technical constraints of smallholder irrigation pump users. Doddota from Arsi and Dugda and Bora woreda from the East Shewa zone were selected. 211 samples size from 2321 pump users were used for data collection. The constraints listed by respondents, like pump damage, pump cost, long priming, and fuel, were the most common bottlenecks in pump irrigation schemes. Pump damage was positively correlation with use of un-recommended suction and delivery head, age of pump, long priming time and continues operation time but negatively correlation with pump maintenance, experience in irrigation farming and educational level of the household. Long priming and fuel consumption was positively (+Ve) correlation with use of un-recommended suction and delivery head, age of pump, operation time and pump size. From the existing pump type respondent responses, KAMA pumps were highly available on the market, vulnerable to damage, and had sufficient spare parts with values of 60.66, 64.45 and 44.08%, respectively. The lowest were Cushion their values were 1.42%, 3.32% and 3.78%, respectively. The respondents also reply, due to absence of governmental pump maintaining organization, cost of maintenance at local and private garage were very expensive (68.25%) and expensive (26.07%). This makes another problem on small holder irrigation pump. Therefore it is recommended to government to add pump maintaining structure at engineering center which serves' closely to scheme users and providing regular training on maintenance checklist. It is also recommended for engineering and socio-economic researchers to conduct research collaboratively to assess the gap frequently for other kebele pump user and technical performance evaluation for pump that have problems.

Heterogeneity in glycaemic control in children and adolescents with type 1 diabetes: A latent class trajectory analysis of Danish nationwide data.

Suboptimal glycaemic control in children and adolescents with type 1 diabetes is prevalent and associated with increased risk of diabetes-related complications and mortality later in life. First, we aimed to identify distinct glycated haemoglobin (HbA1c) trajectories in children and adolescents (2-19 years) with type 1 diabetes. Second, we examined their associations with clinical and socio-demographic factors. Data were obtained from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) comprising all Danish children and adolescents diagnosed with type 1 diabetes from 1996 to 2019. Subgroups of distinct mean trajectories of HbA1c were identified using data-driven latent class trajectory modelling. A total of 5889 children (47% female) had HbA1c measured a median of 6 times (interquartile range 3-8) and contributing to 36,504 measurements. We identified four mean HbA1c trajectories, referred to as 'Stable but elevated HbA1c' (83%), 'Increasing HbA1c' (5%), 'Late HbA1c peak' (7%), and 'Early HbA1c peak' (5%). Compared to the 'Stable but elevated HbA1c' group, the three other groups presented rapidly deteriorating glycaemic control during late childhood or adolescence, had higher HbA1c at study entry, and included fewer pump users, higher frequency of inadequate blood glucose monitoring, more severe hypoglycaemic events, lower proportions with Danish origin, and worse educational status of parents. The groups also represented significant differences by healthcare region. Children and adolescents with type 1 diabetes experience heterogenous trajectories with different timings and magnitudes of the deterioration of HbA1c levels, although the majority follow on average a stable, yet elevated HbA1c trajectory. The causes and long-term health implications of these heterogenous trajectories need to be addressed.

Fetal Overgrowth and Preterm Delivery in Women With Type 1 Diabetes Using Insulin Pumps or Multiple Daily Injections: A Post Hoc Analysis of the EVOLVE Study Cohort.

To compare the risk of fetal overgrowth and preterm delivery in pregnant women with type 1 diabetes (T1D) treated with insulin pumps versus multiple daily injections (MDI) and examine whether possible differences were mediated through improved glycemic control or gestational weight gain during pregnancy. The risk of pregnancy and perinatal outcomes were evaluated in a cohort of 2,003 pregnant women with T1D enrolled from 17 countries in a real-world setting during 2013-2018. In total, 723 women were treated with pumps and 1,280 with MDI. At inclusion (median gestational weeks 8.6 [interquartile range 7-10]), pump users had lower mean HbA1c (mean ± SD 50.6 ± 9.8 mmol/mol [6.8 ± 0.9%] vs. 53.6 ± 13.8 mmol/mol [7.1 ± 1.3%], P < 0.001), longer diabetes duration (18.4 ± 7.8 vs. 14.4 ± 8.2 years, P < 0.001), and higher prevalence of retinopathy (35.3% vs. 24.4%, P < 0.001). Proportions of large for gestational age (LGA) offspring and preterm delivery were 59.0% vs. 52.2% (adjusted odds ratio [OR] 1.36 [95% CI 1.09; 1.70], P = 0.007) and 39.6% vs. 32.1% (adjusted OR 1.46 (95% CI 1.17; 1.82), P < 0.001), respectively. The results did not change after adjustment for HbA1c or gestational weight gain. Insulin pump treatment in pregnant women with T1D, prior to the widespread use of continuous glucose monitoring or automated insulin delivery, was associated with a higher risk of LGA offspring and preterm delivery compared with MDI in crude and adjusted analyses. This association did not appear to be mediated by differences in glycemic control as represented by HbA1c or by gestational weight gain.

Real-world lived experience of older adults with type 1 diabetes after an automated insulin delivery trial.

First-generation closed-loop automated insulin delivery improves glycaemia and psychosocial outcomes among older adults with type 1 diabetes in clinical trials. However, no study has previously assessed real-world lived experience of older adults using closed-loop therapy outside a trial environment. Semi-structured interviews were conducted with older adults who were pre-existing insulin pump users and previously completed the OldeR Adult Closed-Loop (ORACL) randomised trial. Interviews focused on perceptions of diabetes technology use, and factors influencing decisions regarding continuation. Twenty-eight participants, mean age 70 years (SD 5), were interviewed at median 650 days (IQR 608-694) after their final ORACL trial visit. At interview, 23 participants (82%) were still using a commercial closed-loop system (requiring manual input for prandial insulin bolus doses). Themes discussed in interviews relating to closed-loop system use included sustained psychosocial benefits, cost and retirement considerations and usability frustrations relating to sensor accuracy and system alarms. Of the five participants who had discontinued, reasons included cost, continuous glucose monitoring-associated difficulties and usability frustrations. Cost was the largest consideration regarding continued use; most participants considered the increased ease of diabetes management to be worth the associated costs, though cost was prohibitive for some. Almost 2 years after completing a closed-loop clinical trial, closed-loop automated insulin delivery remains the preferred type 1 diabetes therapy for the majority of older adult participants. Chronological age is not a barrier to real-world successful use of diabetes technology. Identifying age-related barriers, and solutions, to diabetes technology use among older adults is warranted.

Real-world safety and effectiveness of dapagliflozin in people living with type 1 diabetes in Spain: The Dapa-ON multicenter retrospective study

ObjectiveTo assess real-world safety and effectiveness of dapagliflozin in people living with type 1 diabetes mellitus (T1DM). MethodsWe conducted a multicenter retrospective study in Spain including data from 250 people living with T1DM receiving dapagliflozin as add-on therapy to insulin (80.8 % on-label use). The number of diabetic ketoacidosis (DKA) events was calculated over a 12-month follow-up (primary outcome). Changes in body weight, HbA1c, total daily insulin dose, and continuous glucose monitoring (CGM) metrics from baseline (at dapagliflozin prescription) to 12 months were also evaluated. ResultsA total of five DKA events (2.4 % [95 % CI 0.3;4.5] were reported in patients with a 12-month follow-up, n = 207): two events related to insulin pump malfunction, two events related to concomitant illnesses, and one event related to insulin dose omission. DKA events were more frequent among insulin pump users than among participants on multiple daily injections (7.7 % versus 1.2 %). Four of the reported DKA events occurred within the first six months after initiation of dapagliflozin. No deaths or persistent sequelae due to DKA were reported. No severe hypoglycemia episodes were reported. Significant reductions in mean body weight (−3.3 kg), HbA1c (−0.6 %), and total daily insulin dose (−8.6 %), P < 0.001, were observed 12 months after dapagliflozin prescription. Significant improvements in TIR (+9.3 %), TAR (−7.2 %), TBR (−2.5 %), and coefficient of variation (−5.1 %), P < 0.001, were also observed in the subgroup of patients with available CGM data. Finally, an improvement in urinary albumin-to-creatinine ratio (UACR) was found among participants with UACR ≥ 30 mg/g at baseline (median decrease of 99 mg/g in UACR, P = 0.001). ConclusionThe use of dapagliflozin in people living with T1DM has an appropriate safety profile after careful selection of participants and implementation of strategies to reduce the risk of DKA (i.e., prescribed according to the recommendations of the European Medicines Agency), and also leads to clinical improvements in this population.

European Survey on Adult People With Type 1 Diabetes and Their Caregivers: Insights Into Perceptions of Technology.

Type 1 diabetes (T1D) is a complex condition requiring constant monitoring and self-management. The landscape of diabetes management is evolving with the development of new technologies. This survey aimed to gain insight into the perceptions and experiences of people with T1D (PWD) and their caregivers on the use of technology in diabetes care, and identify future needs for T1D management. PWD and caregivers (≥18 years) living in five European countries (France, Germany, Italy, Spain, and the United Kingdom) completed an online survey. Data were collected during July and August 2021. Responders included 458 PWD and 54 caregivers. More than 60% of PWD perceived devices/digital tools for diabetes management as useful and 63% reported that access to monitoring device data made their life easier. Nearly half of participants hoped for new devices and/or digital tools. While approximately one-third of all PWD had used teleconsultation, perceptions and usage varied significantly between countries and by age (both P < .0001), with the lowest use in Germany (20%) and the highest in Spain (48%). The proportions of PWD contributing to diabetes care costs varied by device and were highest for smart insulin pen users at 83% compared with 44% for insulin pen users and 37% for insulin pump users. One-quarter (24%) of PWD and 15% of caregivers felt they lacked knowledge about devices/digital tools for T1D. Most PWD and caregivers had positive perceptions and experiences of new technologies/digital solutions for diabetes management, although improved support and structured education for devices/digital tools are still required.

Exploratory Research on Comparing Breast Pumps: Using Data to Objectively Evaluate Pump Qualities

Objective:By understanding the terminology, functionality, and metrics that matter in breast pumps, both lactation professionals and pump users will be able to better identify, compare, and effectively use breast pumps for efficient milk removal.Methods:A device was created (breast pump vacuum monitoring system) that monitors and logs pressure data with respect to time and generates a pressure/time graph for a visual representation of breast pump performance in addition to providing max/min pressures, average pressure, and periodic cycle time estimations.Results:This exploratory testing showed that breast pumps varied widely in their abilities to maintain effective vacuum suction during simultaneous pumping. Maximum suction data points often refer to single-sided pumping. Cycles per minute (CPM) vary widely as well across breast pumps but can be categorized into two main ranges of 10–70 CPM (expression) and 60–120 CPM (stimulation). We found four major categories of suction patterns in our testing: standard pull and release, microvibration, constant suction, and combination patterns. A combination of these metrics makes up an individual pump’s unique programming.Conclusions:Breast pumps are a complex combination of vacuum strength, cycle speeds, and suction pattern, all of which must be optimized appropriately to function effectively. The lack of available important metrics on individual breast pumps, along with an incomplete understanding of the data presented in popular pump marketing, provides a difficult scenario for evaluating and comparing breast pumps.

Social Determinant of Health Impact on Diabetes Device Use and Clinical Outcomes in Youth with Type 1 Diabetes

Background. Youth with Type 1 diabetes (T1D) who are Black, Hispanic, or lower socioeconomic status (SES) have lower rates of diabetes device use, higher hemoglobin A1c (HbA1c), and higher rates of diabetic ketoacidosis (DKA). However, the associations of individual-level social determinants of health (SDoH) and neighborhood-level factors with device use and clinical outcomes are unknown. Area deprivation index (ADI) is a neighborhood level measure of SES reported in deciles (range 1–10 with 10 representing most deprived neighborhood). Methods. We evaluated the association of ADI and other SDoH factors with pump/continuous glucose monitor (CGM) use, HbA1c, and DKA in 1,461 youth with T1D (50% female, age 12.8 ± 3.6 years, HbA1c 8.7 ± 2.1%, 52% pump, 70% CGM) seen between October 1, 2020 and September 30, 2021 at a large pediatric diabetes center. Multiple logistic regression and multiple linear regression analyses were used to determine statistically significant associations adjusting for potential confounders. Results. Youth were less likely to use an insulin pump if they lived in a higher ADI neighborhood, were Black or Hispanic, had Medicaid or were uninsured, or received government assistance (e.g., Supplemental Security Income, Supplemental Nutritional Assistance Program). Youth were less likely to use a CGM if they lived in a higher ADI neighborhood, were Black or Hispanic, had Medicaid or were uninsured. Youth had higher risk of DKA event in the past year if they used government assistance, whereas pump and CGM use were associated with lower DKA risk. HbA1c (%) increased by 0.09 (95% CI: 0.05, 0.13) per unit increase in ADI. HbA1c was 0.62 lower (95% CI: −0.82, −0.42) in pump users vs. nonusers and 0.78 lower (95% CI: −0.99, −0.56) in CGM users vs. nonusers. Conclusions. Interventions that tailor care plans to address SDoH in families living in deprived neighborhoods may be needed to increase successful technology uptake, optimize HbA1c, and prevent DKA.

SAT107 Assessing Continuous Glucose Monitor Alarm Use By Families Of Children With Diabetes

Abstract Disclosure: V.S. Ochs: None. S.E. Woerner: Employee; Self; Lilly USA, LLC. A. Ustyol: None. L.A. DiMeglio: Advisory Board Member; Self; Merck, Abata. Consulting Fee; Self; Vertex. Background: Continuous glucose monitors (CGM) offer customizable alarms which alert persons with diabetes and their caregivers of current or pending glycemic changes. However, there has been little work studying real-world CGM alert setting use in large clinical populations. We sought to understand CGM alarm use through report analyses. Methods: After IRB approval we analyzed data from two-week CGM reports obtained clinically to determine common settings and compared those to target guidelines. Results: CGM download data from 150 children using a Dexcom® G6 were analyzed (median age 14y, (range: 1-19), 89% white, 9.5% black, and 1.5% Asian, 47% female, 51% pump users). Median A1c was 7.8% (range: 5.4-15). Median CGM glucose was 190 (range: 56-374). Average time in range was 47.7% (range: 3.4-99.1).A Low Alarm alert was set for 131 participants (87%) with a median sensor glucose alert threshold of 74 mg/dL (range: 60-100). The High Alarm was used by 109 children (73%) with a median threshold of 272 mg/dL (range: 120-400). The Signal Loss alarm was used by 103 (69%) participants with a median time until notification of 20 min (range: 20-240). Low Repeat and High Repeat alarms were used by only 50 (33%) and 36 (24%) of children, respectively. Rise Rate and Fall Rate alarms were used by 18 (12%) and 34 (23%). There was a significant difference between the median High alarm cutoff of 272 mg/dL and a recommended standard (e.g. PantherProgram.org) of 250 mg/dL (p=0.0016). The same was true with the median Low alarm cutoff of 74 mg/dL and a recommended 70 mg/dL (p&amp;lt;0.0001). There was significant difference between the median High Repeat notification time of 1 hour and the recommended 2 hours (p&amp;lt;0.0001). Pump users were 2.2x more likely to use High Repeat alarms compared to injection users (95% CI: 1.18-4.15, p&amp;lt;0.01). The same was true with the Low Repeat alarm being 1.8x more likely to be used by pumpers compared to injection users (95% CI: 1.12-2.99, p=0.01). There were no significant differences in Low, High, Rise Rate, Fall Rate, Urgent Low Soon, Urgent Low Soon Repeat, or Signal Loss alarms.When the group was divided based on age, above 12 and &amp;lt;=12, younger CGM users were 1.2 times more likely to use the Low alarm compared to older users (95% CI: 1.03-1.30). Also, younger CGM users were more likely to use the Rise Rate (RR=3.6, 95% CI:1.37-9.67), Low Repeat (RR=1.7, 95% CI:1.09-2.71), Signal Loss (RR=1.3, 95% CI:1.04-1.60), Urgent Low Soon (RR=1.2, 95% CI:1.07-1.41), and Urgent Low Soon Repeat (RR=1.2, 95% CI:1.05-1.38) alarms. There were no significant differences in High, High Repeat, or Fall Rate alarm settings. Conclusions: The wide variability of alarm settings used by patients indicates likely educational gaps in CGM onboarding and use. Ensuring CGM alarm best practices will help children with diabetes and their caregivers get needed real-time glycemic data while minimizing alarm fatigue. Presentation: Saturday, June 17, 2023

How Common are the Errors in Insulin Injection Techniques – A Real World Study

Background: Insulin therapy is identified as the cornerstone of diabetes management for more than a century. Even though awareness programs on correct insulin administration have occupied the mainstream of diabetes management interventions, the prevalence of insulin injection errors among people with diabetes is significant in its count. Aims and Objectives: The current study evaluates the prevalence of various insulin injection errors among people with type 2 diabetes. Materials and Methods: The study employed a survey-based cross-sectional design to analyze the prevalence of insulin injection errors. The data was collected from people with T2D visiting the Outpatient Department (OPD) of four comprehensive diabetes research centres in Kerala, India. The inclusion criteria for the study include people with type 2 diabetes. The exclusion criteria included people with other types of diabetes, people with newly diagnosed T2D, and people with T2D who were insulin pump users. Demographic characteristics of the cohort were determined. The common errors in the injection administration were identified and the frequency of each error was determined. Data for the variables including, site selection, cleaning of needle and lipohypertrophy were collected. The categorical variables considered for the study was summarized as frequency (%) and all the continuous variables were presented as mean (SD) or median (Q1, Q3) based on the normality assumption. All the tests were carried out at a level of significance of 5 % using R version 4.2.3. Results: The common errors identified among the study cohort include incorrect site selection, inappropriate storage temperature, cleaning of the needle with spirit, hypoglycemia due to incorrect administration of insulin, and the presence of lipohypertrophy. Conclusion: The findings from the study underline the varied types of errors in the self-administration of insulin among the different age groups of the diabetes population and urge the health-care professionals to impart continuous review of the injection procedures patients follow while taking insulin injections

Expected Basal Insulin Requirement during CSII therapy by Age Group, Sex and BMI, based on 25,718 Young People with Type 1 Diabetes in the DPV Registry.

Background Since the introduction of insulin pumps into the therapy of paediatric subjects, different approaches have been taken to find optimal basal rates. Previously, the DPV registry provided circadian basal rate patterns for different age groups. As the number of pump users has increased recently and short-acting insulin analogues are now predominant, we performed a new analysis with a larger data pool. Methods We included all recent basal profiles from T1D patients between 1 and 25 years from the DPV 2021 data pool. We excluded night-time-only pump users, human regular insulin users, and daily basal rates < 0.05 U/kgBW/d and >1.0 U/kgBW/d. Results In the analysis of profiles from 25,718 young persons with T1D, differences in the daily pattern of basal rates were found between age groups. In addition, we saw significant (p<0.001) differences in total daily basal dose between genders in all age groups except adults. In addition, the shape of the expected basal-rate pattern differed by BMI, HbA1c and use of continuous glucose monitoring. Discussion This analysis demonstrates multiple factors influencing basal patterns and insulin requirement, including age group, gender, overweight, HbA1c, bolus frequency and sensor use. As circadian basal rates are still mandatory for initiating insulin pump therapy with or without automation, a multimodal approach is necessary to estimate optimal basal rates.

Smartphone Bolus Feature Increases Number of Insulin Boluses in People With Low Bolus Frequency.

The t:connect mobile app from Tandem Diabetes Care recently added a feature to allow t:slim X2 insulin pump users to initiate an insulin bolus from their personal smartphone. User experience and user interface considerations prioritized safety and ease of use, and we examined whether the smartphone bolus feature changed bolus behavior in individuals who bolused less than three times/day. We performed a retrospective analysis of t:slim X2 insulin pump users in the United States who had remotely updated their insulin pump software to be compatible with the smartphone bolus version of the app and who gave less than three boluses per day prior to the smartphone bolus update. Of the 4470 early adopters who met these criteria, the median number of boluses was 2.2 per day (prior to smartphone bolus update) versus 2.7 per day (after smartphone bolus update), equating to approximately half a bolus more delivered per day (P < .001). Overall, a median of one bolus per day was administered by smartphone app as opposed to being initiated from the screen on the insulin pump. This analysis found a significant increase in bolusing behavior among early adopters of the smartphone bolus feature of the t:connect mobile app.

681-P: Insulin Pump Use in Teens with Executive Function (EF) Problems and Type 1 Diabetes Is Associated with Lower A1C

Aim: Providers may avoid offering pump therapy to teens with EF challenges (planning, organization). We assessed whether the association of pump use and A1c is modified by EF status, adjusting for relevant factors. Methods: EF was assessed by parent proxy-report using Behavior Rating Inventory of Executive Function (BRIEF). T-score ≥60 defined risk of EF problems for Global Executive Composite (GEC), Behavioral Regulation Index (BRI), and Metacognition Index (MI). Parents also completed the Diabetes Family Conflict Scale (DFCS). T-tests stratified by EF status compared A1c by pump use and non-use. Generalized linear models were adjusted (Tukey) for variables with p&amp;lt;.1 in univariate analysis. Results: Teens (N=169, 54% male) had mean age 14.9±1.3 yrs, diagnosis age 7.5±3.6 yrs, A1c 8.5±1%, 69% pump use, 9% CGM use, and 31% with GEC ≥60. With GEC &amp;lt;60, A1c was similar in pump users and non-users (8.3 vs 8.6%, p=.25); with GEC ≥60, A1c was lower in pump users vs non-users (8.5 vs 9.2%, p=.009). Similar A1c patterns were seen when stratified by EF problems in BRI or MI. In multivariate analysis, with GEC &amp;lt;60, A1c did not differ in pump users vs non-users (8.4 vs 8.6%, p=.36), adjusting for DFCS; a similar pattern was seen with BRI &amp;lt;60 (p=.26) and MI &amp;lt;60 (p=.25). With GEC ≥60, there was a trend towards lower A1c in pump users vs non-users (8.1% vs 8.7%, p=.07), adjusting for income and CGM use. With BRI ≥60, A1c was lower in pump users vs non-users (7.8 vs 8.4%, p=.03), adjusting for CGM use and DFCS score. With MI ≥60, A1c was not significantly different in pump users vs non-users (8.0% vs 8.4%, p=.25), adjusting for income, CGM use, and DFCS score. With elevated GEC, BRI, or MI scores in above multivariate analyses, A1c was lower in CGM users vs non-users (all p&amp;lt;.05). Conclusion: The association of diabetes technology use with lower A1c in those with elevated BRIEF scores suggests a need to re-evaluate provider reluctance to recommend use of diabetes technologies in teens presenting with potential EF problems. Disclosure R.J.Vitale: None. L.K.Volkening: None. L.J.Tinsley: None. 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 National Institutes of Health (P30DK036836, R01DK095273); JDRF (2-SRA-2014-253-M-B); Iacocca Family Foundation

1157-P: Diabetic Ketoacidosis (DKA) Rates Do Not Differ by Insulin Pump Use vs. Nonuse in Teens with Type 1 Diabetes (T1D) and Executive Function (EF) Problems

Aim: Providers may resist offering pump therapy to teens with T1D who have challenges with EF (planning, organization) due to concerns for DKA. We evaluated rates of DKA and severe hypoglycemia according to pump use in teens with and without EF problems. Methods: Parents of teens aged 13-17 years with T1D provided proxy reports of teen EF using the Behavior Rating Inventory of Executive Function (BRIEF). Global Executive Composite (GEC) t-score ≥60 defined risk of executive dysfunction. Families reported severe hypoglycemic episodes and ER visits/hospitalizations for hyperglycemia (including DKA) every 3 months for 18 months. Incidence rates (IR) were calculated as events/100 person-years. DKA IR includes ER visits/hospitalizations for either hyperglycemia or DKA. Poisson regressions evaluated differences in IR by pump use, CGM use, and BRIEF score. Results: 169 teens (54% male) had baseline age 14.9±1.3 years, T1D duration 7.4±3.7 years, A1c 8.5±1.0%; 69% were pump users, 41% used CGM some time during follow-up, and 31% had GEC ≥60. During 297 person-years, severe hypoglycemia IR was 38.3/100 person-years and DKA IR was 7.7/100 person-years. There were no differences in hypoglycemia IR by pump or CGM use or GEC score. There was no difference in DKA IR by CGM use while DKA IR was lower in pump users vs non-users (4.9 vs 14.0, p=.01) and in those with GEC &amp;lt;60 vs ≥60 (4.9 vs 14.0, p=.01). Among those with GEC &amp;lt;60, DKA IR was lower in pump users vs non-users (2.0 vs 13.7, p=.003); in those with GEC ≥60, DKA IR was similar in pump users and non-users (13.7 vs 14.4, p=.94). Conclusion: In this sample of teens with T1D, hypoglycemia IR did not differ by pump or CGM use or EF status; in the teens with EF challenges, DKA IR was not higher in pump users vs non-users. These observations suggest that hesitation by clinicians to offer insulin pump therapy to teens with clinical suspicion of executive dysfunction due to concerns for increased DKA risk may not be warranted. Disclosure R.J.Vitale: None. L.K.Volkening: None. 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 National Institutes of Health (P30DK036836, R01DK095273); JDRF (2-SRA-2014-253-M-B); Iacocca Family Foundation

109-LB: Quality of Life Benefits for Insulin-Using Adults with Type 2 Diabetes after Six Months of Pump Therapy—A Quasi-experimental Approach

While an increasing number of adults with type 2 diabetes (T2D) on multiple daily insulin injections (MDI) are initiating insulin pump therapy, little is known about how, or if, pump therapy may contribute to quality of life (QoL) gains. Adults with T2D on MDI who contacted Insulet about starting a tubeless insulin pump (Omnipod DASH® Insulin Management System) completed two self-report surveys: one before pump start (baseline) and one 6 months later. The surveys assessed self-reported HbA1c, and a series of QoL measures, including overall well-being (WHO-5), diabetes distress (T2-DDAS Core), diabetes impact (DIDP), and perceived restrictions due to T2D. We compared 6-month outcomes in participants who started and remained on Omnipod DASH vs. those who never started on pump therapy and remained on MDI. Of N=435 who completed the baseline survey, 220 (51%) completed the 6-month survey. Of these, the majority (80%) were current pump users, and 20% remained on MDI. There were no significant differences between pump users and continuing MDI (c-MDI) users in any baseline demographics, HbA1C or QoL measures. At 6 months, pump users evidenced a significantly greater rise than c-MDI users in overall well-being (+8.3 vs. -3.1) and greater drops in diabetes distress (-0.97 vs. -0.30), diabetes impact (-0.29 vs. +0.20), and perceived restrictions, including feeling less limited regarding food and exercise and feeling freer to live life as they might want (in all cases, p &amp;lt; 0.005). Also, both pump and c-MDI groups reported a significant HbA1C improvement from baseline, though the difference between groups was not significant (-1.1% vs -0.9%; p=0.10). In this sample of T2D adults, the introduction of pump therapy was associated with broad improvement in QoL after 6 months, compared to those who were interested in, but never started pump therapy. These results provide initial evidence of significant psychosocial benefits of pump therapy for adults with T2D. Disclosure W. H. Polonsky: Consultant; Abbott Diabetes, Boehringer Ingelheim and Eli Lilly Alliance, Eli Lilly and Company, Insulet Corporation, Intuity Medical, Inc., MannKind Corporation, Provention Bio, Inc., Sanofi-Aventis U. S., Vertex Pharmaceuticals Incorporated. E. C. Soriano: None. Funding Insulet Corporation

273-OR: Hybrid Closed-Loop Therapy vs. Other Modalities of Therapy during Ramadan Intermittent Fasting in Adults and Adolescents with Type 1 Diabetes

Introduction: Most people with type 1 diabetes (PwT1D) are considered high risk to fast during the month of Ramadan. Yet, many of them attempt to fast and abstain from eating and drinking from dawn to dusk. Here, we evaluate the association between the sociodemographic indicators, modality of T1D treatment, and number of days when fasting is broken due to diabetes among PwT1D. Methods: We surveyed 294 PwT1D who attempted to fast during Ramadan 2022, were seen at our Endocrine clinics during the month preceding Ramadan, and who agreed to share their health information and fasting experience. Participants were categorized into 5 groups based on their treatment modality: a) Pump + CGM [Hybrid closed loop (HCL)] (n=62); b) Pump + CGM [Conventional open loop] (n=37); c) Pump + Self-monitoring of blood glucose (SMBG) (n=8); d) Multiple daily injections (MDI) + CGM (n=155); e) MDI + SMBG (n=32). Predictors for fasting most days of Ramadan (i.e. breaking fast ≤ 2 days) were analyzed using uni- and multi-variable logistic regression. Results: Private health insurance rates were highest among pump users (82%, 63%, and 41% for HCL, Pump + SMBG, and conventional open loop, respectively); whereas, MDI users had the lowest insurance rates (25% and 21% for MDI + SMBG and MDI + CGM, respectively). The median numbers of days when fasting was broken due to diabetes were 2, 5, 3, 3.5, and 2.5 days among the HCL, conventional open loop, MDI + CGM, Pump + SMBG, and MDI + SMBG groups, respectively (p=.047). Users of HCL therapy were two times as likely to complete fasting most days of Ramadan (i.e. breaking fast ≤2 days) compared to MDI + CGM users [odds ratio (95% CI): 2.37 (1.14, 4.90)] after adjusting for age, sex, educational level, employment status, insurance status, and diabetes duration. Conclusion: Among the common treatment modalities of T1D, the use of HCL pump therapy is associated with the highest rates of fasting most days of Ramadan after adjusting for potential confounders. Disclosure M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Alharthi: None. S.Albunyan: Employee; ProMedEx, Medtronic. N.Alzaman: None. D.C.Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc. A.M.Alguwaihes: Consultant; Eli Lilly and Company, Research Support; AstraZeneca, Novo Nordisk, Speaker's Bureau; Novo Nordisk, Sanofi.

1215-P: Attitudes towards Diabetes Technology in Older Adults with Diabetes

Diabetes technology such as insulin pumps and continuous glucose monitors (CGMs) have been shown to improve glycemic control and reduce the burden of diabetes. Despite these benefits, however, there remain challenges to technology adoption in the aging population. This study aimed to explore older people with diabetes' (PWD) attitudes towards technology and understand barriers to its implementation. In December 2022, 2,585 PWD aged 65 or older (24% type 1, 61% female) in the United States took an online survey assessing how aging affects their ability to manage diabetes as well as how beneficial they believe diabetes technology to be. Those who did not view diabetes technology as very or extremely beneficial (n=737) further elaborated on their hesitations towards adopting technology in open-ended responses (5% type 1, 69% female). Results were analyzed both quantitatively and qualitatively. The most common aging-related challenges with managing diabetes were difficulty exercising (39%), reduced hypoglycemia awareness (11%), and forgetting to take medication/insulin (8%). Interestingly, technology was of little concern; only 1% had difficulties using diabetes technology and the majority (66%) rated diabetes technology as very or extremely beneficial for diabetes management. CGM users (92% vs. 51%, p&amp;lt;.001) and pump users (96% vs. 59%, p&amp;lt;.001) in particular were more likely to view diabetes technology as beneficial than non-users. Qualitative analysis identified main barriers to adopting technology among older PWD, which included cost/insurance coverage (18%), satisfaction with current treatment options (14%), and time and effort spent learning how to use the device (12%). This research reveals that negative actual and perceived benefits of diabetes technology likely do not serve as barriers to their implementation among older PWD. Rather, barriers to adoption stem primarily from cost-related factors and concerns about training, suggesting the need to invest in more in-depth education for older PWD. Disclosure A.Zeng: Employee; dQ&amp;A. E.Xu: Employee; dQ&amp;A. T.Bell: Employee; dQ&amp;A. T.L.Bristow: Employee; dQ&amp;A.

1446-P: Success of a Hybrid Care Model to Maintain Glycemic Control in Older Adults with Type 1 Diabetes (T1D)

Aim: During the COVID-19 pandemic, a hybrid care (in-office and telemedicine) model was urgently implemented. Impact of this hybrid model on clinical visit frequency and glycemic outcomes in older adults with T1D warrants study. Methods: Demographics, clinical characteristics, and clinical visits of older adults (aged ≥65 years) with T1D were retrieved from electronic medical records covering 2 time periods, before the pandemic (pre-pandemic: April 1, 2019-March 1, 2020) and during the pandemic (pandemic: September 1, 2020 to August 31, 2021) periods, with adjustment for length of follow-up. Results: 661 (45% male) unique older adults with T1D received care and had HbA1c measurements in both periods at a tertiary diabetes center. Mean age was 72±5 years; 59% were CGM users, 38% were pump users. Clinic visits in the pre-pandemic period were almost all in-person, averaging 4.2 visits/person/year (CI 3.9-4.4), with &amp;lt;2% as phone visits. During the pandemic period, the mean number of visits was significantly greater than in the pre-pandemic period, at 6.3 visits/person/year (CI 5.7-6.9), with 30% in-office, 38% by video, and 32% by phone. HbA1c values were similar between periods (pre-pandemic: 7.6% (CI 7.5-7.8) vs pandemic: 7.4% (CI 7.3-7.6)). However, there was a significant, favorable shift in HbA1c distribution &amp;lt;7%, 7-8%, &amp;gt;8% when using hybrid care model: pre-pandemic period 21, 42, 37%, respectively; pandemic period 35, 36, 29%, respectively (pre-pandemic vs pandemic period p&amp;lt;.0.001). Conclusion: Compared with the pre-pandemic care model, the hybrid care model during pandemic for older adults with T1D allowed for increased visit frequency and preserved HbA1c values while favorably increasing the proportion with HbA1c &amp;lt;7% and decreasing proportion at the higher end of the distribution. This data support ongoing use of a hybrid care model for older adults with T1D. Disclosure A.Adam: None. M.Munshi: Consultant; Sanofi. R.Hurlbert: None. C.Slyne: None. 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. E.Toschi: Advisory Panel; Eli Lilly and Company. Funding Thomas J. Beatson, Jr. Foundation

1147-P: Disparities in Insulin Pump and CGM Use in Youth with Type 1 Diabetes

Youth with T1D of underrepresented race/ethnicity (URE) have lower pump/CGM use, higher A1c, and greater DKA risk; however, the correlation of social determinants of health (SDoH) and neighborhood-level factors to pump/CGM use and clinical outcomes are unknown. In this study, multivariable models were used to evaluate the association of race/ethnicity, SDoH factors, and area deprivation index (ADI, range 1-10 with 10 being most deprived neighborhood) with pump/CGM use, A1c, and DKA in 1,461 T1D youth (50% F, age 12.8 ± 3.6 yrs, A1c 8.7 ± 2.1%, 52% pump, 70% CGM) seen over a 1-yr period. Youth were less likely to use a pump if they were Black or Hispanic, had Medicaid or were uninsured, received government assistance (i.e., SSI, Temporary Assistance for Needy Families (TANF), WIC, SNAP), or lived in a higher ADI neighborhood. Youth were less likely to use CGM if they were Black or Hispanic, had Medicaid or were uninsured, or lived in a higher ADI neighborhood. Youth had higher DKA risk in the past year if they lived in a higher ADI neighborhood or had government assistance; however, pump and CGM use were associated with lower DKA risk (Figure 1). For every 1 unit increase in ADI, A1c increased by 0.09 (95% CI: 0.05, 0.13). A1c was 0.62 lower (95% CI: -0.82, -0.42) in pump users vs. not and 0.78 lower (95% CI: -0.99, -0.56) in CGM users vs. not. Advocacy efforts and QI projects promoting technology use in T1D youth of URE and lower SES may improve A1c and decrease risk of DKA. Disclosure E.R.Crain: None. R.Ramphul: None. A.Butler: None. X.C.Huang: None. C.G.Minard: None. M.J.Redondo: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation.