Type 1 Diabetes Outcomes Research Articles

Impact of the Patient-Doctor Relationship on Treatment Outcomes in Children with Type 1 Diabetes: A Meta-Analysis and Systematic Review.

(1) Background: Despite the recognized importance of the patient-doctor relationship (PDR) for pediatric diabetes management, the literature presents diverse and emerging findings regarding its impact on treatment outcomes for children with type 1 diabetes (T1D). (2) Methods: Using a meta-analytic approach, a comprehensive search for relevant studies was conducted across major databases, from the earliest study to June 2024. Inclusion criteria were studies on PDR and T1D outcomes in underaged individuals, providing quantitative results. (3) Results: Fifteen reports were included, showing a small but significant overall effect size (r = 0.165, p < 0.05) of PDR on T1D outcomes. Moderator analyses revealed significant associations from elements of PDR, duration of diagnosis, outcome assessment methods, information reporters, and being Caucasian. Demographic variables like gender, age, not being Caucasian, and caregiver's marital status did not significantly impact the association. Specific elements of PDR, such as clinician's objectives, communication, partnership, respect, and supportive care, showed significant positive effect sizes, while telecommunication did not. (4) Conclusions: A strong PDR is essential for managing diabetes in children, particularly in the early years of diagnosis. Future studies should use quantitative designs and include diverse demographics to better understand PDR's connection to T1D outcomes.

Exploring the intersection of income and race in an age diverse sample of people with Type 1 diabetes.

Prior literature suggests that the social gradient in health is racialised such that Black individuals receive fewer health benefits from socioeconomic status than White individuals, yet scarce research studies examine whether this relationship persists in the context of Type 1 diabetes (T1D). Further, most research studies on racial health disparities in T1D outcomes focus on health during early life. We used data from the 2017-2018 wave of the T1D Exchange Registry (N=11,963) and examined the relationship between household income, race and HbA1c in an age diverse sample of people with T1D. Results revealed that the inverse association between income and HbA1c is stronger for Black T1Ds compared to White T1Ds. Despite this, Black T1Ds with an income of $100,000 or more had higher HbA1c values compared to White individuals with an income of less than $25,000. Further, Black adolescents with T1D had particularly high HbA1c values. There is an urgent need for more research on the interpersonal and structural barriers associated with suboptimal glycaemic control among Black individuals.

Discordant Effects of Polyamine Depletion by DENSpm and DFMO on β-cell Cytokine Stress and Diabetes Outcomes in Mice.

Type 1 diabetes (T1D) is an autoimmune disease leading to dysfunction and loss of insulin-secreting β cells. In β cells, polyamines have been implicated in causing cellular stress and dysfunction. An inhibitor of polyamine biosynthesis, difluoromethylornithine (DFMO), has been shown to delay T1D in mouse models and preserve β-cell function in humans with recent-onset T1D. Another small molecule, N1,N11-diethylnorspermine (DENSpm), both inhibits polyamine biosynthesis and accelerates polyamine metabolism and is being tested for efficacy in cancer clinical trials. In this study, we show that DENSpm depletes intracellular polyamines as effectively as DFMO in mouse β cells. RNA-sequencing analysis, however, suggests that the cellular responses to DENSpm and DFMO differ, with both showing effects on cellular proliferation but the latter showing additional effects on mRNA translation and protein-folding pathways. In the low-dose streptozotocin-induced mouse model of T1D, DENSpm, unlike DFMO, did not prevent or delay diabetes outcomes but did result in improvements in glucose tolerance and reductions in islet oxidative stress. In nonobese diabetic (NOD) mice, short-term DENSpm administration resulted in a slight reduction in insulitis and proinflammatory Th1 cells in the pancreatic lymph nodes. Longer term treatment resulted in a dose-dependent increase in mortality. Notwithstanding the efficacy of both DFMO and DENSpm in reducing potentially toxic polyamine levels in β cells, our results highlight the discordant T1D outcomes that result from differing mechanisms of polyamine depletion and, more importantly, that toxic effects of DENSpm may limit its utility in T1D treatment.

1045-P: Walking the Talk—Improving Use of the T1D Exchange Quality Improvement Portal Using QI Methodology

Background: The T1D Exchange QI Collaborative (T1DX-QI) is a network of over fifty endocrinology centers improving type 1 diabetes (T1D) care using QI. Participating centers have access to the QI Portal, an EMR-based data platform to chart and benchmark T1D outcomes. It is a valuable tool for population health and supports use of data to inform clinical QI projects. We aim to demonstrate the use of QI science to increase centers’ QI Portal use. Methods: Users are classified into Tiers based on their cumulative monthly QI Portal log-ins (Tier 1 = one month or never; Tier 2 = 2 or 3 months total; Tier 3 = 4 or more months total). This measure describes regularly (monthly) use. For this analysis, new users (user accounts younger than 3 months) are not included to establish true use. Results: The QI Portal has achieved consistent user growth through this project. As users transition from Tier 1 to Tier 3, the latter tiers expand as users consistently use the QI Portal, with a 12% increase in more experienced Tiers (Tiers 2 and 3; Figure 1a). Figure 1b depicts a ~48% increase in the percentage of Tier 3 users since the project started in July 2022 and annotates four Plan-Do-Study-Act (PDSA) cycles. Conclusion: The T1DX-QI portal usage improved through QI science. These efforts support T1DX-QI centers in more routine use of actionable data and outcomes benchmarking for clinical process improvement. Disclosure A.Mungmode: None. K.Gandhi: None. O.Ebekozien: Advisory Panel; Medtronic, Research Support; Eli Lilly and Company, Dexcom, Inc. T1dx-qi collaborative: n/a. V.Elisha: None. N.R.Fogel: None. B.L.Kiesow: None. G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. M.L.Scott: None. J.A.Indyk: None. M.Gallagher: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Expanding the use of patient-reported outcomes (PROs): Screening youth with type 1 diabetes from underrepresented populations

AimYouth from lower socioeconomic status (SES) have suboptimal type 1 diabetes (T1D) outcomes. Patient reported outcomes (PROs) measure psychosocial states and are associated with T1D outcomes, however are understudied in low SES youth. We aimed to evaluate associations between PROs and public insurance status, a proxy for low SES. MethodsWe analyzed survey data from 129 youth with T1D (age 15.7 ± 2.3 years, 33 % publicly insured) screened with PROMIS Global Health (PGH, measuring global health) and Patient Health Questionnaire (PHQ-9, measuring depressive symptoms) during diabetes appointments. Correlation and regression analyses evaluated differences in PGH and PHQ-9 by insurance status. ResultsFor youth with public insurance, lower global health correlated with lower self-monitoring blood glucose (SMBG; r = 0.38,p = 0.033) and older age (r = −0.45,p = 0.005). In youth with private insurance, lower global health correlated with lower SMBG (r = 0.27,p = 0.018) and female sex (rho = 0.26,p = 0.015). For youth with private insurance, higher depressive symptoms correlated with higher body mass index (r = 0.22,p = 0.03) and fewer SMBG (r = −0.35,p = 0.04). In multivariate regression analyses, public insurance was inversely associated with global health (p = 0.027). ConclusionPGH is a particularly salient PRO in youth with public insurance. Global health may be an important psychosocial factor to assess in youth with T1D from low SES backgrounds.

Akkermansia muciniphilaacts synergistically with Btk-deficiency to prevent Type 1 Diabetes

Abstract Btk-deficiency eliminates autoreactive B cells, but not normal ones, and protects against Type 1 diabetes (T1D). Surprisingly, we recently found that rederivation of Btk−/−/NOD mice into a cleaner, “barrier” facility resulted in loss of disease protection. This suggests that T1D protection is microbiome dependent in Btk−/−mice. Akkermansia muciniphila(A. muciniphila)was found to be increased in Btk−/−/NOD mice that were protected against disease compared to WT and Btk−/−/NOD that were not protected. A. muciniphilahas previously been associated with disease protection in humans and mice under some conditions, although causality and mechanisms are unknown. We previously showed that Btk-deficient K/BxN mice have reduced intestinal IgA, and therefore hypothesized that A. muciniphilaescapes suboptimal IgA-coating in Btk−/−/NOD and works synergistically with the loss of autoreactive B cells to protect against T1D. Germ-free female WT NOD and Btk−/−/NOD were gavaged with A. muciniphilaat 3–4 weeks. Mice were tested weekly for diabetes to 30 weeks of age. Additional mice were treated in parallel and euthanized at 9–10 weeks to examine the effects on mucosal immunity and autoimmune attack on pancreatic islets. Monocolonization of Btk−/−/NOD with A. muciniphilaprotected significantly against T1D compared to monocolonized WT NOD. CD19 +GL7 +staining of Peyer’s patches showed small germinal centers in Btk−/−/NOD compared to WT NOD. Thus, A. muciniphilaprotects against T1D in Btk−/−/NOD but not WT NOD, indicating a synergistic effect. Altogether, the data show that Btkplays a previously unrecognized role in the maintenance of gut health that can have downstream effects on T1D outcomes. National Institutes of Health Grants R01-DK-084246I Veteran’s Affairs I01-BX-002882 Washington University School of Medicine

Socioeconomic deprivation and cardiometabolic risk factors in individuals with type 1 diabetes: T1D exchange clinic registry

AimsSocial determinants of health (SDOH) influence cardiovascular health in the general population; however, the degree to which this occurs in individuals with type 1 diabetes (T1D) is not well understood. We evaluated associations among socioeconomic deprivation and cardiometabolic risk factors (hemoglobin A1c, low-density lipoprotein, blood pressure, body mass index, physical activity) in individuals with T1D from the T1D Clinic Exchange Registry. MethodsWe evaluated the association between the social deprivation index (SDI) and cardiometabolic risk factors using multivariable and logistic regression among 18,754 participants ages 13 – 90 years (mean 29.2 ± 17) in the T1D Exchange clinic registry from 6,320 zip code tabulation areas (2007–2017). ResultsSDI was associated with multiple cardiometabolic risk factors even after adjusting for covariates (age, biological sex, T1D duration, and race/ethnicity) in the multivariable linear regression models. Those in the highest socially deprived areas had 1.69 (unadjusted) and 1.78 (adjusted) times odds of a triple concomitant risk burden of poor glycemia, dyslipidemia, and hypertension. ConclusionsPersistent SDOH differences could account for a substantial degree of poor achievement of cardiometabolic targets in individuals with T1D. Our results suggest the need for a broader framework to understand the association between T1D and adverse cardiometabolic outcomes.

Testing an Automated Approach to Identify Variation in Outcomes among Children with Type 1 Diabetes across Multiple Sites.

Efficient methods to obtain and benchmark national data are needed to improve comparative quality assessment for children with type 1 diabetes (T1D). PCORnet is a network of clinical data research networks whose infrastructure includes standardization to a Common Data Model (CDM) incorporating electronic health record (EHR)-derived data across multiple clinical institutions. The study aimed to determine the feasibility of the automated use of EHR data to assess comparative quality for T1D. In two PCORnet networks, PEDSnet and OneFlorida, the study assessed measures of glycemic control, diabetic ketoacidosis admissions, and clinic visits in 2016-2018 among youth 0-20 years of age. The study team developed measure EHR-based specifications, identified institution-specific rates using data stored in the CDM, and assessed agreement with manual chart review. Among 9,740 youth with T1D across 12 institutions, one quarter (26%) had two or more measures of A1c greater than 9% annually (min 5%, max 47%). The median A1c was 8.5% (min site 7.9, max site 10.2). Overall, 4% were hospitalized for diabetic ketoacidosis (min 2%, max 8%). The predictive value of the PCORnet CDM was >75% for all measures and >90% for three measures. Using EHR-derived data to assess comparative quality for T1D is a valid, efficient, and reliable data collection tool for measuring T1D care and outcomes. Wide variations across institutions were observed, and even the best-performing institutions often failed to achieve the American Diabetes Association HbA1C goals (<7.5%).

Monitoring of paediatric type 1 diabetes.

This article reviews recent developments in methods used to monitor paediatric type 1 diabetes (T1D), including an examination of the role of glycated haemoglobin (haemoglobin A1c) and its limitations for long-term assessment of glycaemia in individual patients, self-monitoring of blood glucose, continuous glucose monitoring (CGM) systems and ketone monitoring. Monitoring of glycemia and ketones, when indicated, is a cornerstone of paediatric T1D management and is essential to optimize glycaemic control. Ongoing technological advancements have led to rapid changes and considerable improvement in the methods used to monitor glucose concentrations in people with T1D. As a result of recent innovations that have enhanced accuracy and usability, CGM is now considered the optimal method for monitoring glucose concentrations and should be introduced soon after diagnosis of T1D. Patients/families and healthcare providers must receive comprehensive education and proper training in the use of CGM and interpretation of the vast amounts of data. Future challenges include ensuring equal access to and optimizing clinical use of CGM to further improve T1D care and outcomes.

1469-P: Inhibition of the Integrated Stress Response Increases PD-L1 in Islet ß-Cells and Protects against Autoimmune Diabetes

Type 1 diabetes (T1D) has become viewed as an autoimmune disease initiated and propagated by stress responses in islet β cells. The integrated stress response (ISR) is activated upon inflammatory signaling and delimits protein production through the actions of phospho-eIF2α. We hypothesized that inhibition of the β cell ISR will protect against β cell immunogenicity and development of T1D. To test this hypothesis, we studied the effect of ISR inhibition using ISRIB (p-eIF2α inhibitor) and VLX-10 (human 12-lipoxygenase inhibitor) on the response of isolated human islets and EndoC-βH1 cells to inflammatory cytokines (IFN-γ+IL-1β) and studied the effect of ISR inhibition on T1D outcomes in NOD mice. Human islets exposed to cytokines exhibited an increase in p-eIF2α and suppression of mRNA translation initiation (by polysome profiling) , consistent with activation of the ISR. Inhibition of the ISR with ISRIB or VLX-10promoted production of PD-L1, an immune checkpoint protein that suppresses the immune response, in human islets and EndoC-βH1 cells. This finding suggested that blockade of the ISR in β cells might thwart immune attack. To assess if inhibition of the ISR using the human-specific 12-lipoxygenase inhibitor VLX-10modifies T1D progression, we generated mice in which the gene encoding mouse 12-lipoxygenase gene was replaced by the corresponding human gene. These “humanized” mice were subsequently backcrossed onto the NOD background, then treated in the prediabetic phase with VLX-1005. Male and female humanized mice developed T1D at the expected frequency, but those receiving VLX-10showed significant delay of T1D onset. Consistent with the suppression of autoimmunity, insulitis was significantly reduced and β cell mass was significantly increased in treated animals. Our results support the targeting of the ISR through inhibition of the 12-lipoxygenase enzyme provides an opportunity for the modification of T1D disease progression. Disclosure F.Huang: None. A.Kulkarni: None. F.Syed: None. D.J.Maloney: Employee; Veralox Therapeutics. S.A.Tersey: n/a. R.G.Mirmira: None. Funding NIH (UDK127786-02)

Clinical Application of Reduced-Carbohydrate Diets for Type 1 Diabetes Management: A Retrospective Case Series

Background: The aim of this study was to explore the clinical application of reduced-carbohydrate (RC) diets for type 1 diabetes (T1D) management at a community-based diabetes centre. Methods: To be included in this retrospective case series, adults with T1D must have attended at least two appointments with a Credentialled Diabetes Educator and Accredited Practising Dietitian (CDE/APD) for advice regarding: (a) advanced carbohydrate counting, (b) carbohydrate reduction, and/or (b) low-carbohydrate diet support. Data regarding specific dietary recommendations and clinical outcomes was extracted from patient records stored at the center. A semi-structured interview with the CDE/APD was conducted to collect additional information about the design and delivery of the RC diets. Thematic analysis was used to identify core components of the RC diets, and descriptive statistics were used to assess pre-post changes in clinical T1D outcomes. Results: 26 adults with T1D were eligible and included (77% female). The RC diets represented a patient-led approach involving adjustments to energy and macronutrient intakes, glucose self-monitoring, and insulin management. 22/26 participants attended the center seeking low-carbohydrate diet support, and the average carbohydrate prescription was 63g/day (22-253g/day) which translated to a 37% reduction from baseline. HbA1c reduced from 9.0% (75mmol/mol) to 7.0% (53mmol/mol) (-5.7 to -0.1%), with an average follow-up of 55weeks (n=8). Estimated A1c reduced from 7.1% (54mmol/mol) to 6.3% (45mmol/mol) (-2.9 to+0.6%) over 21 weeks (n=19). Mean total daily insulin reduced from 44 to 31 U/day (-46 to+6 U/day), with an average follow-up of 17 weeks (n=15). Conclusions: This study provides real-world insights into the clinical application of RC diets in the management of adults with T1D at a community-based diabetes centre. Prospective clinical trials are needed to conclusively determine the effects of RC diets on clinical T1D outcomes.

Associations Between Socioeconomic Status and Patient Experience With Type 1 Diabetes Management and Complications: Cross-sectional Analysis of a Cohort From Québec, Canada

BackgroundLow socioeconomic status (SES) may add to the challenges of type 1 diabetes (T1D) management and be an independent risk factor for chronic and acute diabetes complications. Our aim in this study was to evaluate the association between SES and TID management and risk of complications in a universal health-care system using data from a registry of people living with T1D (PWT1D) in Québec, Canada (the BETTER registry). MethodsThis study was a cross-sectional analysis describing the association between SES factors (education, income, employment and insurance coverage) and T1D outcomes (glycated hemoglobin [A1C], acute and chronic complications and comorbidities), using chi-square tests and regression analyses (adjusted for diabetes duration, sex, ethnicity and diabetes technology use). ResultsIn a sample of 1,333 PWT1D, lower education level was associated with cardiovascular disease (odds ratio [OR], 2.44; p=0.002), depression (OR, 1.56; p=0.020), nephropathy (OR, 2.10; p=0.001) and higher A1C (OR, 1.79; p<0.001). Low-income groups were more likely to report higher A1C (OR, 2.16; p=0.001), retinopathy (OR, 1.84; p=0.038), neuropathy (OR, 1.89; p=0.043), nephropathy (OR, 2.23; p=0.024), severe hypoglycemia (OR, 1.87; p=0.022) and depression (OR, 1.87; p=0.012). Unemployment was associated with retinopathy (OR, 2.37; p=0.009) and neuropathy (OR, 1.96; p=0.035). Diabetic ketoacidosis (OR, 2.81; p=0.001) and neuropathy (OR, 1.67; p=0.020) were more likely to be reported by participants with public insurance. ConclusionsPWT1D from lower SES, particularly those with low income and low education, were more likely to report T1D-related complications and comorbidities. Further longitudinal investigations are needed to better understand the nature and directionality of these associations.

Experience of living with type 1 diabetes in a low-income country: a qualitative study from Liberia

IntroductionWhile epidemiological data for type 1 diabetes (T1D) in low/middle-income countries, and particularly low-income countries (LICs) including Liberia is lacking, prevalence in LICs is thought to be increasing. T1D care...

COVID-19 Precautionary Measures and Type 1 Diabetes Patients in Saudi Arabia

AimTo minimize the spread of COVID-19, the Kingdom of Saudi Arabia (KSA) enforced a nationwide lockdown. We aimed to explore whether the manner in which Saudi patients with type 1 diabetes (T1D) manage their disease has changed during this unparalleled lockdown. MethodsAn online survey exploring the effect of lockdown on T1D outcomes was distributed among T1D patients residing in KSA during lockdown. ResultsA total of 1010 patients responded to the survey. Around 40% reported communicating with their physicians during lockdown. Age, level of education, residence, previous visits to diabetes education clinics, last HbA1c value, and average monthly income were all significantly associated with communication with the treating physician (p = 0.008, p < 0.001, p < 0.001, p = 0.002, p < 0.001, and p < 0.001, respectively). Age, level of education, and average monthly income were significantly associated with experiencing severe hypoglycemia (p = 0.036, p = 0.03, and p < 0.001, respectively), while average monthly income and level of education were significantly associated with experiencing diabetic ketoacidosis (DKA) (p < 0.001 and p = 0.0039, respectively); during lockdown. Patients who communicated with their physicians reported lower rates of severe hypoglycemia compared to those who did not (25.2% vs 30.7%, respectively). ConclusionAge and level of education were significantly associated with communication with the treating physician, and experiencing severe hypoglycemia and DKA; in patients with T1D during the lockdown period in Saudi Arabia. Keeping two-way virtual communication channels between physicians and their T1D patients should be encouraged.

The Evolution of Insulin Administration in Type 1 Diabetes.

Insulin has been utilized in the treatment of type 1 diabetes (T1D) for 100 years. While there is still no cure for T1D, insulin administration has undergone a remarkable evolution which has contributed to improvements in quality of life and life expectancy in individuals with T1D. The advent of faster-acting and longer-acting insulins allowed for the implementation of insulin regimens more closely resembling normal insulin physiology. These improvements afforded better glycemic control, which is crucial for limiting microvascular complications and improving T1D outcomes. Suspension of insulin delivery in response to actual and forecasted hypoglycemia has improved quality of life and mitigated hypoglycemia without compromising glycemic control. Advances in continuous glucose monitoring (CGM) and insulin pumps, efforts to model glucose and insulin kinetics, and the application of control theory to T1D have made the automation of insulin delivery a reality. This review will summarize the past, present, and future of insulin administration in T1D.

The Role of Socioeconomic Status in Latino Health Disparities Among Youth with Type 1 Diabetes: a Systematic Review.

Type 1 diabetes (T1D) incidence is growing faster among Latino than non-Latino White youth, but ethnic disparities in self-management behaviors and HbA1c are unclear. Socioeconomic status (SES) is a key factor in T1D, which may confound or contribute to disparities in Latino pediatric T1D management. A systematic review examined whether ethnic differences in pediatric T1D outcomes occur and are independent of socioeconomic status (SES). Latino youth displayed lower self-management and higher HbA1c in approximately half of the identified studies prior to including SES in analyses. Ethnic differences in self-management were found for objective (i.e., frequency of blood glucose checks), but not subjective measures. Ethnic differences were often eliminated when SES was statistically controlled. SES moderated some differences, suggesting complex sociocultural processes. Articles varied widely in SES measures and the analytic methods used to evaluate ethnic disparities. Pediatric Latino T1D disparities are inconsistent and at least partially dependent on the SES context. Recommendations for future research to systematically evaluate SES and Latino T1D disparities are made.

The Role of Parent Self-Regulation in Youth Type 1 Diabetes Management.

Youth with strong self-regulation (SR), or the ability to manage thoughts, emotions, and behaviors, engage in more effective type 1 diabetes (T1D) management. However, while parent support and engagement are critical to ensuring positive youth T1D outcomes, it is rarely considered that parents' SR may also influence youth T1D management. If this is the case, novel interventions to improve parents' SR or ensure adequate support for parents with SR challenges offer great potential to improve family functioning and youth T1D management. Theoretical and preliminary empirical evidence suggests that parental SR impacts family processes that support youth T1D treatment regimen adherence. Furthermore, parent and youth SR likely interact, with high parent SR enhancing the positive effects of high youth SR or compensating for low youth SR. Continued research is needed to better understand the ways in which parent SR matters to youth T1D management and identify how to support improvements in T1D management among families of parents with low SR.

1192-P: Frequency of Care and Prevalence of Poor Glycemic Control in a Clinic Population with Type 1 Diabetes in Delhi, India

India faces one of the biggest diabetes burdens in the world. Type 1 diabetes (T1D) is mostly overlooked. Investigation of care models that improve T1D outcomes in India and other resource-constrained settings is critically needed. The All India Institute of Medical Sciences (AIIMS) in Delhi operates a free, weekly multidisciplinary T1D self-management clinic. As a preliminary investigation into the effectiveness of this model and the potential benefit of its dissemination, we examined whether frequency of engagement with T1D care among a 2016 sample of AIIMS patients (n=328) close to the frequency recommended by guidelines (3 visits/yr) was associated with a reduction in the prevalence of poor glycemic control (HbA1c&amp;gt;9%) that is the norm among those with diabetes in India, and whether this differed by gender. With multivariate binomial generalized linear regression, we estimated the difference in prevalence of HbA1c&amp;gt;9% comparing those who attended 0-1 clinic visits in 2016 to those who attended 2-3 visits (ref), and comparing those who attended &amp;gt;3 visits to those who attended 2-3. The final adjustment set of T1D duration and gender was guided by directed acyclic graph and comparison of bias and precision of multiple models. T1D duration was 13.7± 9.0 yrs, mean age was 28.6±12.0 yrs, and HbA1c&amp;gt;9% prevalence was 45.7% (n=150). Prevalence of HbA1c&amp;gt;9% was high among those with 2-3 yearly visits (0.57; 95% CI: 0.43, 0.75). However, prevalence of HbA1c&amp;gt;9% was an absolute 16% higher (95% CI: 0.04, 0.27; p=0.01) among those with 0-1 visits. Estimates of the benefit of &amp;gt;3 visits remain unclear due to limitations including sparse data. We did not observe effect modification by gender (p=0.48). In sum, 2-3 vs. fewer yearly visits with a multidisciplinary outpatient team like the model delivered by AIIMS may help alleviate the high prevalence of HbA1c&amp;gt;9% in India. Further research will identify which care features drive glycemic control improvements and may be feasibly adopted elsewhere. Disclosure A. Cristello: None. P.A. Praveen: None. E.J. Mayer-Davis: None. N. Tandon: None.

Neighborhood disadvantage, parent-adolescent relationship quality, and type 1 diabetes in late adolescents transitioning to early emerging adulthood.

We examined whether neighborhood disadvantage predicted subsequent levels, and longitudinal trajectories, of type 1 diabetes (T1D) outcomes among late adolescents transitioning into early emerging adulthood. We also examined whether such associations occur indirectly through parent-adolescent relationship quality. Seniors in high school with T1D (N=236; mean age 17.76±0.39 years; 61% female; 73.7% non-Latino White) completed selfreport measures of relationship quality with mothers and fathers, and adherence to their diabetes regimen; glycemic control was measured using HbA1c assay kits. Both T1D outcomes (i.e. adherence, HbA1c) were assessed annually across three time points (two years). Census tract indicators of neighborhood disadvantage (e.g., % unemployed) were culled from participant addresses at baseline linked to American Community Survey data. Structural Equation Modeling was used to estimate direct and indirect links between neighborhood disadvantage, relationship quality, and both subsequent levels (i.e., intercepts centered at Time 2), and trajectories of T1D outcomes (i.e., slopes across three time points). All models showed excellent fit to the data. Greater neighborhood disadvantage associated with lower relationship quality with both parents. Lower relationship quality with fathers (but not with mothers) measured at Time 1 predicted poorer levels of adherence and HbA1c at Time 2, and formed an indirect path linking neighborhood disadvantage to each Time 2 outcome. Neighborhood disadvantage and parent-adolescent relationship quality during high school did not predict longitudinal trajectories of T1D outcomes across all three time points. Parent-adolescent relationship quality (especially with fathers) remains important for T1D outcomes among late adolescents on the cusp of emerging adulthood, but may be at risk among those living within a socioeconomically-disadvantaged neighborhood.

Diabetes stigma, parent depressive symptoms and Type-1 diabetes glycemic control in India

ABSTRACTDiabetes distress and stigma have been associated with worse patient outcomes in developed countries. However, diabetes stigma has not been studied in low and middle-income countries where clinical practices differ, diabetes awareness is lower, and families face different challenges for supporting children with Type 1 Diabetes (T1D). This study assessed the relationship between parental depression and diabetes stigma with a child’s glycemic control in a clinic-based survey in Nagpur, India. The association between self-reported T1D stigma, depressive symptoms, and child’s measured glycemic control (HbA1C) was assessed with data from 165 of the parents of school-aged (aged 5+) children receiving clinical T1D care at an urban nonprofit organization that provides free clinical care to children with Type-1 Diabetes (T1D) in India. Parents with moderate/severe depressive symptoms who experience stigma associated with their child’s diabetes had children with significantly worse glycemic control than parents with no/mild depressive symptoms who experience the same amount of stigma. Higher reports of stigma were associated with an average of 0.65 points higher HbA1C (β = 0.65, 95% Confidence Interval (CI): 0.18, 1.13) for parents with moderate/severe than parents with mild/no depressive symptoms. Indian parents with depressive symptoms who face social stigma associated with their child’s diabetes have children with worse T1D outcomes.