CSII Use Research Articles

Continuous glucose monitoring in older adults with diabetes: Data from the diabetes prospective follow-up (DPV) registry.

To analyse predictors for continuous glucose monitoring (CGM) use in people with diabetes aged ≥60 years using insulin therapy and to assess the rates of CGM use during recent years (2019-2021). Prospective study including 6849 individuals with diabetes and insulin therapy (type 2 diabetes: n = 5320; type 1 diabetes: n = 1529) aged ≥60 years. Data from 129 treatment centres were retrieved from the Diabetes Prospective Follow-up Registry (DPV) in March 2023. Sensor use in individuals aged ≥60 years has increased in type 1 (2019: 28%, 2020: 39%, 2021: 45%) and type 2 diabetes (2019: 10%, 2020: 16%, 2021: 18%). Predictors for sensor use in older individuals with type 1 diabetes are younger age and CSII use (p < 0.001). Predictors in older individuals with type 2 diabetes are younger age, longer diabetes duration, higher BMI and CSII use (p < 0.001). CGM has become more common in older adults with diabetes and will presumably increase further. Age is a predictor for sensor use in older adults with diabetes. Age-related physical barriers and insufficient usability of devices, lack of interest in technologies, but possibly also effects of prejudice on the grounds of age may contribute to this finding.

Insulin Pump and Closed Loop Systems' Use in People Living with Diabetes: A Narrative Review of Clinical and Cost-Effectiveness to Enable Access to Technology and Meet the Need of Payers.

The use of continuous subcutaneous insulin infusion delivery via insulin pumps is today considered standard of care for type 1 diabetes (T1D). Closed-loop systems combining continuous glucose monitoring (CGM) with automated algorithm-driven insulin delivery have been shown to be safe and efficacious in randomized controlled studies and in real-life studies in both pediatric and adult individuals with T1D. Implementation of hybrid closed-loop (HCL) systems have shown incremental effectiveness with further reduction of hypoglycemia and hyperglycemia. Although less extensively studied in type 2 diabetes (T2D), insulin pumps have demonstrated their effectiveness on glucose control together with the reduction in insulin needs and a neutral effect on weight. Recent studies have also shown promising results with the use of HCL in T2D. Cost-effectiveness studies both in T1D and T2D have shown that pump is cost effective in several countries, leading to improvements in quality adjusted life years. Insulin pumps are currently reimbursed for T1D in many European countries, but only in a few for individuals with T2D. HCL systems are to be evaluated in future trials performed in T2D to compare their incremental efficacy and cost effectiveness in comparison with available intensification tools which include multiple daily insulin injections, metformin, SGLT-2 inhibitors and GLP-1 receptor agonists. There is a need for updated guidelines for the use of CSII and HCL in individuals living with T2D based on the emerging evidence, identifying, and recommending for the people who'd benefit the most, which would eventually form a basis for the reimbursement and health policies. This article is protected by copyright. All rights reserved.

Mediating Effects of Technology-Based Therapy on the Relationship Between Socioeconomic Status and Glycemic Management in Pediatric Type 1 Diabetes.

Background: Socioeconomic disparities exist related to accessibility and uptake of diabetes technologies that impact glycemic management. The aims of this study were to describe diabetes technology use (continuous subcutaneous insulin infusion [CSII] and continuous glucose monitoring [CGM]) in children with type 1 diabetes (T1D) and assess the mediating effects of each technology on the relationship between socioeconomic status (SES) and glycemic management. Methods: Single-center retrospective cross-sectional study of children aged 0-18 years (n = 813) with T1D and valid postal codes between 2018 and 2020. Extracted data were linked to validated census-based material deprivation (MD) quintiles. Exposures included MD and technology use (CSII, CGM), whereas the primary outcome was glycemic management (HbA1c). Results: Of 813 patients included, 379 (46.6%) and 246 (30.3%) individuals used CGM and CSII, respectively. Real-time CGM (rtCGM) and CSII were associated with both MD and HbA1c, but intermittently scanned CGM (isCGM) was not. There was a difference in HbA1c of +1.17% between patients from the most (Q5) and least deprived (Q1) MD quintile (P < 0.0001), and significant mediating effects for rtCGM and CSII use, but not isCGM. rtCGM use and CSII use accounted for 0.14% (P < 0.0001) and 0.25% (P < 0.0001) of the difference in HbA1c between patients from Q1 and Q5 quintiles (indirect effects), representing 12.0% and 23.1% of this difference, respectively. Conclusions: CSII and rtCGM use partially mediated the significant discrepancies observed with SES and glycemic management, highlighting potential benefits of broader access to these technologies to improve diabetes outcomes and help mitigate the negative impact of deprivation on diabetes management.

Suboptimal glycemic control in adolescents and young adults with type 1 diabetes from 2011 to 2020 across Australia and New Zealand: Data from the Australasian Diabetes Data Network registry.

Competing challenges in adolescence and young adulthood can distract from optimal type 1 diabetes (T1D) self-management, and increase risks of premature morbidity and mortality. There are limited data mapping the glycemic control of people with T1D in this age group, across Australasia. Clinical data were extracted from the Australasian Diabetes Data Network, a prospective clinical diabetes registry. Inclusion criteria were individuals with T1D aged 16-25 years at their last recorded T1D healthcare visit (from 1st January 2011 to 31st December 2020), with T1D duration of at least 1 year. Data were stratified by two last recorded T1D healthcare visit ranges, while generalized estimated equation (GEE) modeling was used to examine factors associated with HbA1c across visits during the 10 year period. Data from 6329 young people (52.6% male) attending 24 diabetes centers across Australasia were included. At the last visit within the most recent 5 years, mean ± SD age was 18.5 ± 2.3 years, T1D duration was 8.8 ± 4.7 years and HbA1c was 8.8 ± 1.8% (72.2 ± 19.9 mmol/mol); only 12.3% had an HbA1c below the international target of <7.0% (53 mmol/mol). Across all T1D healthcare visits, in GEE modeling, higher HbA1c was associated with female sex (B=0.20; 95% CI 0.12 to 0.29, p < 0.001), longer T1D duration (B=0.04, 0.03 to 0.05, p < 0.001). Lower HbA1c was associated with attendance at a pediatric T1D healthcare setting (B=-0.33, -0.45 to -0.21, p < 0.001) and use of CSII versus BD/MDI therapy (B=-0.49, -0.59 to 0.40, p < 0.001). This Australasian study demonstrates widespread and persistent sub-optimal glycemic control in young people with T1D, highlighting the urgent need to better understand how healthcare services can support improved glycemic control in this population.

572-P: Perspectives of People with Diabetes and Caregivers Experiencing Insulin Pump Infusion Set Failure (IPISF) : A Qualitative Study

Aim: IPISF can be a life-threatening complication and remains a serious issue for individuals who utilize automated insulin delivery (AID) systems. This study assessed the emotional burden of IPISF and how infusion failure affects sentiment towards insulin pump use. Methods: 50 follow-on interviews (10/2020 - 05/2021) were performed with Caregivers (CG) and People with Diabetes (PWD) from the 2020 Diatech Diabetes - T1D Exchange Insulin Pump Infusion Set Failure Management Survey. Participants consented to a 1-hour video call interview covering topics related to insulin pump use and experiences with infusion set failures. Audio recordings were transcribed using Trint Software and qualitative interview data was analyzed using thematic analysis, R, and Python. Results: 39 PWD and CG were interviewed (PWD age 40.1±20.9 years, CG age 46.2±6.3 years, 72% female, 72% white, 50% household income ≥$100K/year, CSII use for 11.5±8.2 years, 48% use AID, HbA1c 6.9±1.4%, TIR 69.9±18.9%, infusion set wear time 2.9±0.8 days, 62% having ≥1 IPISF/month) . Participants shared quotes on how IPISF is “a direct correlation to my level of happiness...kind of irks me and just makes me angry...because as the caregiver, it's my responsibility to make sure that it goes right” and technology that reduces IPISF and improves detection “would probably be the first step in making me even reconsider going back on the pump.” Identified themes showcase the burden of diagnosing and managing infusion failures when overcoming existing alarm fatigue, trusting care team input, and general stress of CSII therapy. Conclusions: IPISF’s clinical impact is associated with hyperglycemia and DKA, yet IPISF can also affect the mental health of people who use CSII therapy. CSII users heavily rely on hyperglycemia to detect IPISF and can have issues identifying true IPISF from other confounding factors, thus increasing the risk of CSII therapy and justifying the need for better IPISF detection. Disclosure L.E.Blanco: Other Relationship; Diatech Diabetes, Inc. L.M.Vanengelen: None. J.C.Gray: Other Relationship; Diatech Diabetes, Inc. J.H.Wilcox: Other Relationship; Diatech Diabetes, Inc. Funding The West Coast Consortium for Technology &amp; Innovation in Pediatrics (Indirect Support Request)

1256-P: Lower Diabetes Technology Adoption and Worse Glycemic Control in Minorities with Type 1 Diabetes

Introduction: Poorer outcomes in acute and late complications of type 1 diabetes (T1D) persist among racial/ethnic minorities, and technology adoption may be lower in these groups. Technologies such as continuous glucose monitors (CGM) and insulin pumps (CSII) enhance diabetes management and improve glycemic control. We examined differences in use of diabetes technology by race/ethnicity among patients 12 and older followed at the Barbara Davis Center who had T1D for at least 1 year. Methods: Use of CGM and/or CSII vs. neither was examined in 5,539 patients by racial/ethnic groups: Non-Hispanic White (NHW, n=3,945) , Black (n=161) , Hispanic (n=719) and Other racial groups (OR, n=714) . General liner models compared HbA1c and technology use by race/ethnicity. Results: Black, Hispanic and OR patients were younger, had shorter T1D duration, higher HbA1c and less use of technology. In linear models adjusted for age, diabetes duration and visits over the past year, use of technology was associated with lower HbA1c in each race/ethnic group. However, among technology users, minority patients had higher HbA1c compared to NHW patients. Conclusion: HbA1c was highest and diabetes technology use lowest among Blacks and Hispanics. Efforts to increase technology use for diabetes management in these populations may result in greater glycemic control and ultimately the reduction of acute and late complications of diabetes. Disclosure B.Conway: None. V.Shah: Advisory Panel; Medscape, Sanofi, Consultant; Dexcom, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk. C.Geno rasmussen: None. A.Gerard gonzalez: n/a. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. Funding NIH grant P30-DK116073

Hybrid Close-Loop Systems Versus Predictive Low-Glucose Suspend and Sensor-Augmented Pump Therapy in Patients With Type 1 Diabetes: A Single-Center Cohort Study.

IntroductionPredictive low-glucose suspend (PLGS) and hybrid closed-loop (HCL) systems may improve glucose control and quality of life in type 1 diabetic individuals. This is a cross-sectional, single-center study to compare the effect on metabolic control and glucose variability of PLGS and HCL systems as compared to standard sensor-augmented pump (SAP) therapy.MethodsWe retrospectively analyzed 136 adults (men/women 69/67, mean age 47.3 ± 13.9 years) with T1D on insulin pump therapy, divided accordingly to type of insulin pump system (group 1: SAP, 24 subjects; group 2: PLGS, 49 subjects; group 3: HCL, 63 subjects). The groups were matched for age, gender, years of disease, years of CSII use, and CGM wear time.ResultsThe analysis of CGM metrics, in the three groups, showed a statistically significant different percentage of time within the target range, defined as 70–180 mg/dl, with a higher percentage in group 3 and significantly less time spent in the hypoglycemic range in groups 2 and 3. The three groups were statistically different also for the glucose management indicator and coefficient of variation percentage, which were progressively lower moving from group 1 to group 3. In the HCL group, 52.4% of subjects reached a percentage of time passed in the euglycemic range above 70%, as compared to 32.7% in those with PLGS and 20.2% in those with SAP. A positive correlation between the higher percentage of TIR and the use of auto-mode was evident in the HCL group. Finally, the three groups did not show any statistical differences regarding the quality-of-life questionnaire, but there was a significant negative correlation between CV and perceived CSII-use convenience (r = -0.207, p = 0.043).ConclusionHCL systems were more effective in improving glucose control and in reducing the risk of hypoglycemia in patients with type 1 diabetes, thereby mitigating risk for acute and chronic complications and positively affecting diabetes technologies’ acceptance.

Size matters: Influence of center size on quality of diabetes control in children and adolescents with type 1 diabetes-A longitudinal analysis of the DPV cohort.

BackgroundTreatment of patients with type 1 diabetes requires experience and a specific infrastructure. Therefore, center size might influence outcome in diabetes treatment.ObjectiveTo analyze the influence of center size on the quality of diabetes treatment in children and adolescents in Germany and Austria.Patients and methodsIn 2009 and 2018, we analyzed metabolic control, acute complications, and rates of recommended screening tests in the DPV cohort. Diabetes centers were classified according to the number of patients from “XS” to “XL” (<20 [XS], ≥20 to <50 [S], ≥50 to <100 [M], ≥100 to <200 [L], ≥200 [XL]).ResultsOver the 10‐year period, metabolic control improved significantly in “M”, “L” and “XL” diabetes centers. Treatment targets are best achieved in “M” centers, while “XS” centers have the highest mean hemoglobin A1c. The relation between hemoglobin A1c and center size follows a “v‐shaped” curve. In 2009, conventional insulin therapy was most frequently used in “XS” centers, but in 2018, there was no difference in mode of insulin therapy according to center size. Use of CSII and sensor augmented CSII/hybrid closed loop increased with center size. Patients cared for in “XS” diabetes centers had the fewest follow‐up visits per year. The rates of severe hypoglycemia and DKA were lowest in “XL” diabetes centers, and the rate of DKA was highest in “XS” centers.ConclusionCenter size influences quality of care in pediatric patients with type 1 diabetes. Further investigations regarding contributing factors such as staffing and financial resources are required.

Temporal Trends for Diabetes Management and Glycemic Control Between 2010 and 2019 in Korean Children and Adolescents with Type 1 Diabetes.

Purpose: There is increasing use of modern devices in the management of patients with type 1 diabetes (T1D). We investigated temporal trends for diabetes management and outcomes in Korean pediatric T1D patients over 10 years. Methods: We retrospectively collected the data from 752 participants (boys: 311, 41.4%) diagnosed with T1D and aged ≤18 years, with ≥1 year of follow-up between 2010 and 2019 in any of the seven study hospitals in Korea. Results: Over the 10-year study period, use of continuous glucose monitoring (CGM) increased from 1.4% to 39.3%. From 2010 to 2019, there was an increased use of multiple daily insulin injections (MDI; 63.9%-77.0%, respectively) and continuous subcutaneous insulin infusion (CSII; 2.1%-14.0%, respectively), but decreased use of conventional insulin therapy (CIT, 33.9%-9.0%, respectively). Mean glycated hemoglobin (HbA1c) decreased from 8.56% to 8.01% (P < 0.001) and was lower in younger patients, boys, and CGM users (P < 0.001). MDI and CSII users had lower mean HbA1c levels than CIT users (P = 0.003). Regarding the acute complications of T1D, CGM use was associated with lower incidences of diabetic ketoacidosis (P = 0.015); CSII users were likely to experience less severe hypoglycemia (P = 0.008). Conclusions: The use of CSII and CGM increased ∼7- and 30-fold, respectively, over the 10-year study period. The glycemic control of pediatric T1D patients in Korea improved from 2010 to 2019, probably because of increased use of T1D technologies.

696-P: Insulin Pump Infusion Set Failure (IPISF) Management: T1D Exchange Survey

Aim: To identify IPISF occurrence and troubleshooting methods, determine habits and perceptions of diabetes technology use, and assess the history and satisfaction of education in those who utilize CSII. Methods: A 57-item online survey was constructed and included demographic questions, assessment with Likert scales, and open-ended questions regarding infusion sets. Participants were recruited via the T1D Exchange online community database. Statistical analysis was performed using R and JMP. Results: A total of 715 individuals were surveyed including 639 people with diabetes (PwD) and 76 caretakers among 49 states and territories from 09/2020 - 11/2020. Demographics: PwD age 51.6±15.1 years, caretaker age 46.1±7.6 years (dependent PwD age 15.2±11.2 year), 99.6% type 1 diabetes, 69% female, 92% white, CSII use for 14.1±8.5 years, 44% use AID, HbA1c 6.8±0.97%, TIR 72.3±16.1%, TIR&amp;lt;70% 32%. Infusion set wear time was 3.3±0.95 days and 27% wore infusion sets for &amp;gt;3 days. 97% of participants experience IPISF with 41% reporting ≥1 IPISF/month. Following IPISF, participants administered correction boluses using their pump with (41%) and without (44%) changing their failed infusion set. 61% of subjects had not received IPISF education in over a year and 19% had never received IPISF education. For users who experience ≥1 IPISF/month, hyperglycemia and related symptoms were more likely to alert users of IPISF than pump alarms (n=259, p=0.0355). Respondents with ≥1 IPISF/month were also more likely to both feel burned out by their diabetes technology (p&amp;lt;0.001) and want to end CSII for another diabetes therapy option (p&amp;lt;0.001). Not experiencing ≥1 IPISF/month was a significant indicator of reporting good diabetes control (p=0.0134). Conclusion: Developing technologies that reduce and mitigate IPISF should be a critical focus, especially as extended wear infusion sets become available. Disclosure J. H. Wilcox: Employee; Self; Diatech Diabetes, Inc. J. C. Gray: Employee; Self; Diatech Diabetes, Inc. N. R. Cooper: Employee; Self; Diatech Diabetes, Inc. L. E. Blanco: Employee; Self; Diatech Diabetes, Inc. R. Kelleher: Employee; Self; Diatech Diabetes, Inc. L. M. Vanengelen: Employee; Self; Diatech Diabetes, Inc. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool.

Effect of an Integrated, Multidisciplinary Nationwide Approach to Type 1 Diabetes Care on Metabolic Outcomes: An Observational Real-World Study.

Objective: Achieving good metabolic control in people with type 1 diabetes (T1D) remains a challenge, despite the evolutions in diabetes technologies over the past decade. Here we investigate the evolution of metabolic control in people with T1D, where care is provided by specialized centers with access to technology, diabetes education, and regular follow-up. Methods: Data were cross-sectionally collected between 2010 and 2018 from more than 100 centers in Belgium. The evolutions over time of hemoglobin A1C (HbA1c), low-density lipoprotein (LDL) cholesterol, and systolic blood pressure (SBP) were investigated, together with the evolutions of use of insulin pump (continuous subcutaneous insulin infusion [CSII]), continuous glucose monitoring (CGM), and lipid-lowering and antihypertensive drugs. Association of HbA1c with gender, age, diabetes duration, and technology use was analyzed on the most recent cohort. Results: The study population contained data from 89,834 people with T1D (age 1-80 years). Mean HbA1c decreased from 65 mmol/mol (8.1%) in 2010-2011 to 61 mmol/mol (7.7%) in 2017-2018 (P < 0.0001, adjusted for gender, age, diabetes duration, and technology use). Respectively, mean LDL cholesterol decreased from 2.45 mmol/L (94.6 mg/dL) to 2.29 mmol/L (88.5 mg/dL) (P < 0.0001, adjusted for gender, age, and diabetes duration), and mean SBP remained stable. CGM usage increased, whereas the use of CSII and lipid-lowering and antihypertensive drugs remained stable. Gender, age, diabetes duration, and technology use were independently associated with HbA1c. Conclusions: Our real-world data show that metabolic and lipid control improved over time in a system where T1D care is organized through specialized multidisciplinary centers with emphasis on linking education to provision of technology, and its quality is monitored.

Mental and somatic health in university students with type 1 diabetes: new results from DiaSHoT18, a cross sectional national health and well-being survey.

To explore mental and somatic health, quality of life, alcohol-related problems, sleep problems, and diabetes related distress in university students with type 1 diabetes (T1D), compared to students without T1D. Further, we evaluated associations with gender, treatment modalities, and achieved metabolic control. All fulltime Norwegian students aged 18-35 years pursuing higher education in 2018 (n=162.512) were invited into a comprehensive national survey on health and well-being. Students that stated having diabetes was asked further questions about their diabetes care. Of 49,684 participating students, 324 participants stated having T1D. Students with T1D did not show more mental or somatic health symptoms, or report a higher level of loneliness. However, T1D was significantly associated with lower quality of life (QoL). Students with good metabolic control reached the same QoL as students without T1D. Mental disorders and suicidality were associated with lacking metabolic control. The proportion of unhealthy drinking habits was generally low, and even lower in students with T1D. Sleeping patterns were generally good, but students using continuous glucose measurement were awakening more often during sleep. Females with T1D showed higher levels of diabetes related problems and distress, but good metabolic control was associated with lower diabetes distress level. Students with T1D scored equally on most mental and somatic health scales. Their quality of life was significantly worse compared to their healthy peers. Knowledge on the impact of metabolic control, gender and the use of CSII and CGM can be valuable for the caretakers of young adults with T1D.

Insulin Pump Therapy Issues Among Adults with Type 1 Diabetes Mellitus in Saudi Arabia: A Retrospective Study.

IntroductionType 1 diabetes mellitus (T1DM) is on the rise in Saudi Arabia. Management of T1DM is crucial in curbing the economic burden of this disease. Studies on insulin pump issues are scarce in the region. The present study aims to fill this gap.MethodsIn this single-centre, retrospective study done in King Abdulaziz Medical City (KAMC) from March 2018 to March 2019, a total of 118 known Saudi T1DM adults (34 males and 84 females) were included. Data on demographics, glycated haemoglobin (HbA1c) and CSII use were collected.ResultsThe most common problem encountered by the patients on CSII was breaking down of the pump (30.0%), relocation of the cannula or tubing (22%) and air bubbles affecting delivery (16.1%). Eighty-one subjects (68.6%) claimed to have been admitted for DM management while on CSII. The use of CSII led to a significant reduction in HbA1c in all subjects (p < 0.001), but levels remain suboptimal. Only 53 subjects (44.9%) reported no significant problems in their CSII experience.ConclusionThere is a high prevalence of T1DM adult patients experiencing device malfunctions and other issues while on CSII therapy. This may account for suboptimal improvement in the glycaemic control among T1DM Saudi patients. Issues on adherence and device malfunctions should be investigated further.

DiaSHoT18 : A cross‐sectional national health and well‐being survey of university students with type 1 diabetes

To achieve a better understanding in how university students live with and are able to manage their type 1 diabetes (T1D). In 2018, all fulltime Norwegian students aged 18 to 35 years pursuing higher education were invited into a national survey, which included data on demographics and health. In all, 162 512 students fulfilled these inclusion criteria. Students that stated having diabetes were asked to answer further questions about their diabetes care. We included data from 50 054 students responding to the survey, and identified 324 students with T1D (64% females, mean age 23 years, mean HbA1c 7.65% [60 mmol/mol]). Male students had a lower HbA1c (7.28% vs 7.86%, 56 vs 62 mmol/mol), reached an HbA1c of <7.5% (58 mol/mol) more often (62.2% vs 44.2%) and were using continuous glucose measurement (CGM) less often (19.5% vs 36.7%). Exercise and smoking habits in students with T1D were equal to the non-diabetic group. More students with T1D were overweight or obese (44.1% vs 32.2%). Students who achieved an HbA1c <7.5% (58 mmol/mol) measured their blood sugar more often, had a lower body-mass index, exercised more and were smoking less. An HbA1c >7.5% (58 mmol/mol) was associated with less activity, more overweight or obesity, and smoking. The use of continuous subcutaneous insulin infusion and CGM was not associated with a better metabolic control. These data have implications for the follow-up of adolescents and young adults, showing the need to focus on general lifestyle habits, especially in female subjects, whereas the use of technical devices might be of secondary importance.

1102-P: Impact of Treatment with Sotagliflozin on the Incidence of Severe Hypoglycemia in Patients with T1D

Objective: Severe hypoglycemia (SH) is an acute and life-threatening complication of T1D. Factors impacting the risk of SH include A1C, eGFR, insulin dose changes, and use of MDI versus CSII. An adjunctive treatment that simultaneously improves glycemic control and reduces SH across broad groups would be beneficial for patients (pts) with T1D. Methods: Data were pooled from two, 52-week, placebo (PBO)-controlled studies in adults with T1D in the overall population and in prespecified subgroups (Table). SH was defined using Level 3 hypoglycemia criteria and all events were independently adjudicated. Results reflect exposure-adjusted incidence rate per 100 patient-years. Results: Sotagliflozin (SOTA) 400 mg treatment significantly reduced the overall incidence of SH by 41% vs. placebo (relative risk [95% CI] 0.59 [0.35, 0.98]). A dose-responsive reduction was observed in the overall population, and maintained in subgroup analyses (Table), regardless of baseline A1C, eGFR, or percentage reduction in daily insulin dose. Patients using MDI versus CSII alone are generally at higher risk of SH. SOTA 400mg reduced the risk of SH by 69% (relative risk [95% CI] 0.31 [0.13, 0.68]) in MDI-treated pts but did not affect the relatively low rate in those using CSII. Conclusion: These data confirm that SOTA reduced the incidence of SH in pts with T1D, and indicates consistent dose-related risk reduction in almost all subgroups. Disclosure J. Pettus: Consultant; Self; Diasome Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., MannKind Corporation, Novo Nordisk Inc., Sanofi. T. Danne: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Medtronic, Novo Nordisk A/S, Sanofi. A.L. Peters: Advisory Panel; Self; Abbott, Bigfoot Biomedical, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, MannKind Corporation, Medscape, Novo Nordisk Inc., Sanofi US. Consultant; Self; Livongo Health. Research Support; Self; Dexcom, Inc., vTv Therapeutics. Other Relationship; Self; Livongo Health, Mellitus Health, Omada Health, Stability Healthcare, Whole Biome Inc. A.K. Carroll: Employee; Self; Lexicon Pharmaceuticals, Inc. Stock/Shareholder; Self; Lexicon Pharmaceuticals, Inc. S. Sawhney: None. W. Jiang: Employee; Self; Lexicon Pharmaceuticals, Inc. Stock/Shareholder; Self; Lexicon Pharmaceuticals, Inc. P.L. Banks: Employee; Self; Lexicon Pharmaceuticals, Inc. J.B. McGill: Advisory Panel; Self; Aegerion Pharmaceuticals, Bayer AG, Lilly Diabetes, Novo Nordisk A/S. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc. Research Support; Self; Medtronic, Novo Nordisk Inc., Sanofi. Speaker’s Bureau; Self; Aegerion Pharmaceuticals, Dexcom, Inc., Janssen Pharmaceuticals, Inc.

1284-P: Adolescent Type 1 Diabetes: Technology, Depression, Distress, and Glycemic Control

Background: Diabetes (DM) is a chronic illness that has major impacts on patients’ physical and emotional health. Advances in technology have aimed to improve diabetes control and lessen the burden of self-care by using continuous glucose monitors (CGM) and insulin pumps (CSII) as opposed to multiple dose injections (MDI). The goal of this study was to determine the effects of technology use on depression, DM distress, and DM control. Methods: Patients with type 1 DM were approached at their endocrinology visits from 2018-2019 to fill out Problem Areas in Diabetes in Teenagers (PAID-T) assessment and Patient Health Questionnaire (PHQ9) screen. Inclusion criteria included age&amp;gt;13 years. Charts were abstracted for demographic (age, insurance) and clinical (A1c, duration of DM, technology use) information. Data was analyzed using x2 square, ANOVA, and Tukey’s test. Results: Total of 310 patients (mean age 15.11 + 1.40 years) were included in the study with average DM duration of 5.37 + 3.86 years. CGM, CSII, and combined use were higher in the private insurance (PI) group vs. state insurance (SI) (p=0.000). When PAID-T scores were evaluated based on insurance and technology use, only insurance was associated (p=0.013), with SI being linked to higher PAID-T scores. PHQ9 scores were higher in patients with SI vs. PI (p=0.000), whereas technology use was not significant. PAID-T and PHQ9 were not related to DM duration. ANCOVA revealed that A1c was related to technology use (p=0.048), PHQ9 (p=0.018), and PAID-T scores (p=0.000). MDI use, higher PHQ9, and higher PAID-T scores were associated with higher A1c. Conclusions: Insurance, a marker of socioeconomic status, is the principal determinant of technology use (CGM and CSII). Insurance, not technology use, is the best predictor of depression and DM distress, which are both strongly associated with higher A1c. Future efforts should be directed at improving both depression and DM distress via access to mental health services to ultimately improve DM control. Disclosure N. Patel: None. S.K. Sinha: None. K. Hong: None. B. Glick: None. R.P. Hoffman: Research Support; Spouse/Partner; Provention Bio, Inc.

1017-P: Effects of the T:slim X2 Insulin Pump with Basal-IQ Technology on Glycemic Control in a Pediatric Urban Academic Diabetes Practice

The predictive low glucose suspend (PLGS) algorithm of the t:slimx2 insulin pump with Basal-IQ technology, which is used with the Dexcom G6 continuous glucose monitor (CGM), has been shown to reduce hypoglycemia, though the effect on glucose variability longitudinally in a real-world pediatric population is unknown. We hypothesized that children and adolescents who obtain their care at an urban, academic diabetes center and use the PLGS algorithm would have improved glycemic outcomes, compared to their previous method of diabetes care. We recruited pediatric patients aged 6-18 years old with T1D for &amp;gt;1 year prior to starting the PLGS system. At baseline, glycemic control was assessed using CGM or fingerstick glucose metrics. For the 3 month timepoint, Tandem T:connect software was used. Of the 97 pediatric patients at our center with T1D for &amp;gt;1 year using the PLGS system, 41 pediatric subjects (51.2% female) with a median age of 13.6 years (range 6.6-17.8) and 3 month follow-up data were eligible for analysis. Baseline CSII and CGM use were 87.8% and 92.7%, respectively. Subjects were using Basal-IQ for a median of 92% of the time with 6 suspensions per day in the 2 weeks prior to 3 month follow-up. HbA1c, mean glucose, and percent time in range improved from 7.5%, 186 mg/dl and 51.9% on their previous diabetes care to 7.35%, 171 mg/dl and 57% after 3 months of Basal-IQ use (p= 0.005, p=0.03 and p=0.001). Percent time glucose below 55 mg/dl was a median of 0% at baseline and also at follow-up. There were no significant differences in coefficient of variation, percent time glucose below 70 mg/dl, and percent time glucose above 180 mg/dl. There were also no episodes of DKA or severe hypoglycemia after initiation of Basal-IQ in this cohort. The t:slim x2 insulin pump with Basal-IQ technology resulted in improved HbA1c, mean glucose, and percent time in range in pediatric patients after 3 months of use, without an increase in hypoglycemia or adverse events. 6 month data is being analyzed. Disclosure A. Weiner: None. E. Robinson: None. R. Gandica: None. Funding National Institutes of Health (T32DK065522-14)

Anesthesiological perspectives on perioperative management in continuous subcutaneous insulin infusion (CSII): stop or continue?

Perioperative handling of insulin pumps (CSII) is inconsistent. The aims of this study were aliterature search addressing this clinical question, analysis of data found and aproposal for perioperative management recommendations for clinical practice. A systematic search was conducted in PubMed and Clinical Research Network. A total of 11publications on CSII in perioperative medicine were identified. According to the evidence CSII guarantees perioperative glycemic stability under certain clinical situations. The use of CSII could be continued in patients undergoing elective non-cardiac minor surgery with fasting for up to one meal only. International guidelines on surgery in diabetes do not address the use of perioperative CSII. There is no nationwide register data for CSII, the use of which could be around 18%. Based on the search results, ahospital internal protocol for perioperative management with CSII and patient information material were designed. Growing evidence for improved patient outcome with perioperative CSII usage warrants interdisciplinary transfer of knowledge and experiences on intensified insulin therapy and patient empowerment.

1420-P: Improvements in Contraception Uptake and Reduced Pregnancy Rates in Women with Type 1 Diabetes after Changes to the Running of a Tertiary Centre Diabetes Transition Clinic

Objective: Unplanned pregnancies among young women with diabetes are associated with hyperglycaemia related fetopathy. We have evaluated whether introducing a structured approach to contraception and pregnancy planning in the clinic was associated with greater uptake of contraception and reduced pregnancy rates. Methods: Repeat retrospective reviews before (2012-2016) and after (2017- 2018) the introduction of a proforma including documentation of contraception uptake, provision of educational materials, reserved waiting area space and early evening clinic slots in a tertiary hospital diabetes transition clinic (for those aged 17-25 years). Between clinic telephone support continued unchanged. Results: The pre-/post-change reviews included 43 and 48 women with type 1 diabetes (T1DM) respectively. Age at diagnosis (10-11 years), time between first and last clinic attendance (25-26 months), diabetes duration (10-12 years), CSII use (23%) and HbA1c (9.5-9.7%) on first attendance were similar. Number of clinic attendances dropped from 6.8±4.1 to 5.0±3.7 (p=0.01). HbA1c reduction since first attendance (0.1±1.8 vs. 1.2±3.0%, p&amp;lt;0.001) was greater, and episodes of diabetic ketoacidosis (55.8% vs. 14.6% p&amp;lt;0.001) and severe hypoglycaemia (18.6% vs. 2.1% 0.01) were less, in the ‘after’ group. Metformin use increased from 2.3% to 18.4% (p&amp;lt;0.05). Use of CGMS increased from 0% to 39.6% (p&amp;lt;0.001). Documented advice on contraception increased from 0% to 95.8% (p&amp;lt;0.001). Use of contraception increased from 25.6% to 43.8% (p&amp;lt;0.001: implants 7 to 15%, OCPs 16 to 27%). Prior/current pregnancy rates were less (18.6% vs. 8.3% respectively; p=0.03). Conclusions: Introduction of more proactive approaches to diabetes management including contraception awareness and advice were associated with improved glycaemia and a reduced risk of pregnancy in younger women with T1DM. Disclosure D. Simmons: Speaker's Bureau; Self; Sanofi-Aventis. Other Relationship; Self; Medtronic. U.L. Osuagwu: None. A. Gupta: None. M. Ratnaweera: None.

Prevalence, characteristics, and diabetes management in children with comorbid autism spectrum disorder and type 1 diabetes.

To determine autism spectrum disorder (ASD) prevalence within our pediatric type 1 diabetes (T1D) clinic population and determine clinical characteristics and technology used by individuals with both ASD and T1D compared to matched controls with T1D alone and compared to our overall pediatric T1D clinic. Medical chart review showed 30 individuals with both ASD and type 1 diabetes (ASD + T1D). Controls (n = 90) were matched for age, sex, race/ethnicity, and T1D duration. ASD + T1D was compared to both matched controls and the pediatric T1D clinical population. ASD prevalence in the pediatric T1D population was 1.16% (CI 0.96-1.26). Compared to the T1D clinic, ASD + T1D had more males (93% vs 52%; P < 0.0001), lower hemoglobin A1c (HbA1c) (8.2% vs 8.9%; 66 vs 74 mmol/mol; P = 0.006), and lower insulin pump (CSII) use (37% vs 56%; P < 0.0001). No differences were found between ASD + T1D and matched controls in HbA1c or blood glucose checks per day. The ASD + T1D group was less likely to use CSII than matched controls (37% vs 61%; P = 0.03). HbA1c did not change after CSII initiation in ASD + T1D, but increased for matched controls. Prevalence of ASD in the pediatric T1D population is comparable to the general population in Colorado. Individuals with ASD may experience barriers limiting CSII use, but achieve equivalent glycemic control compared to those without ASD. CSII may be more effective in maintaining lower HbA1c over time in those with ASD than in those without ASD.