Search

We evaluated COVID-19 outcomes in children and young adults with type 1 diabetes (T1D) to determine if those with comorbidities are more likely to experience severe COVID-19 compared to those without.This cross-sectional study included questionnaire data on patients25 years of age with established T1D and laboratory-confirmed COVID-19 from 52 sites across the US between April 2020 and October 2021. We examined patient factors and COVID-19 outcomes between those with and without comorbidities. Multivariate logistic regression analysis examined the odds of hospitalization among groups, adjusting for age, HbA1c, race and ethnicity, insurance type and duration of diabetes.Six hundred fifty-one individuals with T1D and COVID-19 were analyzed with mean age 15.8 (SD 4.1) years. At least one comorbidity was present in 31%, and more than one in 10%. Obesity and asthma were the most frequently reported comorbidities, present in 19% and 17%, respectively. Hospitalization occurred in 17% of patients and 52% of hospitalized patients required ICU level care. Patients with at least one comorbidity were almost twice as likely to be hospitalized with COVID-19 than patients with no comorbidities (Odds ratio 2.0, 95% CI: 1.3-3.1). This relationship persisted after adjusting for age, HbA1c, race and ethnicity (minority vs nonminority), insurance type (public vs. private), and duration of diabetes.Our findings show that comorbidities increase the risk for hospitalization with COVID-19 in children and young adults highlighting the need for tailored COVID-19 prevention and treatment strategies in T1D.

Background: There is a dearth of research focused on youth living with T1D from publicly insured and ethnically and racially diverse populations. Additionally, there are very few interventions that target social determinants of health (SDH) , despite their documented impact on diabetes outcomes, uptake of diabetes technology, and healthcare utilization. Novel Interventions in Children’s Healthcare (NICH) was developed as a systems and community-based intervention that targets SDH. We describe demographics and outcomes of youth with T1D enrolled in NICH services and related research. Methods: Youth with T1D were eligible if they had >=1 SDH and >=1 of the following in the year prior to enrollment: >=1 DKA hospitalizations after diagnosis, hemoglobin A1c (A1c) >=14%, >=2 emergency room visits or >=2 missed clinic visits. Demographics were collected from chart review and baseline surveys. Outcomes included continuous glucose monitoring (CGM) use, A1c values, hospital costs, and number of hospital days. Results: Participants (n=18) had a mean age of 15.1 (±2.4) years, 67% reported female gender, 89% self-identified as Black and/or Latinx, and 94% were publicly insured. CGM use significantly increased from 33% prior to NICH enrollment to 78% after enrollment (p=0.005) . Noted trends included a 1.0% decrease in mean A1c, 20% reduction in average per member, per month (PMPM) hospital costs, and 33% decrease in mean hospital days per month from the year prior to enrollment to the time since being enrolled in the NICH intervention. Conclusions: Enrollment of publicly insured and ethnically and racially diverse youth living with T1D in research is feasible despite limited existing interventional studies on these populations. Youth with T1D from underrepresented populations experience increased use of technology from participation in the NICH intervention, and they show encouraging trends in improved glycemic control, hospital cost savings, and healthcare utilization. Disclosure L.Yglecias: None. D.V.Wagner: None. J.C.Wong: Consultant; Provention Bio, Inc., Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A.Reed: None. C.E.Noya: None. M.T.Mcgrath: None. A.Stone: None. M.Lodish: None. K.B.Spiro: None. I.C.Gomez: None. M.A.Harris: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust (G-1911-03543)

Objective: A subset of youth with T1D experience ongoing challenges with diabetes self-management, often due to social risk. This 5-site study examined which social factors were associated with hemoglobin A1c (A1c) , specifically in youth with preexisting high A1c. Methods: Youth with T1D for more than 1 year were included if between 12-17 years old and with at least one A1c value ≥10% in the past year. Chart review captured A1c values, and caregivers reported on social risk- with 16 risk variables (e.g., housing security, employment status) in initial analyses. Multivariable linear regression model included A1c from 1 year prior to enrollment as an outcome and backwards stepwise procedure retained covariates with p Results: Participants (n=130) had a mean age of 14.4 (±1.6) years and mean A1c of 11.1 (±1.7) ; 49% reported male gender; 51% self-identified as Non-Hispanic White. A1c prior to study enrollment was predicted to be 0.68 lower in individuals whose caregiver had at least a college education and 0.65 higher when caregivers were divorced or separated. Conclusion: Findings suggest that, in youth with preexisting difficulty with glycemic variability, caregiver education level and marital status are associated with A1c - and, while not causal, may reflect unique value when screening for risk. This cohort will be followed to determine which factors predict future health concerns and associated need for intervention. Disclosure D.V.Wagner: None. L.Yglecias: None. J.J.Flores garcia: None. E.Salcedo-rodriguez: None. A.Torres sanchez: None. P.Dasika: None. J.Viana: None. D.D.Williams: None. D.Ferro: None. M.A.Harris: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Abbott Diabetes, Dexcom, Inc. J.Raymond: None. J.C.Wong: Consultant; Provention Bio, Inc., Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. A.Reed: None. D.Naranjo: None. C.Jenisch: None. C.Cruz: None. S.Mitchell: None. Funding JDRF

Continuous subcutaneous insulin infusion (CSII) therapy is becoming increasingly popular. CSII provides convenient insulin delivery, precise dosing, easy adjustments for physical activity, stress, or illness, and integration with continuous glucose monitors in hybrid or other closed-loop systems. However, even as insulin pump hardware and software have advanced, technology for insulin infusion sets (IISs) has stayed relatively stagnant over time and is often referred to as the “Achilles heel” of CSII. To discuss barriers to insulin pump therapy and present information about advancements in, and results from clinical trials of extended wear IISs, Diabetes Technology Society virtually hosted the “Improving the Patient Experience with Longer Wear Infusion Sets Symposium” on December 1, 2021. The symposium featured experts in the field of IISs, including representatives from Steno Diabetes Center Copenhagen, University of California San Francisco, Stanford University, Medtronic Diabetes, and Science Consulting in Diabetes. The webinar’s seven speakers covered (1) advancements in insulin pump therapy, (2) efficacy of longer wear infusion sets, and (3) innovations to reduce plastics and insulin waste.

Background: Diabetes clinicians are key facilitators of continuous glucose monitoring (CGM) provision, but data on provider behavior related to CGM use and CGM generated data are limited. Methods: We conducted a national survey of providers caring for people with diabetes on CGM-related opinions, facilitators and barriers to prescription, and data review practices. Results: Of 182 survey respondents, 73.2% worked at academic centers, 70.6% were endocrinologists, and 70.7% practiced in urban settings. Nearly 70% of providers reported CGM use in the majority of their patients with type 1 diabetes. Half of the providers reported CGM use in 10% to 50% of their patients with type 2 diabetes. All respondents believed CGM improved quality of life and could optimize diabetes control. We found no differences in reported rates of CGM use based on providers’ years of experience, patient volume, practice setting, or clinic type. Most providers reviewed CGM data each visit (97.7%) and actively involved patients in the data interpretation (98.8%). Only 14.1% of clinicians reported reviewing CGM data without any prompting from patients or their family members outside of visits. Most providers (80.7%) reported their CGM data review was valued by patients although only half reported having adequate time (45.1%) or an efficient process (56.1%) to do so. Conclusions: Despite uniform support for CGM by providers, ongoing challenges related to cost, insurance coverage, and difficulties with prescription were major barriers to CGM use. Increased use of CGM in appropriate populations will necessitate improvements in data access and integration, clearly defined workflows, and decreased administrative burden to obtain CGM.

Objective: Real-time continuous glucose monitoring (CGM) is effective for diabetes management in cases of type 1 diabetes and adults with type 2 diabetes (T2D) but has not been assessed in adolescents and young adults (AYAs) with T2D. The objective of this pilot interventional study was to assess the feasibility and acceptability of real-time CGM use in AYAs with T2D. Methods: Adolescents and young adults (13-21 years old) with T2D for six months or more and hemoglobin A1c (A1c) greater than 7%, on any Food and Drug Administration–approved treatment regimen, were included. After a blinded run-in period, participants were given access to a real-time CGM system for 12 weeks. The use and acceptability of the real-time CGM were evaluated by sensor usage, surveys, and focus group qualitative data. Results: Participants’ (n = 9) median age was 19.1 (interquartile range [IQR] 16.8-20.5) years, 78% were female, 100% were people of color, and 67% were publicly insured. Baseline A1c was 11.9% (standard deviation ±2.8%), with median diabetes duration of 2.5 (IQR 1.4-6) years, and 67% were using insulin. Seven participants completed the study and demonstrated statistically significant improvement in diabetes-related quality of life, with the mean Pediatric Quality of Life inventory (PedsQL) diabetes score increasing from 70 to 75 after using CGM ( P = .026). Focus group results supported survey results that CGM use among AYAs with T2D is feasible, can improve quality of life, and has the potential to modify behavior. Conclusion: Real-time CGM is feasible and acceptable for AYAs with T2D and may improve the quality of life of patients with diabetes. Larger randomized controlled trials are needed to assess the effects on glycemic control and healthy lifestyle changes.

Objectives: Achieving optimal glycemic outcomes in young children with type 1 diabetes (T1D) is challenging. This study examined the durability of continuous glucose monitoring (CGM) coupled with a family behavioral intervention (FBI) to improve glycemia. Study Design: This one-year study included an initial 26-week randomized controlled trial of CGM with FBI ( CGM+FBI) and CGM alone ( Standard-CGM) compared with blood glucose monitoring (BGM), followed by a 26-week extension phase wherein the BGM Group received the CGM+FBI ( BGM-Crossover) and both original CGM groups continued this technology. Results: Time in range (70-180 mg/dL) did not improve with CGM use (CGM+FBI: baseline 37%, 52 weeks 41%; Standard-CGM: baseline 41%, 52 weeks 44%; BGM-Crossover: 26 weeks 38%, 52 weeks 40%). All three groups sustained decreases in hypoglycemia (Conclusion: Over 12 months young children with T1D using newer CGM technology sustained reductions in hypoglycemia and, in contrast to prior studies, persistently wore CGM. However, pervasive hyperglycemia remained unmitigated. This indicates an urgent need for further advances in diabetes technology, behavioral support, and diabetes management educational approaches to optimize glycemia in young children.