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Individuals with type 1 diabetes have higher rates of depression and suicidal ideation than the general population, and symptoms of depression are often associated with higher A1C levels and complications. This study evaluated mental health follow-up rates in youth and young adults with type 1 diabetes who screened positive for depressive symptoms or suicidal ideation and identified differences between those who obtained follow-up mental health care and those who did not. Specifically, males were less likely to obtain follow-up, and those who had mental health follow-up had decreasing A1C over the following year. These findings suggest increased assistance and monitoring are needed to ensure follow-up mental health care is obtained.

Disparities and inequities exist for individuals with diabetes in marginalized communities of color, especially among people with low socioeconomic status. Although these barriers are apparent, only a few care models have been designed for and examined in racially and ethnically diverse individuals. This article reviews models that have been developed and examined in a variety of different populations and focuses on how to implement elements from these programs in clinical practice. Health equity–promoting ideas and approaches that can be applied throughout the life span (children to seniors) are also included. As diabetes health care providers, researchers, educators, policymakers, and advocates, we must now combine our efforts and focus on historically excluded populations to bridge the gap to essential diabetes care.

The ongoing coronavirus pandemic led to a rapid and dramatic increase in the use of telehealth for diabetes care. In the wake of this transition, we examine new opportunities and ongoing challenges for using telehealth within diabetes management, based on data and experiences from the pre-pandemic and pandemic time frames.

Supplemental Figure 1: Comparison of targeted sequencing of cfDNA using standard hybridization selection versus Resolution methods. (A) UCSC genome browser depiction of read coverage in the TP53 vicinity. The coverage track representing hybridization selection of cfDNA was created by mapping the reads from sample SRR1197557 of Newman et al 2014. The other coverage track represents unique reads from Sample 511 in this paper. The off-target noise outside of the TP53 gene is higher in SRR1197557 compared with Sample 511. (B) Genome-wide calculation of off-target versus on-target coverage for the two samples. The percentage of read coverage overlapping the declared target regions (widened by an extra 100 nucleotides on each side) was calculated using bedtools. Supplemental Figure 2: Sensitivity of mutant allele detection as a function of dilution. A total of four gene fusions (orange open squares), thirteen point mutations (black circles) and one indels (orange open squares), were assayed at varying mutant allele concentrations (Supplemental Table 1). All 18 lesions were detected in the 2.5%, 1.0%, and 0.4% pools, while fourteen out of the 18 were detected at 0.1%. We expect gene fusions to be more difficult to detect because adequate sequence coverage demands a larger assay footprint than point mutations and probe orientation is unidirectional rather than bidirectional. Consistent with this expectation, the ROS1 fusion in cell line HCC78 and the ALK fusion in cell line H3122 were underrepresented. Supplemental Figure 3: Schematic of predicted genomic junctions for 5 translocations identified in plasma specimens.

Supplemental Table 3: Summary of ddPCR and NGS findings. The table shows the tissue genotype, ddPCR results, ddPCR allele frequency (mut / mut +wt allele frequency), NGS mutation calls and allele frequencies, and sequencing reads.

Supplemental Table 1: Summary of probe sequences

Supplemental Table 2: Compilation of cell line admixture experimental data. The table shows the number of detected mutant reads, the total number of wild-type reads that correspond to the genomic coordinates of the mutant allele, and the frequency of mutant allele detection.

Purpose: Tumor genotyping is a powerful tool for guiding non–small cell lung cancer (NSCLC) care; however, comprehensive tumor genotyping can be logistically cumbersome. To facilitate genotyping, we developed a next-generation sequencing (NGS) assay using a desktop sequencer to detect actionable mutations and rearrangements in cell-free plasma DNA (cfDNA).Experimental Design: An NGS panel was developed targeting 11 driver oncogenes found in NSCLC. Targeted NGS was performed using a novel methodology that maximizes on-target reads, and minimizes artifact, and was validated on DNA dilutions derived from cell lines. Plasma NGS was then blindly performed on 48 patients with advanced, progressive NSCLC and a known tumor genotype, and explored in two patients with incomplete tumor genotyping.Results: NGS could identify mutations present in DNA dilutions at ≥0.4% allelic frequency with 100% sensitivity/specificity. Plasma NGS detected a broad range of driver and resistance mutations, including ALK, ROS1, and RET rearrangements, HER2 insertions, and MET amplification, with 100% specificity. Sensitivity was 77% across 62 known driver and resistance mutations from the 48 cases; in 29 cases with common EGFR and KRAS mutations, sensitivity was similar to droplet digital PCR. In two cases with incomplete tumor genotyping, plasma NGS rapidly identified a novel EGFR exon 19 deletion and a missed case of MET amplification.Conclusions: Blinded to tumor genotype, this plasma NGS approach detected a broad range of targetable genomic alterations in NSCLC with no false positives including complex mutations like rearrangements and unexpected resistance mutations such as EGFR C797S. Through use of widely available vacutainers and a desktop sequencing platform, this assay has the potential to be implemented broadly for patient care and translational research. Clin Cancer Res; 22(4); 915–22. ©2015 AACR.See related commentary by Tsui and Berger, p. 790

Type 1 diabetes is a challenging chronic condition and can lead to diabetes-related distress and disengagement. Historically disadvantaged, racially and ethnically diverse young adults (YAs) with type 1 diabetes experience higher blood glucose levels and encounter more barriers to care than their White counterparts. Current research shows that telehealth may provide a route for improving psychosocial issues and diabetes care among YAs.

Background: Type one diabetes (T1D) management is challenging for adolescents and young adults (AYAs) due to physiological changes, psychosocial challenges, and increasing independence, resulting in increased diabetes distress and hemoglobin A1c (HbA1c). Alternative care models that engage AYAs and improve diabetes-related health outcomes are needed. Methods: A 15-month study evaluated an adaptation of the Colorado Young Adults with T1D (CoYoT1) Care model. CoYoT1 Care includes person-centered care, virtual peer groups, and physician training delivered via telehealth. AYAs (aged 16-25 years) were partially randomized to CoYoT1 or standard care, delivered via telehealth or in-person. As the study was ending, the COVID-19 pandemic forced all AYAs to transition to primarily telehealth appointments. This secondary analysis compares changes in clinic attendance, T1D-related distress, HbA1c, and device use between those who attended more than 50% of diabetes clinic visits via telehealth and those who attended more sessions in-person throughout the course of the study. Results: Out of 68 AYA participants, individuals (n = 39, 57%) who attended most (>50%) study visits by telehealth completed more diabetes care visits (3.3 visits) than those (n = 29, 43%) who primarily attended visits in-person (2.5 visits; P = .007). AYAs who primarily attended visits via telehealth maintained stable physician-related distress, while those who attended more in-person visits reported increases in physician-related distress ( P = .04). Conclusions: Greater usage of telehealth improved AYA engagement with their care, resulting in increased clinic attendance and reduced physician-related diabetes distress. A person-centered care model delivered via telehealth effectively meets the needs of AYAs with T1D.

Rates of Type 1 diabetes are rising, and diabetes management often deteriorates during adolescence. Adolescent disclosure to parents is a key factor for effective diabetes management, and parent affective responses to disclosures affect the timing of future disclosures in healthy populations, but no studies to our knowledge have examined parent affective behaviors that facilitate or inhibit disclosure in the context of managing Type 1 diabetes. The present study examined how observed parental affective responses to adolescent disclosures predict the timing of subsequent disclosures during a discussion task in a sample of adolescents with Type 1 diabetes and their parents (

This commentary article discusses the recent trends and changes in popularity of telehealth usage as well as the most recent efforts to redefine telehealth value and usability. Six strategies to improve the patient experience and increase telehealth acceptance by overcoming simultaneous barriers are presented, which include (1) creating a new healthcare paradigm using telehealth, (2) scheduling the telehealth visit, (3) preparing for the telehealth visit, (4) conducting the telehealth visit, (5) using data and biomarkers, and (6) providing digital equity. With the application of these strategies, we believe that the recent decline in the popularity of telehealth can be reversed.

Background: Diabetes technologies, such as insulin pumps and continuous glucose monitors (CGM), have been associated with improved glycemic control and increased quality of life for young people with type 1 diabetes (T1D); however, few young people use these devices, especially those from minority ethnic groups. Current literature predominantly focuses on white patients with private insurance and does not report experiences of diverse pediatric patients with limited resources. Methods: To explore potential differences between Latinx and non-Latinx patients, English- and Spanish-speaking young people with T1D ( n = 173, ages 11-25 years) were surveyed to assess attitudes about and barriers to diabetes technologies using the Technology Use Attitudes and Barriers to Device Use questionnaires. Results: Both English- and Spanish-speaking participants who identified as Latinx were more likely to have public insurance ( P = .0001). English-speaking Latinx participants reported higher Hemoglobin A1c values ( P = .003), less CGM use ( P = .002), and more negative attitudes about technology (generally, P = .003; and diabetes-specific, P Conclusions: Latinx English-speaking participants had less positive attitudes toward general and diabetes technology than Latinx Spanish-speaking and non-Latinx English-speaking peers, and differences in CGM use were associated with socioeconomic status. Additional work is needed to design and deliver diabetes interventions that are of interest to and supportive of patients from diverse ethnic and language backgrounds.

Objective For youth with type 1 diabetes (T1D), the early adolescent period is associated with worsening diabetes management and high rates of negative psychosocial issues, including depressive symptoms and family conflict. Alternative clinical models may help improve both diabetes and psychosocial outcomes. Our study aims to investigate whether Team Clinic, a shared medical appointment model developed specifically for adolescents with T1D, will improve psychosocial outcomes for middle school-aged youth. Methods Youth with T1D, 11-13 years of age, and their caregivers, participated in a randomized controlled trial comparing Team Clinic to traditional clinic visits (control group). Diabetes characteristics were obtained at every visit. Participants and caregivers completed depression screening and family conflict questionnaires at baseline and end of study. Changes in mean scores on clinical and psychosocial outcomes from baseline to end of study were compared between groups using linear mixed-effects models. Results Eighty-six youth (51% female; 74% White; 10% Hispanic) completed at least one visit during the twelve-month study period. At the end of the study, control group participants reported increases in Emotional Problems compared to Team Clinic participants, including higher levels of Negative Mood/Physical Symptoms (p=0.02). Team Clinic participants reported reduced family conflict surrounding diabetes at study end, compared to control group participants (p=0.03). Caregivers did not report change in depressive symptoms or family conflict during the study. Hemoglobin A1C levels did not change over time in either group. Conclusions Participation in Team Clinic was associated with improved psychosocial outcomes in middle school-aged participants with T1D. This article is protected by copyright. All rights reserved.

Introduction Multisystem inflammatory syndrome in children (MIS-C) is a unique clinical complication of SARS-CoV-2 infection observed in pediatric patients. COVID-19 is emerging as a potential trigger for the development of diabetes in children. Here, we report a patient presenting with MIS-C and new onset diabetes, and discuss the implication and clinical management of these concomitant conditions. Case presentation An eight-year-old female presented with hyperglycemia, ketosis and metabolic acidosis consistent with diabetic ketoacidosis (DKA) in the setting of fever, rash, respiratory distress, hemodynamic instability, reduced systolic function with dilation of the left anterior descending artery, and positive SARS-CoV-2 antibodies suggestive of MIS-C.

Management of type 1 diabetes mellitus for pediatric and young adult patients is well suited for telehealth. Diabetes management requires frequent communication with health care providers as well as the interpretation of many types of data that can be measured in the home and shared virtually to the provider by the patient. Telehealth technologies allow for a safe alternative and/or addition to in-person care for youth with diabetes. Telehealth increases access to health care, saves time and money, and results in improvements in rates of appointment adherence, patient satisfaction, and quality of life.

ContextMinority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied.ObjectiveTo describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES).DesignCross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES.SettingSix diabetes centers across the United States.ParticipantsA total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic).Main OutcomeRacial-ethnic disparity in HbA1c levels.ResultsNon-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P ConclusionThis study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors.

BACKGROUND Type 1 Diabetes (T1D) management is complex and associated with significant psychosocial burden. Continuous glucose monitors (CGM) can improve disease management and outcomes, but also introduce new or exacerbate existing psychosocial concerns. Patient Reported Outcome Measures (PROMs) can be used to capture this information, but there is no consensus on which PROMs should be used in pediatric CGM research. OBJECTIVE We describe out the process to: 1) identify PROMs that could be used to assess the impact of CGMs on pediatric patients with T1D, 2) implement a modified e-Delphi methodology to arrive at an expert consensus on which PROMs are most suitable for clinical and research applications, and 3) establish a periodicity table for the administration of PROMs over time in Real-World Evidence study. METHODS In order to identify appropriate PROMs for pediatric patients and families with T1D and CGMs, we conducted an asynchronous, electronic Delphi (e-Delphi) process with a multidisciplinary group of experts from around the country. We identified candidate instruments through a literature review. The three-round e-Delphi process was conducted via a study website, email, and online forms. Participants provided opinions on usefulness of instruments, age validation, feasibility, time, and frequency of administration. RESULTS Sixteen experts participated in the E-Delphi process; four of them consistently in all three rounds. We identified 62 candidate instruments, which were narrowed down to 12 final PROMs across five domains: Diabetes Distress and Burden (4 instruments), Autonomy (2 instruments), Quality of Life (1 instrument), Psychosocial (3 instruments) and Technology Acceptance (2 instruments). A quarterly administration schedule was developed to reduce burden on participants. CONCLUSIONS PROMs can provide critical insights into the psychosocial well-being of patients. The specific measures identified in the paper are particularly well suited for pediatric patients with T1D and CGMs. Clinical implementation could help healthcare providers, patients and families engage in more comprehensive disease management.

BackgroundRandomized controlled trials of time restricted eating (TRE) in adults have demonstrated improvements in glucose variability as captured by continuous glucose monitors (CGM). However, little is known about the feasibility of CGM use in TRE interventions in adolescents, or the expected changes in glycemic profiles in response to changes in meal-timing. As part of a pilot trial of TRE in adolescents with obesity, this study aimed to 1) assess the feasibility of CGM use, 2) describe baseline glycemic profiles in adolescents with obesity, without diabetes, and 3) compare the difference between glycemic profiles in groups practicing TRE versus control.MethodsThis study leverages data from a 12-week pilot trial (ClinicalTrials.gov Identifier: NCT03954223) of late TRE in adolescents with obesity compared to a prolonged eating window. Feasibility of CGM use was assessed by monitoring 1) the percent wear time of the CGM and 2) responses to satisfaction questionnaires. A computation of summary measures of all glycemic data prior to randomization was done using EasyGV and R. Repeat measures analysis was conducted to assess the change in glycemic variability over time between groups. Review of CGM tracings during periods of 24-hour dietary recall was utilized to describe glycemic excursions.ResultsFifty participants were enrolled in the study and 43 had CGM and dietary recall data available (16.4 + 1.3 years, 64% female, 64% Hispanic, 74% public insurance). There was high adherence to daily CGM wear (96.4%) without negative impacts on daily functioning. There was no significant change in the glycemic variability as measured by standard deviation, mean amplitude glycemic excursion, and glucose area under the curve over the study period between groups.ConclusionsCGM use appears to be a feasible and acceptable tool to monitor glycemic profiles in adolescents with obesity and may be a helpful strategy to confirm TRE dosage by capturing glycemic excursions compared to self-reported meal timing. There was no effect of TRE on glucose profiles in this study. Further research is needed to investigate how TRE impacts glycemic variability in this age group and to explore if timing of eating window effects these findings.

INTRODUCTION: Glycemic control is challenging for adolescents with type 1 diabetes (T1D). Team Clinic, a shared medical appointment model, has improved psychosocial outcomes in middle school patients with T1D. We aimed to evaluate the costs of delivering Team Clinic. METHOD: Participants were randomized into Team Clinic (n = 44) or usual care (n = 42) groups. RESULTS: We found no significant difference in 6-month total costs per subject ($3,204 [intervention] vs. $3,476 [control]. No significant differences were found in health care use, test strip use, or continuous glucose monitoring and/or pump. The intervention had more clinic visits (2.41 vs. 1.52 times) and a longer length of visit (2.34 vs. 0.74 hr, but no difference in provider time per patient per visit (median, 0.67 vs. 0.68 hr). DISCUSSION: The Team Clinic care model may help young adolescents with T1D improve psychosocial outcomes and increase completion of clinical visits without increasing costs.

Due to its simplicity, time-limited eating (TLE) may represent a more feasible approach for treating adolescents with obesity compared to other caloric restriction regimens. This pilot study examines the feasibility and safety of TLE combined with continuous glucose monitoring (CGM) in adolescents. Fifty adolescents with BMI ≥95th percentile were recruited to complete a 12-week study. All received standard nutritional counseling, wore a CGM daily, and were randomized to: (1) Prolonged eating window: 12 h eating/12 h fasting + blinded CGM, (2) TLE (8 h eating/16 h fasting, 5 days per week) + blinded CGM, (3) TLE + real-time CGM feedback. Recruitment, retention, and adherence were recorded as indicators of feasibility. Weight loss, dietary intake, physical activity, eating behaviors, and quality of life over the course of the intervention were explored as secondary outcomes. Forty-five participants completed the study (16.4 ± 1.3 years, 64% female, 49% Hispanic, 75% public insurance). There was high adherence to prescribed eating windows (TLE 5.2 d/wk [SD 1.1], control 6.1 d/wk [SD 1.4]) and daily CGM wear (5.85 d/wk [SD 4.8]). Most of the adolescents (90%) assigned to TLE reported that limiting their eating window and wearing a CGM was feasible without negative impact on daily functioning or adverse events. There were no between-group difference in terms of weight loss, energy intake, quality of life, physical activity, or eating behaviors. TLE combined with CGM appears feasible and safe among adolescents with obesity. Further investigation in larger samples, with a longer intervention duration and follow-up assessments are needed.

Background: Time Limited Eating (TLE) is an effective strategy for management of obesity in adults, but there is a paucity of data that have examined its use in the clinical management of children with obesity. A TLE approach involves interspersing normal daily caloric intake with periods of prolonged calorie restriction several times per week. TLE may actually be more feasible, non-stigmatizing, flexible and effective in children, especially for adolescents, compared to alternatives like daily caloric or macronutrient restriction. This is because TLE removes the need for intensive counting of daily calorie intake or macronutrient content and focuses on a straightforward task of consuming food during a pre-specified time period. Also it avoids periods of extended caloric restriction which may interfere with growth and/or risk evoking development of eating behaviors. This case series describes four patients who trialed a TLE approach in a clinical weight management clinic and describes BMI reduction at 4 months. Case Presentation: To date, 4 patients, ages 5-15, with varying underlying pathologies (i.e. Bardet Biedl Syndrome (BBS), previously healthy, craniopharyngioma and epilepsy) have tried a TLE type approach (16-hour fast/8-hour feed for 3-5 days per week) for 4 months and have demonstrated an average decrease in their BMI z-score compared to baseline of -0.24 SD. Patients and their families reported high degrees of satisfaction with this dietary approach. Conclusions: Families were very satisfied with the TLE intervention and reported it was feasible, flexible and sustainable to implement in a real life setting and associated with decreased zBMI. Further investigation is required to determine if this approach is effective in both the short and long term as a weight management technique.

Purpose To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D). Methods YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale. Results Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress ( P = .03), increased diabetes self-efficacy ( P = .01), and improved ability to communicate with others about diabetes ( P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms ( P = .03) during the study period, but CoYoT1 participants showed no changes. Conclusion Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs’ long-term diabetes outcomes. Further investigation of the model is needed.

Background Type 1 diabetes (T1D) management is complex and associated with significant psychosocial burden. Continuous glucose monitors (CGM) can improve disease management and outcomes and introduce new or exacerbate existing psychosocial concerns. Patient-reported outcome measures (PROMs) can be used to capture this information, but there is no consensus on which PROMs should be used in pediatric CGM research. Objective Here we describe the process to (1) identify PROMs that could be used to assess the impact of CGMs on pediatric patients with T1D, (2) implement a modified electronic Delphi (e-Delphi) methodology to arrive at an expert consensus on which PROMs are most suitable for clinical and research applications, and (3) establish a periodicity table for the administration of PROMs over time in a real-world evidence study. Methods To identify appropriate PROMs for pediatric patients and families with T1D and CGMs, we conducted an asynchronous, e-Delphi process with a multidisciplinary group of experts from around the country. We identified candidate instruments through a literature review. The 3-round e-Delphi process was conducted via a study website, email, and web-based forms. Participants provided opinions on the usefulness of instruments, age validation, feasibility, time, and frequency of administration. Results In total, 16 experts participated in the e-Delphi process; 4 of whom consistently participated in all 3 rounds. We identified 62 candidate instruments, which were narrowed down to 12 final PROMs across 5 domains: diabetes distress and burden (n=4), autonomy (n=2), quality of life (n=1), psychosocial (n=3), and technology acceptance (n=2). A quarterly administration schedule was developed to reduce burden on participants. Conclusions PROMs can provide critical insights into the psychosocial well-being of patients. The specific measures identified in the paper are particularly well suited for pediatric patients with T1D using CGMs. Clinical implementation could help health care providers, patients, and families to engage in more comprehensive disease management.

Purpose: The purpose of this study was to analyze the impact of virtual group appointments (VGA) on self-reported health-related outcomes and care activities for young adults (YA) with type 1 diabetes (T1D). Methods: Fifty-three YA (ages 18-25 years) with T1D participated in a randomized controlled trial (RCT) of the Colorado Young Adults with T1D (CoYoT1) Clinic intervention, encompassing telehealth (TH) with or without VGA. Both new patients ( n = 32) and those who participated in a pilot phase ( n = 26) were randomized to CoYoT1 Clinic (TH+VGA; n = 23) or TH-only ( n = 35) and followed for 1 year. YA completed the Diabetes Distress Scale (DDS), Diabetes Strengths and Resilience (D-STAR), Self-Efficacy in Diabetes (SED), Self-Management of Type 1 Diabetes in Adolescence (SMOD-A), Center for Epidemiologic Studies Depression (CES-D), and EuroQol (EQ-5D) scales at baseline and study end. Results: YA were 67% female, 84% white, 10% Latinx, and the mean age was 20.4 years old. At study end, participants in CoYoT1 Clinic reported significantly reduced diabetes distress compared to those in TH-only, who reported increased levels [Effect Size (ES) = −0.40, P = .02]. Specifically, CoYoT1 Clinic participants reported relative reductions in Physician (ES = −2.87, P = .02) and Regimen-related distress (ES = −0.35, P = .01). In addition, participants in CoYoT1 Clinic reported improved self-management of T1D-related problem solving (ES = 0.47, P = .051) and communication with care providers (ES = 0.39, P = .07). Conclusions: Virtual group attendance in CoYoT1 Clinic was associated with significant improvements in diabetes-related distress. Long-term exposure to VGA should be investigated in YA with T1D and other pediatric chronic conditions.

Background This scoping review provides a timely synthesis of the use of continuous glucose monitoring in obesity research with considerations to adherence to continuous glucose monitor devices and metrics most frequently reported. Methods This scoping review was conducted adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Eligible studies (n = 31) evaluated continuous glucose monitor use in research on participants, of all ages, with overweight or obesity. Results Reviewed studies varied in duration from one to 84 days (mean: 8.74 d, SD 15.2, range 1–84 d) with 889 participants total (range: 11–118 participants). Across all studies, the mean percent continuous glucose monitor wear time (actual/intended wear time in days) was 92% (numerator – mean: 266.1 d, SD: 452, range: 9–1596 d/denominator – mean: 271.6 d, SD: 451.5, range: 9–1596 d). Continuous glucose monitoring was utilized to provide biofeedback (n = 2, 6%), monitor dietary adherence (n = 2, 6%), and assess glycemic variability (n = 29, 93%). The most common variability metrics reported were standard deviation (n = 19, 62%), area under the curve (n = 12, 39%), and glycemic range (n = 12, 39%). Conclusions Available evidence suggests that continuous glucose monitoring is a well-tolerated and versatile tool for obesity research in pediatric and adult patients. Future investigation is needed to substantiate the feasibility and utility of continuous glucose monitors in obesity research and maximize comparability across studies.

Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 12 to November 14, 2020. This meeting brought together speakers to cover various perspectives about the field of diabetes technology. The meeting topics included artificial intelligence, digital health, telemedicine, glucose monitoring, regulatory trends, metrics for expressing glycemia, pharmaceuticals, automated insulin delivery systems, novel insulins, metrics for diabetes monitoring, and discriminatory aspects of diabetes technology. A live demonstration was presented.

Introduction: COVID-19 has had profound impacts on clinical research worldwide. We examined COVID-19’s impact on recruitment, retention, and individual characteristics, pre- vs. post-pandemic, of YA who enrolled in a randomized trial designed to evaluate a telehealth self-management intervention for T1D. Methods: Participant surveys, A1c, and process data from the ongoing trial were analyzed for differences before and after California’s stay-at-home order was issued on 3/18/2020. All surveys except social needs were collected at enrollment, while social needs were assessed post-COVID for all participants. Fisher exact tests and Wilcoxon rank-sum tests were used to compare categorical and continuous variables, respectively. Results: Time from referral to enrollment more than doubled post-COVID. Participants who enrolled post-COVID (n=19) had higher SES (private health insurance, parental education), but poorer psychosocial well-being (diabetes distress, self-efficacy) and higher social needs (e.g., food insecurity, access to healthcare) than those who enrolled pre-COVID (n=41) (Table 1). Discussion: The COVID era has imposed logistical difficulties and competing priorities that create challenges in clinical research. Understanding the impact of COVID on participant and trial characteristics will be critical in interpreting the findings of studies conducted during COVID. Disclosure E. Pyatak: None. J. Sideris: None. J. Diaz: None. G. Granados: None. C. Vigen: None. A. Ali: None. S. C. Kuizon: None. E. Salazar: None. J. Blanchard: None. E. S. Lee: None. E. Taylor: None. J. Raymond: None. D. Fox: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK116719)

Among youth with type 1 diabetes (T1D), non-Latino Whites, and those from higher socioeconomic status (SES) homes, typically show lower average HbA1c (A1c) levels, and slower deterioration in A1c across childhood through emerging adulthood. However, different SES metrics (income, educational achievement, type of health insurance) may have unique associations with T1D management, and the complex interplay between race/ethnicity and multiple SES metrics in T1D across development has yet to be systematically examined. This study investigated how a diverse sample of youth with T1D may vary in A1c across childhood through emerging adulthood as a function of multiple SES metrics. Medical records from a metropolitan clinic serving socioeconomically, ethnically, and racially diverse youth (N = 614; 36.7% Latino, 18.6% non-Latino White, 6.8% Black, 3% Asian/Pacific Islander, 35% Other Race/Multiracial; 48.9% Female) were coupled with US Census Tract data to index important measures of SES: Median neighborhood household income, % of the population with ≥ high school education (from US Census Tract data); type of health insurance: Private vs. Public/No Insurance (from medical records). Black youth had higher average A1c than Whites, Latinos, and Asian/Pacific Islanders, even after controlling for SES. Latinos had slower deterioration in A1c than all other racial groups across development, but this disappears after covarying SES. Income, education, and type of health insurance individually linked only to average A1c, with no associations to trajectories, but only insurance remained predictive of average A1c when all SES metrics are simultaneously covaried. Ethnic comparisons in average A1c and trajectories across development varied depending on income, education, and insurance status between groups, providing new insight for clinicians, researchers, and policymakers to help youth properly manage T1D. Disclosure D. Mello: None. J. Raymond: None. A. Torres sanchez: None. A. Main: None. D. Wiebe: None.

Background: One limitation to studying time limited eating (TLE) in adolescents is difficulty in reliably assessing adherence to fasting periods. Dietary recalls, which are currently used to monitor diet adherence, have been criticized due to potential error in reporting, omission bias and suboptimal compliance. Continuous glucose monitoring (CGM) may be a useful tool to overcome these barriers; however, it requires daily wear and understanding of expected glycemic excursions. The present study examines the feasibility of daily CGM use and its utility as a tool to monitor adherence to fasting periods in a diverse cohort of adolescents with obesity participating in a pilot study of 8-hour TLE. Methods: Twenty adolescents (mean age 16.0+1.3 years, 70% female, 55% Latinx, 75% public insurance) with BMI ≥ 95th percentile, were enrolled in a 12-week study and randomized to: (1) Group 1 (control schedule): 12-hour eating period + blinded CGM, (2) Group 2 (TLE schedule): 8-hour eating period + blinded CGM, or (3) Group 3: 8-hour eating period + CGM with real-time feedback. CGM wear time was calculated as the actual weekly wear time divided by the prescribed wear time. At weeks 0, 4 and 12, CGM data from 7 days of self-reported fasting periods were reviewed to evaluate any glycemic excursions >50 ng/dL. Results: Overall, the mean CGM wear time was 90% (35-100%) with no difference between intervention arms. During self-reported fasting periods, only 4 adolescents had excursions >50 ng/dL, one of whom was diagnosed with type 2 diabetes. The remaining 16 participants had no excursions >50 ng/dL during their fasting periods. Conclusions: These data suggest that CGM may be a feasible tool to monitor adherence to TLE and provide a more accurate assessment of true fasting periods with less opportunity for error and bias when compared to self-report. Larger studies are needed to validate these findings and further explore the use of CGM as a tool in obesity research in adolescents. Disclosure M. Naguib: None. M. I. Goran: None. J. Raymond: None. E. Hegedus: None. C. Wee: None. A. Vidmar: None.

The $\beta$-decay of neutron-rich $^{129}$In into $^{129}$Sn was studied using the GRIFFIN spectrometer at the ISAC facility at TRIUMF. The study observed the half-lives of the ground state and each of the $\beta$-decaying isomers. The level scheme of $^{129}$Sn has been expanded with thirty-one new $\gamma$-ray transitions and nine new excited levels, leading to a re-evaluation of the $\beta$-branching ratios and level spin assignments. The observation of the $\beta$-decay of the (29/2$^{+}$) 1911-keV isomeric state in $^{129}$In is reported for the first time, with a branching ratio of 2.0(5)$\%$.

Objective To (1) test associations between parents’ empathic accuracy for their adolescents’ positive and negative emotions and adolescents’ physical and mental health (HbA1c, diabetes self-care, and depressive symptoms) in a predominantly Latinx sample of adolescents with type 1 diabetes and their parents, and (2) explore how familism values were associated with parent empathic accuracy and adolescent physical and mental health in this population. Methods Parents and adolescents engaged in a discussion about a topic of frequent conflict related to the adolescents’ diabetes management. Parents and adolescents subsequently completed a video recall task in which they rated their own and their partner’s emotions once per minute; parents’ empathic accuracy was calculated from an average discrepancy between parent and adolescent ratings of the adolescent’s emotions. Adolescents reported on their depressive symptoms and both parents and adolescents reported on adolescents’ diabetes self-care and their own familism values; HbA1c was obtained from medical records. Results Results from structural equation modeling revealed that parents’ empathic accuracy for adolescents’ negative (but not positive) emotions was uniquely associated with adolescents’ HbA1c, self-care, and depressive symptoms. There was limited evidence that familism was related to parent empathic accuracy or adolescent physical and mental health. Conclusions Promoting parents’ empathic accuracy for adolescents’ negative emotions in the context of type 1 diabetes management may have important implications for adolescents’ mental and physical health.