Experience with burdens of diabetes device use that affect uptake and optimal use in people with type 1 diabetes

Diabetes technology continues to advance, with more individuals with type 1 diabetes (T1D) adopting insulin pumps, continuous glucose monitoring (CGM), and automated insulin delivery (AID) systems that integrate real-time glucose data with an algorithm to assist with insulin dosing decisions. These technologies are linked with benefits to glycemic outcomes (e.g. increased time in target range), diabetes management behaviors, and quality of life. However, current devices and systems are not without barriers and hassles for the user. The intent of this review is to describe the personal challenges and reactions that users experience when interacting with current diabetes technologies, which can affect their acceptance and motivation to engage with their devices. This review will discuss user experiences and strategies to address three main areas: (i) the emotional burden of utilizing a wearable device; (ii) the perceived and experienced negative social consequences of device use; and (iii) the practical challenges of wearing devices

“I’m essentially his pancreas”: Parent perceptions of diabetes burden and opportunities to reduce burden in the care of children <8 years old with type 1 diabetes

Background: Across all age groups, management of type 1 diabetes (T1D) places substantial responsibility and emotional burden upon families. This study explored parent perceptions of the burdens of caring for very young children with T1D. Methods: Semi-structured qualitative interviews were conducted with parents (85% mothers) of 79 children with T1D, aged 1 to <8 years old, from four diverse pediatric diabetes clinical centers. Interviews were transcribed, coded, and analyzed using hybrid thematic analysis to derive central themes. Results: Youth (77% White) had T1D for ≥6 months: age (M ± SD) 5.2 ± 1.5 years, diabetes duration 2.4 ± 1.3 years, and A1c 63 ± 10 mmol/mol (7.9 ± 0.9%); 66% used an insulin pump and 61% used CGM. Three major themes emerged related to diabetes burdens: (a) the emotional burden of diabetes on themselves and their children, (b) the burden of finding, training, and trusting effective secondary caregivers to manage the child's diabetes, and (c) suggestions for how more comprehensive, personalized diabetes education from healthcare providers for parents and secondary caregivers could help reduce parent burden and worry. Conclusions: In families with very young children with T1D, parental perceptions of the burden of managing diabetes are common and could be mitigated by tailored education programs that increase parent knowledge, bolster parents' confidence in themselves, and increase trust in their secondary caregivers to manage diabetes. Reduced parental burden and increased caregiver knowledge may positively impact child's glycemic control, as well as improve parent and child quality of life

Competing Demands of Young Adulthood and Diabetes: A Discussion of Major Life Changes and Strategies for Health Care Providers to Promote Successful Balance

Young adults (YAs) are often faced with many new transitions and major milestones specific to their life stage. For YAs with diabetes, it can be particularly difficult to balance diabetes management with the age-typical demands of young adulthood. Clinicians can play an important role in helping YAs navigate major life changes and find balance in the competing demands of young adulthood, while protecting their health and well-being.</jats:p

788-P: “That’s How You Connect with Someone”: Preferences of Minority Young Adults (YA) with Type 1 Diabetes (T1D) for In-Person Visits over Telemedicine

Objective: Telemedicine has gained popularity as an approach to improve health outcomes by enhancing care delivery to vulnerable populations. However, research is lacking on minority patient preferences for telemedicine, to whom these interventions would likely be offered. In this study, we explored opinions of ethnically diverse, underserved YA with T1D on the use of telemedicine videoconferencing for medical visits. Methods: We conducted semi-structured interviews in 41 YA, ages 18-25, at a major diabetes center in the Bronx, NY. We audio-recorded, transcribed, and coded interviews using content analysis. We achieved thematic saturation. Results: YA participants (53% female, 96% Black or Hispanic, 88% Medicaid) were 21±2.4 yrs, with T1D duration 11±2.3 yrs and mean HbA1c 9.6±1.2%. We found that the overwhelming majority of participants preferred to meet with their healthcare provider in person. Participants cited 3 major reasons for preference of in-person over telemedicine visits: 1) in-person visits felt more personal; 2) meeting in clinic helped YA feel more focused and accountable for past and future diabetes management (particularly if they liked their provider); and 3) it was easier to communicate diabetes issues person-to-person. Few stated a preference for telemedicine visits, however noted convenience and not having to navigate transportation as benefits. Notably, some participants would consider virtual communication with providers between visits, but preferred standard visits to remain in clinic. Conclusions: In this sample of ethnically diverse, underserved YA with T1D, telemedicine visits were not well-accepted. Participants suggested that virtual visits would not provide the same comfort and investment in care as in-person visits. Future interventions using telemedicine as a new mode of care delivery in YA with T1D should consider minority patient preferences. Disclosure P.V. Commissariat: None. G. Crespo-Ramos: None. A. Jang: None. S. Agarwal: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (K23DK115896 to S.A.), (P30DK036836 to P.V.C.) </jats:sec

547-P: Worry and Mental Health in Young Adults with Type 1 Diabetes during the COVID-19 Pandemic

Aim: There are many challenges to navigating young adulthood with type 1 diabetes (T1D). The COVID-19 pandemic has negatively impacted mental health, particularly in young adults (YA) who may already struggle to find structure and support. Methods: Surveys were distributed electronically to YA with T1D (ages 17-30) associated with the College Diabetes Network, a nonprofit organization serving YA with diabetes, in Spring and Fall 2020. Participants in each cohort were asked to rate their worry about contracting COVID-19 (scale of 1-5, 5=”very worried”), and report current diagnoses of depression or anxiety by a healthcare professional (yes/no). T-tests and chi-square tests examined the differences in reported COVID-19 worry, anxiety, and depression from Spring to Fall, as well as the association between worry and diagnosed depression/anxiety at both time points. Results: Participants were demographically similar at both time points ((M±SD) Spring: n=468, age 22.1±2.7 years, 82% female, 84% white; Fall: n=375, 22.4±3.2 years, 79% female, 82% white; p&amp;gt;.10). Overall, participants endorsed significantly more COVID-19 worry in Fall than in Spring (3.57±1.1 vs. 3.29±1.4; p&amp;lt;.001). Self-reported anxiety diagnoses showed an increasing trend from Spring to Fall (p=.065), while self-reported depression diagnoses showed no change between time points (p&amp;gt;.10). Participants with a pre-existing diagnosis of anxiety or depression endorsed significantly more COVID-19 worry than those without a mental health diagnosis at both time points during the pandemic (Spring: anxiety p=.012, depression p=.031; Fall: anxiety: p=.001, depression: p=.004). Conclusions: YA with T1D endorse more worry about contracting COVID-19 as the pandemic progresses, with an upward trend in anxiety diagnoses. Worry was exacerbated in those with a pre-existing mental health condition. These results underscore the need for greater support for YA with T1D, to reduce COVID-19 related worry and protect mental health outcomes. Disclosure P. V. Commissariat: None. D. St. pierre: None. A. Sabino: None. S. Lee: None. J. Saylor: None. </jats:sec