Experiences of health care transition voiced by young adults with type 1 diabetes: a qualitative study

Objective: This qualitative study aimed to explore the experience of transition from pediatric to adult diabetes care reported by posttransition emerging adults with type 1 diabetes (T1D), with a focus on preparation for the actual transfer in care. Methods: Twenty-six T1D emerging adults (mean age 26.2±2.5 years) receiving adult diabetes care at a single center participated in five focus groups stratified by two levels of current glycemic control. A multidisciplinary team coded transcripts and conducted thematic analysis. Results: Four key themes on the process of transfer to adult care emerged from a thematic analysis: 1) nonpurposeful transition (patients reported a lack of transition preparation by pediatric providers for the transfer to adult diabetes care); 2) vulnerability in the college years (patients conveyed periods of loss to follow-up during college and described health risks and diabetes management challenges specific to the college years that were inadequately addressed by pediatric or adult providers); 3) unexpected differences between pediatric and adult health care systems (patients were surprised by the different feel of adult diabetes care, especially with regards to an increased focus on diabetes complications); and 4) patients’ wish list for improving the transition process (patients recommended enhanced pediatric transition counseling, implementation of adult clinic orientation programs, and peer support for transitioning patients). Conclusion: Our findings identify modifiable deficiencies in the T1D transition process and underscore the importance of a planned transition with enhanced preparation by pediatric clinics as well as developmentally tailored patient orientation in the adult clinic setting

Experiences of health care transition voiced by young adults with type 1 diabetes: a qualitative study

OBJECTIVE: This qualitative study aimed to explore the experience of transition from pediatric to adult diabetes care reported by posttransition emerging adults with type 1 diabetes (T1D), with a focus on preparation for the actual transfer in care. METHODS: Twenty-six T1D emerging adults (mean age 26.2±2.5 years) receiving adult diabetes care at a single center participated in five focus groups stratified by two levels of current glycemic control. A multidisciplinary team coded transcripts and conducted thematic analysis. RESULTS: Four key themes on the process of transfer to adult care emerged from a thematic analysis: 1) nonpurposeful transition (patients reported a lack of transition preparation by pediatric providers for the transfer to adult diabetes care); 2) vulnerability in the college years (patients conveyed periods of loss to follow-up during college and described health risks and diabetes management challenges specific to the college years that were inadequately addressed by pediatric or adult providers); 3) unexpected differences between pediatric and adult health care systems (patients were surprised by the different feel of adult diabetes care, especially with regards to an increased focus on diabetes complications); and 4) patients’ wish list for improving the transition process (patients recommended enhanced pediatric transition counseling, implementation of adult clinic orientation programs, and peer support for transitioning patients). CONCLUSION: Our findings identify modifiable deficiencies in the T1D transition process and underscore the importance of a planned transition with enhanced preparation by pediatric clinics as well as developmentally tailored patient orientation in the adult clinic setting

147-OR: Use of Closed-Loop Insulin Therapy in Older Adults with Type 1 Diabetes: Real-World Experience

Background: Closed-loop control insulin delivery systems (CLC) have been available to adults with type 1 diabetes (T1D) for many years. However, for older adults with T1D, Tandem Control IQ is the first CLC available through Medicare. We evaluated the use of CLC in older adults with T1D in a real-world scenario. Methods: We retrospectively analyzed electronic health record (EHR) data for older adults (&amp;gt;65) with T1D started on CLC in a single tertiary center between January and December 2020. Continuous glucose monitoring (CGM) data from the 2 weeks prior (baseline) and 2 weeks post CLC system (post-CLC) initiation were analyzed. We evaluated glycemic measures, including coefficient of variation (CV) for glucose variability and glucose management indicator (GMI) for overall glycemic control. Demographic, clinical and diabetes technology data were gathered from EHR. Results: We present interim data from 25 older adults (Mean age 69±4 yrs, duration of diabetes 43±13 yrs) who started using CLC over the 12 month period. Overall, 23/25 were prior pump users, and 23/25 were prior CGM users. Only 2/25 discontinued CLC use. Comparison of CGM metrics measured at baseline vs. post-CLC showed an increase in Time in Range (TIR) from 63±13% to 77±9% (p&amp;lt;0.001) and a reduction in time &amp;gt;180 mg/dL from 30±12% to 18±9% (p=0.004). While there was a trend in decrease of time &amp;lt;70 mg/dL from baseline to post-CLC, this change was not statistically significant (2.8±2.4% vs. 2.2±2.5% (p=0.5)). CV improved from 0.33±0.04% to 0.30±0.04% (p=0.04) and GMI decreased from 7.0±0.5% to 6.7±0.4% (p=0.06). CLC use averaged 92% of the time over 2 weeks. Conclusion: In a small cohort of older adults with T1D using CLC in a real-world scenario, the majority of the cohort was able to use the system successfully, resulting in a higher TIR and improved glycemic variability, as seen by a decrease in CV over a 3 month period. Thus, CLC has the potential to improve glycemic outcomes in this elderly population. Disclosure E. Toschi: Consultant; Self; Medtronic. C. Slyne: None. A. Atakov-castillo: None. M. Munshi: Consultant; Self; Sanofi. Funding National Institutes of Health (1DP3DK112214-01) </jats:sec

879-P: Positive Impact of Use of Continuous Glucose Monitoring on Glycemic Outcomes in Young Adults with Type 1 Diabetes, in Adult Clinical Setting, Independent of Insulin Administration Method

Introduction: Young adults (YA) with type 1 diabetes (T1D) are at risk of poor glycemic control. Use of continuous glucose monitoring (CGM) has been shown to improve glucose control. However, real-world data on the impact of CGM use on glucose control in YA is limited. Methods: We analyzed data from electronic medical records collected across 2018 from a tertiary adult clinic of YA patients age 18- 30 yrs with T1D. A1C and insulin administration methods defined as sliding scale (SS), multiple daily injection while carbohydrate counting (MDI), or via pump therapy (Pump) were collected along with CGM use. Results: Data from 891 patients (mean age 26±3, T1D duration 12±7 years, 52% female, average A1C 7.9%±1.5) were analyzed. Twelve % (n= 110) were on SS; 37% (n=331) on MDI, and 51% (n= 450) on pump therapy; mean age of all 3 groups was 26 ± 3yrs. Use of CGM was recorded in 32% of patients on SS, while use of CGM was recorded in 46% and 66% of patients using MDI and pump, respectively. A1C differed between CGM users and non-users in each subgroup. Conclusion: With increasing complexity of insulin regimen, CGM use rises. However, independent of insulin administration method, CGM use was associated with lower A1C. These findings highlight the potential benefit of CGM use, in YA with T1D in adult clinic settings. Disclosure E. Toschi: None. R.A. Gabbay: Advisory Panel; Self; FormHealth, Health Reveal, Lark, Onduo, Vida Health. A. Clift: None. M. Bennetti: None. A. Atakov-Castillo: None. </jats:sec

1402-P: Impact of Diabetes Duration on Functional and Clinical Status in Older Adults with Type 1 Diabetes

Background: Adults with type 1 diabetes (T1D) are aging more successfully than ever. However, in this older, heterogeneous population, diabetes duration can vary widely, as people may have been diagnosed many decades ago in early childhood or as recently as late adulthood. There is little information about the impact of diabetes duration on psychosocial factors and functional status as patients with T1D age. Methods: We evaluated a cohort of older adults (age≥65 years) with T1D. All participants completed surveys regarding demographics, medical history, overall health (Short Form 36; SF-36), hypoglycemia awareness (Clarke Score), and hypoglycemia fear (HFSII). Laboratory A1C was measured, and Montreal Cognitive Assessment (MoCA) was performed to assess cognitive function. Results: We evaluated 148 older adults, mean age 71 ± 5 years, 55% female, 97% white, mean A1C 7.4 ± 0.9%, mean diabetes duration 39 ± 17 years, with 20% of participants living alone. The participants were divided into tertiles of diabetes duration; ≤30 years (n=48), 31-49 years (n=54) years, and ≥50 years (n=46). Comparison of the shortest and longest tertiles of diabetes duration showed that participants of the group with the shortest duration had significantly less depression (35% vs. 59%; p=0.02), less hypoglycemia unawareness (31% vs. 61%; p=0.008), fewer recent falls in the prior 6 months (5 vs. 12; p=0.05), fewer daily medications (9 vs. 11; p=0.02), and fewer comorbidities (8 vs. 9; p=0.05). Additionally, the overall health survey (SF-36) showed that the group with longer duration reported more difficulty and limitation in daily activities due to physical health. The two groups did not differ in age, A1C, cognitive dysfunction (MoCA score &amp;lt;26), or hypoglycemia fear. Conclusion: In older adults with T1D, duration of diabetes impacts clinical and functional status, and should be kept in consideration when developing management strategies for maximum safety and success. Disclosure M. Munshi: Consultant; Self; Eli Lilly and Company, Sanofi. C. Slyne: None. K. Sifre: None. R. O’Donnell: None. A. Atakov-Castillo: None. E. Toschi: None. Funding National Institutes of Health (1DP3DK112214-01) </jats:sec

Experiences of Adults With Type 1 Diabetes Using Glucose Sensor–Based Mobile Technology for Glycemic Variability: Qualitative Study (Preprint)

BACKGROUND Adults with type 1 diabetes (PWDs) face challenging self-management regimens including monitoring their glucose values multiple times a day to assist with achieving glycemic targets and reduce the risk of long-term diabetes complications. Recent advances in diabetes technology have reportedly improved glycemia, but little is known about how PWDs utilize mobile technology to make positive changes in their diabetes self-management. OBJECTIVE The aim of this qualitative study was to explore PWDs’ experiences using Sugar Sleuth, a glucose sensor–based mobile app and Web-based reporting system, integrated with the FreeStyle Libre glucose monitor that provides feedback about glycemic variability. METHODS We used a qualitative descriptive research design and conducted semistructured interviews with 10 PWDs (baseline mean glycated hemoglobin, HbA1c) 8.0%, (SD 0.45); 6 males and 4 females, aged 52 years (SD 15), type 1 diabetes (T1D) duration 31 years (SD 13), 40% (4/10, insulin pump) following a 14-week intervention during which they received clinical support and used Sugar Sleuth to evaluate and understand their glucose data. Audio-recorded interviews were transcribed, coded, and analyzed using thematic analysis and NVivo 11 (QSR International Pty Ltd). RESULTS A total of 4 main themes emerged from the data. Participants perceived Sugar Sleuth as an Empowering Tool that served to inform lifestyle choices and diabetes self-management tasks, promoted preemptive self-care actions, and improved discussions with clinicians. They also described Sugar Sleuth as providing a Source of Psychosocial Support and offering relief from worry, reducing glycemic uncertainty, and supporting positive feelings about everyday life with diabetes. Participants varied in their Approaches to Glycemic Data: 40% (4/10) described using Sugar Sleuth to review data, understand glycemic cause and effect, and plan for future self-care. On the contrary, 60% (6/10) were reluctant to review past data; they described receiving benefits from the immediate numbers and trend arrows, but the app still prompted them to enter in the suspected causes of glucose excursions within hours of their occurrence. Finally, only 2 participants voiced Concerns About Use of Sugar Sleuth; they perceived the app as sometimes too demanding of information or as not attuned to the socioeconomic backgrounds of PWDs from diverse populations. CONCLUSIONS Results suggest that Sugar Sleuth can be an effective educational tool to enhance both patient-clinician collaboration and diabetes self-management. Findings also highlight the importance of exploring psychosocial and socioeconomic factors that may advance the understanding of PWDs’ individual differences when using glycemic technology and may promote the development of customized mobile tools to improve diabetes self-management. </sec