SUN-526 - Diabetes Distress and Mealtime Insulin Use Among Adolescents and Young Adults Enrolled in an Equity-Focused Type 1 Diabetes Intervention

Background:
Diabetes related distress is common in type 1 diabetes and can influence daily self-management behaviors. Adolescence and young adulthood are particularly challenging periods for diabetes management due to rapid developmental, social, and behavioral changes that can affect achieving diabetes targets.

Methods:
We examined the relationship between diabetes distress and mealtime insulin bolusing in a subset of participants in the Using Technology to Address Disparities and Promote Healthcare Equity in Type 1 Diabetes (EquiT1D) study. This interventional study provides CGM support from a Patient Navigator to youth and adults with type 1 diabetes who have experienced higher-risk clinical outcomes, such as recurrent DKA or hemoglobin A1C persistently greater than 10%. The study collects detailed data on diabetes management, psychosocial well-being, and device usage to better understand barriers and facilitators to diabetes care. For this cross-sectional analysis, inclusion criteria were participants age 12–24 years, use of an insulin pump or smart pen, and completion of the Problem Areas in Diabetes (PAID) or PAID-Teen (PAID-T) survey within one month of available device data. Diabetes distress was assessed using the PAID-T questionnaire for participants aged 14–19 years and the adult PAID questionnaire for those aged 20–24 years. Mealtime insulin engagement was measured using the mean daily BOLUS score, which quantifies the frequency and timing of insulin boluses relative to meals.

Results:
Participants showed wide variability in diabetes distress and mealtime insulin engagement. About 21% of participants had significantly high diabetes distress. Higher PAID scores were modestly associated with higher mean daily BOLUS scores (Spearman ρ = 0.37, not significant). Scatter plots revealed heterogeneity, including participants with high distress who maintained relatively high engagement. After excluding a single participant with an extreme BOLUS score, which was notably different from the rest of the cohort and appeared to be an outlier, the association strengthened and reached statistical significance (Spearman ρ = 0.32, p < 0.05), suggesting a modest relationship between higher distress and greater mealtime insulin use at baseline.

Conclusions:
Among adolescents and young adults enrolled in the EquiT1D study, diabetes distress showed a modest positive association with objectively measured mealtime insulin engagement. Substantial heterogeneity in our data may reflect different coping patterns among participants. Some youth appeared to experience high diabetes distress while maintaining high mealtime insulin engagement, which could reflect more vigilant or effortful coping, whereas others with lower engagement might be using different approaches.

*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*