Aim: Emerging adults (EA) with type 1 diabetes (T1D) have higher rates of suicide risk compared to their peers without T1D. This is the first known study to examine the association between diabetes distress (DD) and suicide risk in EA with T1D. Methods: EA completed measures of DD (Problem Areas in Diabetes-Teen; PAID-T), depressive symptoms (Patient Health Questionnaire-9; PHQ-9) and anxiety (General Anxiety Disorder-7) as part of routine clinical care. Suicide risk was assessed as a binary variable using PHQ-9 item 9, which queries about thoughts of suicide or self-harm. Mixed effects logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) to assess the relationship between DD and suicide risk. Analyses were adjusted for depression as measured by the PHQ-8 (first 8 PHQ-9 items), anxiety, sex, and BMI. Results: Sample included 450 EA. Approximately 9% of participants reported suicide risk; endorsement of suicide risk was associated with elevated A1C and female sex (Table 1). Adjusted regression analyses show an additional 10 points on the PAID-T was associated with over doubled odds of endorsing suicide risk (OR 2.07, 95% CI 1.12-3.83). Conclusion: DD may be a unique risk factor for suicide risk in EA with T1D. Routine screening of DD is critical for early identification and offers a potential intervention point for patients who may be at increased risk for suicide. Disclosure A.Moss: Other Relationship; American Diabetes Association. F.Malik: None. S.J.Lowry: None. A.J.Roberts: None. A.Huang: None. C.Pihoker: None. K.Weaver: None. I.B.Hirsch: Consultant; Abbott Diabetes, Lifecare, Inc., Hagar, Research Support; Beta Bionics, Inc., Insulet Corporation, Dexcom, Inc. N.M.Ehrhardt: Advisory Panel; Novo Nordisk, Dexcom, Inc., Consultant; Nestlé Health Science. A.Zenno: None.

Background: The Achieving Health in Emerging Adults with Diabetes (AHEAD) Program is designed to meet the health care transition and psychosocial needs of emerging adults (EA) with type 1 diabetes (T1D). Objective: To evaluate the impact of the AHEAD Program on diabetes distress (DD) in EA with T1D. Methods: DD was evaluated using the Problem Areas in Diabetes-Teen survey (PAID-T). Mixed-effects linear regression with a random effect for individual to account for repeated measures was used to evaluate change in DD over time. Models were adjusted for age, race, ethnicity, technology use, and insurance. We assessed whether improvement varied by age, technology use, insurance, or baseline (BL) elevated DD (PAID-T≥44). Results: Sample included 489 EA with T1D (BL visit: mean age 20.3 years, 52% male, 75% Non-Hispanic White, 26% public insurance, 59% continuous glucose monitor use, 58% insulin pump use, 19% elevated DD). Overall mean PAID-T scores decreased from 31.4 at BL (95% CI: 30.1, 32.8) by 4.6 points (95% CI: -7.4, -1.7; p=0.001) at 2 years (Figure). By 2 years, mean PAID-T scores for patients with elevated DD at BL decreased by 16.2 points (95% CI: -22.9, -9.5; p<0.001) compared to a 3.3 point (95% CI: -6.2, -0.5; p=0.02) decrease in those without elevated DD at BL. PAID-T improvement did not vary by age, technology use, or insurance (all p>0.05). Conclusion: The AHEAD Program offers a promising approach to reduce DD in EA with T1D. Disclosure F.Malik: None. N.M.Ehrhardt: Advisory Panel; Novo Nordisk, Dexcom, Inc., Consultant; Nestlé Health Science. K.Hoch: None. K.Weaver: None. I.B.Hirsch: Consultant; Abbott Diabetes, Lifecare, Inc., Hagar, Research Support; Beta Bionics, Inc., Insulet Corporation, Dexcom, Inc. C.Pihoker: None. A.J.Roberts: None. C.Taplin: Stock/Shareholder; Quest Diagnostics. S.J.Lowry: None. J.P.Yi-frazier: None. A.Moss: Other Relationship; American Diabetes Association. A.Huang: None. Funding Forest Foundation; Sequoia Foundation

Background: Preconception planning can reduce complications in pregnancy with type 1 diabetes. However, high periconception HbA1C is not uncommon and increases maternal and fetal risks. Due to limited data regarding preconception counseling, questions about education and contraception use were added to the 2022 T1DX-QI survey. Methods: The annual T1DX-QI survey was conducted August-September 2022 with a site response rate of 94% of 50 sites: 33 pediatric (66%), 17 adult (34%). Respondents answered questions relating to clinic resources and practices. Response data was cleaned and summarized. Results: Most sites report discussing contraception (74%) and pregnancy planning (72%) once a year or more. Of pediatric sites, 42% report always asking about menstruation history compared to 6% of adult sites. Only 12% of adult and 6% of pediatric sites have a formal preconception counseling protocol. Only 12% of adult and 9% of pediatric sites estimated that >80% of their patients of childbearing potential were using contraception, and all sites estimated that <60% had a HbA1C under 7%. Conclusions: Though most sites report discussing contraception and pregnancy planning, estimated rates of formal counseling programs, contraception use and attaining goal HbA1C remain low. QI efforts are needed to determine rates of preconception counseling and implement best practices to improve pregnancy outcomes. Disclosure G.O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. M.Basina: None. R.Fallurin: None. C.J.Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. T1dx-qi collaborative: n/a. S.J.Ogyaadu: None. C.Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. N.Rioles: None. H.Hardison: None. A.J.Roberts: None. S.Accacha: None. I.Guttmann-bauman: None. F.Vendrame: Consultant; Eli Lilly and Company. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Background: The primary objective of this U.S. based multi-center study was to examine the association of overweight and obesity with A1c levels for children and adolescents with type 1 diabetes (T1D) . Methods: Electronic health record data spanning 2017-2021 for children and adolescents from the T1D Exchange Quality Improvement (T1DX-QI) Collaborative was analyzed. BMI percentiles were calculated using the Centers for Disease Control and Prevention growth curves, and children were categorized into normal weight, overweight, obese and severely obese groups. Normal weight was defined as a BMI < 85th percentile for age and sex. Overweight was defined as a BMI ≥ 85th to < 95th percentile. Obesity was defined as having a BMI <120% of the 95th percentile whereas severe obesity was defined as having BMI ≥120% of the 95th percentile. HbA1c levels and BMI were from last in-person encounter. Results: Of 14,484 T1D patients aged < 18 years, 2,063 (14%) were underweight, 9,320 (65%) normal weight, 1,769 (12%) overweight, 977 (7%) obese and 333 were severely obese (2%) . More people of Black (12%) and Hispanic (18%) race/ethnicity were in the obese group relative to the normal weight group (8% and 10% respectively; p<0.001) . HbA1c levels were higher in the obese/severely obese group compared to normal weight patients (HbA1c Mean (SD) : Obese (9.1 (2.3)) /severely obese (9.1 (2.2) vs. Normal weight: 8.7 (2.0) ; p<0.001) . Conclusion: In this extensive real-world study, we found obese children and adolescents with T1D were more likely of Black or Hispanic race/ethnicity and have higher HbA1c levels compared to those with healthy weight. Disclosure A.B.Mekhoubad: None. B.Miyazaki: None. J.M.Lee: Advisory Panel; GoodRx, Consultant; Tandem Diabetes Care, Inc. S.Hsieh: None. N.Noor: None. O.Ebekozien: None. S.Rompicherla: None. E.L.Ospelt: None. A.J.Roberts: None. J.Sanchez: None. D.Ferro: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Background: The UW AYA Diabetes Program is a partnership between Seattle Children’s Hospital and UW Medicine designed to meet AYA health care transition and mental health needs. Objective: To evaluate the impact of the UW AYA Diabetes Program on glycemic control. Methods: The study included 453 AYA with diabetes (baseline visit: mean age 20.8 years, 51% male, 70% Non-Hispanic White, 27% public insurance, 95% type 1 diabetes, 55% continuous glucose monitoring (CGM) use, 55% pump/automated insulin delivery use) who have received diabetes care within the UW AYA Diabetes Program for ≥6 months. Mixed-effects linear regression with a random effect for individual to account for repeated measures was used to evaluate change in A1C over time. Regression model was adjusted for age, race, ethnicity, diabetes technology use, and health insurance. Results: Mean adjusted A1C decreased steadily with increasing time in the UW AYA Diabetes Program (Figure) . The difference was statistically significant compared to baseline A1C levels by the time participants had been in the program for 2 years (8.1%, 95% CI: 7.8-8.4 vs. 8.8%, 95% CI: 8.6-9.0) . A1C improvement did not vary by age, diabetes technology use, or health insurance (all p>0.05) . Conclusion: The UW AYA Diabetes Program offers a promising approach to improve glycemic control in AYA transitioning from pediatric to adult diabetes care. Disclosure F.Malik: n/a. N.M.Ehrhardt: Advisory Panel; Dexcom, Inc., Novo Nordisk, Research Support; Dexcom, Inc., Merck & Co., Inc., Novo Nordisk. A.Paget: None. K.Hoch: None. K.W.Weaver: None. I.B.Hirsch: Consultant; Abbott Diabetes, Bigfoot Biomedical, Inc., GWave, Roche Diabetes Care, Research Support; Beta Bionics, Inc., Insulet Corporation, Medtronic. C.Pihoker: None. C.Taplin: Advisory Panel; Insulet Corporation, Speaker's Bureau; Medtronic. A.J.Roberts: None. S.J.Lowry: None. J.Yi-frazier: None. A.Moss: None. A.Huang: None. Funding Forest Foundation, Sequoia Foundation