Background: Children and adolescents with diabetes mellitus (DM) are faced with a unique set of challenges associated with the management of their disease. There is evidence that extrinsic rewards can help patients to meet health goals. Gift cards were used as incentives. Objective: Assess the incentive program’s impact on patient hemoglobin A1c (HbA1c) during the program’s first year. Methods: A retrospective chart review was conducted of all clinic patients with DM with clinic visits between February 24, 2018 and December 31, 2019. Any patient with DM seen in the TMCOne Pediatric Endocrinology clinic who set a behavioral modification and achieved that goal were included. Patients set two goals at each visit. In phase 1, if two goals were met patients received a $5 gift card or a small prize. In phase 2, if two subsequent goals were met, a $10 gift card or a larger prize was awarded. In phase 3, if four subsequent goals were met, a $20 gift card was rewarded. HbA1C values were recorded at baseline and after goals 2, 4, and 8. Results: At baseline N=123 (45% F; ages 1-22), with a mean HbA1c of 8.3% (SD= 2.2). In phase 1, the change after the first two behavior modification goals were achieved was -0.19 (P = 0.43; SD=2.6). Only 37 were able to achieve goals 3 and 4. In phase 2, the mean HbA1c was 7.7% (SD= 1.9) and the change in HbA1c was -0.19 (P = 0.66y; SD=1.16). In phase 3, only 4 of the 123 patients were able to achieve goals 5, 6, 7 and 8. The mean HbA1c was 6.5% (SD=0.98). The change in HbA1c was +0.73 (P = 0.17; SD=0.66). Conclusion: This study demonstrates the potential of extrinsic incentives to achieve the behavioral goals did not result in improvement of HbA1c values. The number of children who were able to achieve goals 3 and 4 dropped drastically compared to the those who are able to achieve goals 1 and 2. In addition, the mean HBA1c value dropped which with each phase. The SD of each phase also decreased. We surmise patients who maintained excellent control were more likely to start and complete the behavior change goals over an extended period of time. Disclosure C.K. Wu: None. P.G. Patel: None. J. Lai: None. A. Bashar: Other Relationship; Self; Medtronic. K.M. Siderewicz: None. R. Tiwari: None. N.J. Cuzman: None. K. Payton: None. S. Goral: None. C.M. Patel: None. Funding TMC Foundation

Purpose The management of foreign body ingestion proves to be a challenge. Magnets pose a unique set of risks when ingested due to their attractive forces and subsequent risk of adherence, pressure necrosis, and perforation complications. Radiographs only provide a limited snapshot in the setting of multiple magnet ingestion when the risk of complication is highest. We hypothesize that abdominal ultrasound (US) has the potential to supplement radiographs in assessing ingested magnets by determining the presence of bowel loop entrapment and of any extraluminal fluid. Methods We recreated various scenarios of magnet configurations using animal cadaveric bowel models. X-ray and US images were obtained in various bowel-magnet orientations. Results We identified several key US features to suggest bowel wall tethering. These include direct visualization of bowel wall entrapment between magnets (what we term the “dangerous V sign”), anti-dependent positions of the magnets, and inability to separate loops of bowel with compression. Conclusion These findings could potentially provide valuable information when directing the urgency of intervention in foreign body ingestion. Ultrasound may supplement and improve the current guidelines in management of magnet ingestion.