Background: AID systems improve glycemic control in youth with type 1 diabetes (T1D). There was a full market release of the OmniPod 5 (OP5) AID system in the United States on 8/1/2022 and it was FDA approved for ages ≥2 on 8/22/22. OP5 is available through pharmacy benefits and requires users to have a smartphone. We hypothesized that disparities exist in OP5 access. Methods: We assessed OP5 use at two pediatric diabetes centers among youth with T1D ages 2-21 who were using any version of an OmniPod (OP) insulin pump 3-months after the full market release. Differences in demographic characteristics of OP5 users compared to other OP pump users were assessed using Chi-squared and student’s independent two-sample t tests. Results: Of 1037 youth (mean age 12.8±4.4 years, 49.5% female, mean T1D duration 5.3±3.7 years), 510 (49.2%) were using OP5. Rates of OP5 use were higher among non-Hispanic White youth than among youth of all other racial/ethnic identities (53.2% vs 38.0%, p<0.0001). Youth using OP5 were more likely to be younger (12.3±4.0 years vs 13.2±4.7 years, p=0.0001) and to have a shorter T1D duration (4.9±3.5 vs 5.8±3.9 years, p=0.0002). There was a trend towards lower rates of uptake among publicly versus privately insured youth (43.1% vs 50.7%, p=0.054). There was no difference in OP5 use by sex (48.2% female vs 51.8% males, p=0.43). Conclusions: Minority youth were less likely to access the OP5 AID system 3-months after full-market release. Given the glycemic improvements associated with AID systems, it is important to promote equitable access to the latest diabetes technologies. Improving insurance coverage of technologies and supporting AID access without the need for a smartphone may support these goals. Disclosure B.E.Marks: Research Support; Tandem Diabetes Care, Inc., Dexcom, Inc., Medtronic. S.Meighan: Speaker's Bureau; Dexcom, Inc. E.A.Brown: None. A.Zehra: None. R.Suresh: None. J.L.Douvas: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. Funding National Institutes of Health (K23DK129827)

Diabetic retinopathy (DR) is a complication of diabetes that can result in vision loss, but early detection and treatment through screening can prevent this. Few individuals with diabetes meet recommended DR screening guidelines, and racial/ethnic minority youth are less likely to undergo recommended screening. We sought to determine if implementing point of care (POC) autonomous artificial intelligence (AI) screening could mitigate disparities in diabetic eye exam completion. In a preregistered prospective study, ACCESS2, youth with type 1 and type 2 diabetes meeting American Diabetes Association criteria for needing DR screening underwent point of care autonomous AI diabetic eye exams at diabetes clinic visits. Completion rates of diabetic eye screening exams were compared prior to and after implementation of autonomous AI using chi-square tests. A total of 152 youth with T1D (69.7%) and T2D (30.3%) were enrolled, mean age 15.5y, 45.4% non-Hispanic (NH) White, with duration of diabetes of 5.7y, and median HbA1c of 8%. A greater percentage of NH White participants reported any prior diabetic eye exam compared to non-white and Hispanic participants (92.8% v 65.1%, p<0.001). Multivariable analysis demonstrated that even when controlling for age, sex, HbA1c, Medicaid insurance, diabetes type and duration of diabetes, non-white youth are less likely to have had a prior diabetic eye exam (OR 0.26, CI: 0.07-0.93, p=0.04). After undergoing POC autonomous AI diabetic eye exams, completion rates were 99% for participants in all subgroups. Implementation of autonomous AI at the point of care increases access to and completion of diabetic eye exams, and promotes health equity for minority youth with diabetes. Disclosure A.Zehra: None. M.D.Abràmoff: Board Member; Digital Diagnostics, Consultant; AbbVie Inc., NovaGo Therapeutics AG, Other Relationship; Digital Diagnostics, Stock/Shareholder; Digital Diagnostics. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. L.A.Bromberger: None. B.Pan: None. A.Shehadeh: None. D.Patel: None. E.A.Brown: None. R.Channa: None. T.Liu: None. H.Lehmann: None. Funding National Eye Institute (R01EY033233, 5K23EY030911-03)

Diabetic retinopathy (DR) is a microvascular complication of type 2 diabetes (T2D) and a major cause of vision loss worldwide. The TODAY study reported a DR prevalence of 51% among patients with youth onset T2D (average T2D duration 13.3 years, mean age of 26.4 years). Prevalence rates of DR in youth-onset T2D with shorter duration and younger age is unclear. In a multicenter analysis, eye exams or retinal images from patients with youth-onset T2D at Cincinnati Children’s, Johns Hopkins, and University of Wisconsin were assessed for presence of DR using t-tests and fisher’s exact test. The study included 228 youth (mean age 16.5±3.5years, mean T2D duration 3.0±2.6 years). Seven participants (3%) were positive for DR. Compared to youth negative for DR (n=221), those with DR (n=7) had a longer duration of diabetes (5.3±3.1 v. 2.9±2.6years, p=0.015) and higher hemoglobin A1c at the time of the diabetic eye exam (10.0±2.1 v. 7.5±2.6%, p=0.012). There were no differences in age, race/ethnicity, sex, or types of medication prescribed between those with and without DR. Of those with DED, when compared to all other ethnicities, NH Black youth had a higher rate of positive diabetic eye exams (p=0.04). Our study found a lower prevalence of DR in youth with T2D at younger age and shorter duration of diabetes. Further work is needed to determine the inflection point when the incidence of DR increases. Disclosure R.Channa: None. R.M.Wolf: Research Support; Dexcom, Inc., Boehringer Ingelheim Inc. A.S.Shah: None. V.S.Shah: None. M.Bahrainian: None. E.A.Brown: None. T.Liu: None. B.Magella: None. H.Lehmann: None. M.D.Abràmoff: Board Member; Digital Diagnostics, Consultant; AbbVie Inc., NovaGo Therapeutics AG, Other Relationship; Digital Diagnostics, Stock/Shareholder; Digital Diagnostics. Funding National Eye Institute (R01EY033233, 5K23EY030911-03)

Background: Continuous glucose monitoring (CGM) improves glycemic control for youth with type 1 diabetes (T1D) . Despite these benefits, less than half of youth with T1D use CGM. Objective: To determine if trial CGM use (10-days) increases CGM uptake and is associated with improved glycemic control among minority youth and youth with poorly controlled T1D. We also examined barriers to CGM use. Methods: This prospective study was conducted at an academic Pediatric Diabetes Center. Youth with T1D for more than 3 months, with no previous CGM usage, or no CGM usage in the last year were enrolled. Diabetes staff placed CGM at the point of care (POC) and provided CGM education. Barriers to prior CGM use, hemoglobin A1c (HbA1c) , and demographic information were recorded. Participants received 5 and 10-day follow up calls from the diabetes team to review glycemic trends. At 3 months, participants' use of CGM and HbA1c were recorded. Results: Youth with T1D (n=22) were enrolled (13 first time CGM users, 9 past users) , mean age 14.1years (SD 3.1) , 41% non-Hispanic black, 68% female, mean diabetes duration 6.3 ± 4.4years, and baseline mean HbA1c of 10.8%. Patient-cited barriers to prior CGM use included technical difficulties (n=5) , unawareness of CGM (n=4) , difficulty obtaining CGM (n=4) , general apprehension (n=3) , not wanting devices (n=3) , and pain, fear of needles, and new diabetes diagnosis (n=1 each) . Of participants, 20 completed some follow-up, and 18/20 (90%) cited wanting to use CGM long-term. Of 13 participants who completed 3 and/or 6-month follow-up visits, only 9 were actively using CGM. Further barriers to use included insurance issues (n=2) and CGM falling off (n=1) . There was no change in mean HbA1c from baseline to follow-up (10.8 ±2.4% vs. 10.3 ±2.3%, p=0.46) . Conclusion: There are many barriers to CGM uptake in youth. Providing a trial use of CGM at the POC may increase uptake of CGM use in at-risk diabetes populations, but further investigation of additional barriers that impact long-term adherence to CGM is needed. Disclosure T.L.Lin: None. J.A.Manfredo: None. N.Illesca: None. K.Abiola: None. N.Hwang: None. M.Seel: None. E.A.Brown: None. R.M.Wolf: Consultant; NEMA Research, Research Support; Dexcom, Inc. Funding Johns Hopkins Children's Center Innovation Award, and Dexcom

Background: Continuous glucose monitor (CGM) is a widely accepted tool for managing glycemia in youth with type 1 diabetes (T1D) and adults with type 2 diabetes (T2D) ; however, studies exploring its use in T2D in youth are limited. Objective: Determine if a day trial use of CGM in youth with T2D improves short term and long term glycemic control as measured by time in range (TIR = percentage of time blood glucose is 70-180 mg/dL) , and 3 mo hemoglobin A1c (HbA1c) , respectively. Methods: Youth with T2D for more than 3 mos, on insulin therapy, with no prior CGM use were enrolled. Diabetes staff placed the CGM at the point of care and provided standardized education. At initial visit, HbA1c and demographic information were recorded. Participants received a 5 day and day follow up (FU) phone call from diabetes staff to review glucose and TIR data, with counseling and dose adjustments as needed. At 3 mos, HbA1c was recorded. We compared 5 day TIR and day TIR, and baseline and 3 mo HbA1c via paired t-test. Results: Youth with T2D (n=35) enrolled had mean age of 15.9 y (SD 1.9 y) , 63% female, 83% black, and average diabetes duration of 1.8 y (SD 1.6 y) . A majority had household income <$50K (63%) and parental education level of HS degree or less (68%) . Average 5 day TIR 48% was similar to day TIR 51% (p=0.28) . There was no change in HbA1c after 3 months (10.3% v 11.1%, p=0.39) . Only 18 participants completed the full day CGM use; those that did not cited device connection issues (3) , device fell off early (8) , device removed early due to irritation (3) or lost to FU (3) . Of the 18 youth who completed day CGM use and nursing FU calls, 78% wanted to use a CGM long term. Conclusion: Although a trial CGM use over days did not impact short term or long term glycemic control in youth with T2D, most participants who completed the full days wanted to continue using CGM. Issues with device connectivity and adhesion were barriers to consistent device use. Future larger studies with longer use of CGM may help clarify the potential impact of CGM in youth with T2D. Disclosure J.A.Manfredo: None. R.M.Wolf: Consultant; NEMA Research, Research Support; Dexcom, Inc. T.L.Lin: None. R.Gupta: Consultant; Cabaletta Bio. K.Abiola: None. M.West: None. K.Busin: None. J.Tracey: None. E.A.Brown: None. S.N.Magge: None. Funding Johns Hopkins Childrens Center Innovation Award Dexcom (investigator-initiated support)