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Traditional methods for treating central diabetes insipidus during infancy, such as fluid therapy or the use of intranasal hormone replacement, have significant potential limitations. In a retrospective study of infants with diabetes insipidus, we examined outcome using subcutaneous (sc) DDAVP, and compared this to infants treated with intranasal lysine vasopressin or DDAVP. After in-patient dosage titration, outpatients' serum sodium concentrations were maintained in a narrower range in the sc group compared with the intranasal group, and the percentage of serum sodium concentrations within the normal range was greater in the sc group. There were no significant complications in either group. We conclude that DDAVP administered subcutaneously can be a safe and effective alternative to traditionally recommended treatments of central diabetes insipidus during infancy.

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Introduction: Adolescents and young adults (AYAs) with diabetes are at risk for suboptimal psychological functioning. This study aims to describe the prevalence of elevated depression scores, outpatient psychotherapy referrals, and individuals receiving follow-up care in a clinic with an integrated psychologist. Further, we examine whether having an integrated psychologist leads to better access to mental health services for AYA. Methods: Participants were seen in a multidisciplinary diabetes clinic from September 2016 to 2017. Assessment included a semi-structured interview and depression screener (PHQ). Families with concerns related to diabetes management were offered on-site outpatient psychotherapy, others given community referrals. Follow-up with referrals was assessed at next diabetes visit. Results: Participants included 100 ethnically diverse AYAs, 11-21 years (M=16.06±2.42; 56% female), diagnosed with type 1 (79%), type 2 (19%), or MODY (2%), with a range of glycemic control (HbA1c 5.5 to >14%). PHQ scores were: no/minimal (58%), mild (26%), moderate (11%), moderately severe (3%), and severe (2%). 59% of patients were referred for outpatient psychotherapy. Referral reasons included depression, anxiety, behavioral difficulties, family conflict, and diabetes management challenges. At follow-up, only 9% were receiving services. Barriers included transportation, organization (e.g., losing referral), and stigma. Conclusions: Pediatric psychologists within integrated diabetes teams offer effective mental health screening and referrals. Almost half (42%) of AYA in our cohort had ≥5 depressive symptoms, and while 59% were referred for outpatient therapy, only 9% received these services. Despite patient access to a pediatric psychologist in clinic, a large discrepancy between referral and follow-up rates remains. This disparity highlights the importance of identifying and reducing barriers to follow-up care for AYAs with diabetes. Disclosure J. Tsikis: None. J.M. Valenzuela: None. A. Vassilopoulos: None. C. Wilcocks: None. L. Reitblat: None. E.J. Blanco: None. S. Nicholls: None. R. Wolf: None.