Introduction: Diabetes Distress refers to the negative emotional impact and unremitting frustrations associated with living with type 1 diabetes (T1D). 1 While multiple scales have been developed to assess diabetes distress, the T1D Diabetes Distress Scale (T1-DDS) is a recently-validated scale designed to quantify diabetes distress in individuals with T1D specifically. 2 This scale consists of 28 items assessed on a 6-point Likert-type scale, grouped into 7 subscales: powerlessness, management distress, hypoglycemia, negative social perceptions, eating distress, physician distress, and friend/family distress. Diabetes distress in adolescents with diabetes has been previously evaluated, 3 but previous studies have not looked at the T1-DDS in the adolescent transition population specifically. The purpose of this study was to characterize diabetes distress in adolescents transitioning to adult care using the T1-DDS. Methods: Between 2016-2018, we recruited 100 adolescents with T1D at their last pediatric visit before transitioning to adult care. We collected demographic and basic clinical data and administered the T1-DDS using RedCap, an online data management platform. We analyzed T1-DDS scores as a continuous variable and used linear regression to determine the demographic and clinical factors associated with diabetes distress (and each diabetes distress subscale) in this population. We used the Bonferroni correction to account for multiple comparisons for each T1-DDS subscale. Results: 68% of participants completed the T1-DDS in its entirety and the mean T1-DDS score for each question was 1.93 (standard deviation 0.83), where 1 indicates low diabetes distress and where 6 indicates high diabetes distress. The only variable that was consistently associated with higher diabetes distress across most T1-DDS subscales was female sex (p <0.001 for T1-DDS total score). Higher average A1C was associated with higher diabetes distress on the management distress subscale (p = 0.009). More frequent hospitalizations were associated with higher diabetes distress in the total T1-DDS score (p = 0.009), the hypoglycemia subscale (p = 0.009), and the friend/family distress subscale (p = 0.009). Conclusions: Consistent with previous studies, female sex and poorer glycemic control were associated with higher diabetes distress. 1-3 This study showed that the T1-DDS can be used to identify diabetes distress in adolescents with T1D as they transition to adult care. Future research should collect one-year post-transition T1-DDS scores in this cohort of patients. References: 1. Dennick et al. J Diabetes Complications. 2017;31(5):898-911. 2. Fisher et al. J Diabetes Complications. 2015;29(4):572-7. 3. Hagger et al. Curr Diab Rep. 2016;16(1):9.

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Introduction: Adolescents with type 1 diabetes (T1D) experience ongoing deterioration in their glycemic control as they transition to young adulthood.1 Several trials have evaluated possible transition interventions to ameliorate the care gap between pediatric and adult services in T1D care, although it remains unclear which are the most appropriate.2,3 In this pragmatic study, we sought to determine whether the change in quality of life pre- and post-transition was different between adolescents with T1D accessing a transition program versus those who did not. Methods: Between 2016-2018, we recruited 68 adolescents with T1D at their last pediatric diabetes clinic visit from a tertiary diabetes center without a structured transition program (control group) and 33 from a community-based outreach clinic with a transition program (intervention group) consisting of a transition coordinator, joint transition clinics, and pediatric and adult clinics located in the same building. At the time of transition and at one-year post-transition, we conducted chart reviews and administered surveys, including the SF-8 quality of life questionnaire. Analysis included descriptive statistics and linear regression models. Results: The control and intervention groups had the following characteristics, respectively: age at transition 18.4 years vs. 20.5 years (p&lt;0.001); female 47% vs. 55% (p=0.49); average A1C at the time of transition 8.2% vs. 9.1% (p=0.0053). There was no statistically significant difference in the change in SF-8 scores for each of the eight domains (general health, physical functioning, role physical, bodily pain, vitality, social functioning, mental health, and role emotional) between the two groups. However, older age at transition was associated with an improvement in SF-8 vitality domain scores between the pre- and post-transition timepoints (p=0.034). Female sex was associated with a worsening in SF-8 vitality domain (p=0.004) and social functioning domain (p=0.015) scores between the pre- and post-transition timepoints. Finally, higher average A1C in the year prior to transition was associated with a worsening in SF-8 role physical domain scores between the pre- and post-transition timepoints (p=0.002). Conclusions: Quality of life scores in the vitality domain improved in the first year post-transition amongst young adults with T1D who transitioned at an older age, suggesting that a later transition may benefit adolescents with T1D. Additionally, worsening quality of life scores amongst young women and in those with higher pre-transition A1Cs suggest that these populations may require more specialized care at the time of transition. References: 1. Foster et al. Diabetes Technol Ther. 2019;21(2):66-72. 2. White et al. Lancet Child Adolesc Health. 2017;1(4):274-83. 3. Spaic et al. Diabetes Care. 2019;42(6):1018-26.

Introduction: It has been well-established that, among Adolescents with type 1 diabetes mellitus (T1D), glycemic control deteriorates during the transition from pediatric to adult care. 1 This transition is associated with short- and long-term consequences, including microvascular and macrovascular complications, and mortality. 2,3 Further, adolescents with T1D who have poor glycemic control pre- transition to adult care continue to have poor glycemic control during and post- transition. 4 Identifying patients at highest risk of having poor glycemic control at the time of transition is critical, so providers can intervene and mobilize resources for these adolescents even before they reach the age of transition to adult care. The objective of this study was to determine clinical and demographic characteristics that predict poor glycemic control in adolescents with T1D at the time of transition to adult care. Methods: Between 2016-2018, we recruited 100 adolescents with T1D at their last pediatric visit from a community outreach clinic (n = 32) and a tertiary diabetes clinic (n = 68). We collected the following demographic and clinical data: age at T1D diagnosis, age at transition to adult care, clinic site (community vs. tertiary), sex, ethnicity, insulin regimen, comorbid conditions, last 3 A1C levels, mother and fathers’ marital status and highest education, emergency department visits and hospitalizations in the last year. Study participants also completed the AM I ON TRAC questionnaire and the T1D Diabetes Distress Scale (T1-DDS). We used univariable logistic regression to determine predictors of poor glycemic control (A1C>7.5%). Results: An average of the last three A1Cs was ≤7.5% in 26% of participants, and >7.5% in the remaining 74%. Pediatric care at the community outreach clinic (p=0.042) and female sex (p=0.001) were predictive of an average A1C >7.5% at the time of transition to adult care. Also, those who scored higher on management distress and eating distress at the time of transition were more likely to have poor glycemic control. Conclusions: This study suggests that adolescents accessing care at a community-based outreach clinic and those experiencing higher levels of diabetes distress may be at higher risk of poor glycemic control at the time of transition. Further, female youth with T1D who are approaching transition age have poorer glycemic control. The results of this study can be used by clinicians to identify patients who have the highest risk of having poor glycemic control at the time of transition, allowing them to intervene early and potentially prevent poor outcomes post-transition. References: 1. Miller et al. Diabetes Care. 2015;38(6):971-8. 2. Peters et al. Diabetes Care. 2011;34(11):2477-85. 3. Orchard et al. JAMA. 2015;313(1):45-53. 4. Lotstein et al. Pediatrics. 2013;131(4): 1062-1070...

Introduction: The AM I ON TRAC questionnaire (also known as ON TRAC) is a 25-item survey that evaluates readiness for transition to adult care in adolescents with chronic conditions. 1 This questionnaire is comprised of a knowledge scale (KS, 16 items) and a behavior cut-off score (BCS, 9 items). Adolescents with a score of ≥8 on the BCS are considered ready for transition to adult care. The validation study (n = 200) of the ON TRAC questionnaire included participants from pediatric diabetes, cardiology, gastroenterology, and neurology clinics, but there have been no studies on the use of the ON TRAC questionnaire in adolescents with type 1 diabetes (T1D) at the time of transition to adult care. 1 The objective of this study was to determine which patient characteristics are associated with “readiness for transition” according to the ON TRAC BCS in this population. Methods: We obtained demographic information, clinical data, ON TRAC questionnaire scores, and T1D Diabetes Distress Scale scores (T1-DDS) from 100 adolescents with T1D recruited between 2016 and 2018 at their last pediatric clinic visit before transition to adult care. Transition readiness as defined by the BCS was analyzed as a dichotomous variable (i.e. ready for transition vs. not ready for transition). T1-DDS scores were summarized for each of the 7 diabetes distress subscales. We used univariable logistic regression to determine the factors associated with transition readiness. Results: 74% of study participants completed the ON TRAC questionnaire in its entirety, of which only 38% had a BCS that indicated readiness for transition. “Transition readiness” as indicated by the BCS was associated with lower T1-DDS management distress (OR 0.61, 95% CI 0.38-0.96, p = 0.034). “Transition readiness” was also associated with lower diabetes distress on the T1-DDS 5-item screen (OR 0.48, 95% CI 0.25-0.93, p = 0.029), which uses 5 questions from different subscales of the T1-DDS. These results suggest that those who are “ready for transition” have lower levels of diabetes distress. Transition readiness as defined by the BCS score was not associated with any other demographic or clinical parameter. Conclusions: Our results show that levels of diabetes distress may be able to predict transition readiness (and vice versa). Despite numerous recommendations from international consortiums on the best practices for the pediatric-to-adult transition in T1D care, there are few well-accepted tools to inform clinicians, patients, and families of transition readiness. 2-3 This study demonstrates that the ON TRAC questionnaire may be an appropriate tool to assess transition readiness in youth with T1D and that diabetes distress is associated with transition readiness. References: 1. Moynihan et al. J Adv Nurs. 2015;71(6):1324-35. 2. Wafa and Nakhla. Can J Diabetes. 2015;39(6...