We developed a pediatric T1D remote patient monitoring (RPM) program, ROCKET T1D (Remote Outreach & Care for Kids’ Empowerment and Technology use in T1D), with the aims of supporting youth at risk for chronic hyperglycemia and DKA and their families to leverage emerging technology, improve self-management habits, and achieve self-care goals to thrive with T1D. The ROCKET T1D program, supported by diabetes educators and social workers, includes a proactive “Launch Phase” with frequent virtual touchpoints for education, psychosocial support, and therapy adjustments, followed by an “Orbit Phase” with a less frequent remote data review and therapy adjustments. Prior to ROCKET T1D go-live, we developed an electronic medical record (EMR)-based diabetes registry with dashboards to enable remote monitoring, visualization of a validated DKA risk score and clinical data (e.g., pump/CGM use, A1C, etc.) to quickly assess clinical progress and facilitate targeted outreach. Patients are added to the ROCKET T1D Registry via the EMR’s “FYI Flag” feature, which allows visualization of progress through the Launch and Orbit Phases in the dashboard (Figure 1). We are actively working on automated integration of CGM data into ROCKET T1D dashboards to enable proactive outreach to patients at highest glycemic risk, with intent to optimize time in range and prevent DKA. Disclosure S.Lyons: None. R.Y.Sonabend: None. D.D.Schwartz: None. K.D.Timmons: None. D.Desalvo: Consultant; Dexcom, Inc., Research Support; Insulet Corporation. Funding The Leona M. and Harry B. Helmsley Charitable Trust (2206-05307)

Current practice guidelines recommend considering a diagnosis of MODY in patients with a strong family history but without typical features of type 2 diabetes (T2D) (i.e., obesity, insulin resistance, high-risk ethnicity) or type 1 diabetes (T1D) (i.e., islet autoantibodies). We aimed to test if these criteria apply to a racially diverse pediatric patient population. Using EPIC Population Health, we retrospectively reviewed electronic medical records (IRB H-41512) of youth diagnosed with MODY between 2013-2017 in a large academic pediatric hospital in Southwestern U.S. We found that, out of 46 patients with MODY, 50% (n=23) had MODY 2, 17.3% (n=8) MODY 3, 17.3% (n=8) MODY 5, 8.6% (n=4) MODY 1, 2.1% (n=1) MODY 4, and 8.6% of patients had a clinical diagnosis of MODY due to inability to perform molecular testing. The mean (SD, range) age of diabetes diagnosis was 10.1 years (4.4, 2-17); 52% of patients were females; 50% were non-Hispanic white, 32.5% Hispanic, 6.5% African American, 6.6% Lebanese, 2.2% Asian and 2.2% others/unknown. Notably, 15.2% (n=7, all with a molecular diagnosis of MODY) had positive islet antibodies, 8.6% (n=4) Hashimoto’s thyroiditis and 2.1% (n=1) vitiligo. Obesity/overweight was present in 23.8%, 15.2% had hypertension / prehypertension and 21.7% had dyslipidemia. Diabetes was absent in parents and siblings of 26% (n=12) of patients, although in 5 patients, the mother had gestational diabetes. Persistent microalbuminuria was found in 2 youth with MODY 2 and diabetic neuropathy in 1 patient with MODY 2. The mean (SD, range) time between the diagnoses of diabetes and MODY was 14.3 months (22.3, 1-120). In conclusion, youth with MODY often were of ethnic minorities, lacked a family history of diabetes and had characteristics typical of T1D or T2D, suggesting that the current guidelines to consider a diagnosis of MODY may not apply to a racially diverse U.S. pediatric population. Furthermore, in contrast to previous studies, we identified microvascular complications in youth with MODY 2. Disclosure S. Relan: None. F.C. Hessel: None. K.D. Timmons: None. R. Sonabend: None. M.J. Redondo: None.