1008-P: Trends in Improvement in Clinical Outcomes and Health Care Access in Underrepresented Youth with Type 1 Diabetes (T1D)

Background: There is a dearth of research focused on youth living with T1D from publicly insured and ethnically and racially diverse populations. Additionally, there are very few interventions that target social determinants of health (SDH) , despite their documented impact on diabetes outcomes, uptake of diabetes technology, and healthcare utilization. Novel Interventions in Children’s Healthcare (NICH) was developed as a systems and community-based intervention that targets SDH. We describe demographics and outcomes of youth with T1D enrolled in NICH services and related research. Methods: Youth with T1D were eligible if they had >=1 SDH and >=1 of the following in the year prior to enrollment: >=1 DKA hospitalizations after diagnosis, hemoglobin A1c (A1c) >=14%, >=2 emergency room visits or >=2 missed clinic visits. Demographics were collected from chart review and baseline surveys. Outcomes included continuous glucose monitoring (CGM) use, A1c values, hospital costs, and number of hospital days. Results: Participants (n=18) had a mean age of 15.1 (±2.4) years, 67% reported female gender, 89% self-identified as Black and/or Latinx, and 94% were publicly insured. CGM use significantly increased from 33% prior to NICH enrollment to 78% after enrollment (p=0.005) . Noted trends included a 1.0% decrease in mean A1c, 20% reduction in average per member, per month (PMPM) hospital costs, and 33% decrease in mean hospital days per month from the year prior to enrollment to the time since being enrolled in the NICH intervention. Conclusions: Enrollment of publicly insured and ethnically and racially diverse youth living with T1D in research is feasible despite limited existing interventional studies on these populations. Youth with T1D from underrepresented populations experience increased use of technology from participation in the NICH intervention, and they show encouraging trends in improved glycemic control, hospital cost savings, and healthcare utilization.