643-P: Engagement of Young Adults with Type 1 Diabetes (T1D) in a Virtual Young Adult Diabetes Clinic as a Component of Transition from Pediatric to Adult Diabetes Care

Objectives: Young adults with Type 1 Diabetes (T1D) face unique challenges with engaging in care as they transition from the pediatric to the adult setting. The Young Adult Diabetes Clinic (YADC) is a multidisciplinary clinic that includes a group clinic, combining endocrinology, diabetes education, and behavioral health. Due to the COVID-19 pandemic, the need for a virtual YADC group clinic arose. We sought to understand how this virtual setting could impact engagement as compared with the in-person model. Methods: We conducted a retrospective cohort study comparing in-person to virtual engagement, characterized by three central measures: rates of scheduled group visits after referral, rates of attended group visits after scheduling, and rates of follow-up after attending a group visit. A z-test was used to compare proportions of no-shows and lost-to-follow-ups between the in-person and virtual attendees. Results: Two hundred and seventy-one patients were referred to the YADC between December 2017 and December 2022. Out of those, 149 (54%) scheduled a group visit. Subsequently, 112 scheduled patients attended a group visit. Sixty-one (54%) attended a virtual group visit, compared to 51 (46%) in-person. Out of these attendees, 45 (62%) in-person attendees followed-up subsequently with a member of the care team, and 28 (38%) virtual attendees. No-show rates were significantly higher in the virtual population at 35% vs. 4% in-person (P=.002). Lost-to-follow-up rate was 27% in the virtual population and 12% in-person, (P=.07). Conclusions: Young adults with T1D face significant barriers to engagement that virtual medicine may help overcome. This data illustrates the continued challenges with engaging young adults in the virtual setting, and need for further understanding of what other factors may influence follow-up in this patient population.