Youth with Type 1 Diabetes and Elevated A1C during the Coronavirus Disease-2019 (COVID-19) Pandemic-Examination of Family, Caregiver, and Medical Team Factors

Introduction: A subset of youth with T1D experience avoidable health problems, but it is unclear how specific social factors relate to these problems, particularly during the COVID-19 pandemic. We examined how systemic factors (caregiver, family, medical team) were related to medical outcomes in youth with elevated A1c from five academic medical centers during the pandemic. Methods: Youth 12-17 yrs with 1) T1D for ≥1 yr and 2) A1c≥10% in the past year were enrolled. Caregivers and youth completed measures of family conflict (Diabetes Family Conflict Scale-R); parent practices, stress, and health literacy (Alabama Parenting Questionnaire, Stress Index for Parents of Adolescents, BRIEF Health Literacy Scale); youth strengths and social support (Diabetes Strengths and Resilience, PROMIS); and family-medical team relationship (Quality of Healthcare Relationship) with EHR review including baseline A1c and acute complications (e.g., ED visits). Results: Participants were 157 youth with mean age 14.6 ± 1.6 years and mean A1c 11.0% ± 1.9%. 51% self-identified as Non-Hispanic White. Caregiver, family, and relational factors were significantly (p<.05) related to frequency of complications and A1c, with higher family conflict associated with higher A1c (r=.23) and more ED visits (r=.18). For caregivers, low health literacy (r=.17), inconsistent discipline practices (r=.20), and high parental stress related to low adolescent achievement (r=.26), were significantly (p<.05) associated with acute complications, as was youth report of low social support (r=-.20, p<.01). Positive family-medical team relationship was strongly related to lower A1c (r=-.30, p<.01). Discussion: Given these findings, screening and intervention efforts should emphasize targeting multiple systems and relationships with this population of youth, potentially with increased focus on the family-medical team relationship. Disclosure D.V.Wagner: None. L.Yglecias: None. J.Flores garcia: None. A.Torres sanchez: None. A.Bonilla ospina: None. J.Raymond: None. M.A.Harris: None. M.Perry: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. J.C.Wong: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc. D.Naranjo: None. A.Reed: None. C.Jenisch: None. C.Cruz: None. S.Mitchell: None. Funding JDRF