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In diabetic pathology, insufficiency in β-cell mass, unable to meet peripheral insulin demand, and functional defects of individual β-cells in production of insulin are often concurrently observed, collectively causing hyperglycemia. Here we show that the phosphorylation of ERK1/2 is significantly decreased in the islets of db/db mice as well as in those of a cohort of subjects with type 2 diabetes. In mice with abrogation of ERK signaling in pancreatic β-cells through deletion of Mek1 and Mek2, glucose intolerance aggravates under high-fat diet–feeding conditions due to insufficient insulin production with lower β-cell proliferation and reduced β-cell mass, while in individual β-cells dampening of the number of insulin exocytosis events is observed, with the molecules involved in insulin exocytosis being less phosphorylated. These data reveal bifunctional roles for MEK/ERK signaling in β-cells for glucose homeostasis, i.e., in regulating β-cell mass as well as in controlling insulin exocytosis in individual β-cells, thus providing not only a novel perspective for the understanding of diabetes pathophysiology but also a potential clue for new drug development for diabetes treatment.

AIAN women have higher risk for GDM. Early preconception counseling (PC) about healthy lifestyle/weight and mothers’ support could reduce these risks. We describe and compare parallel measures of SS with RH/GDM risk: daughters’ perceived SS from mothers, and mothers’ perceived SS for daughters. Methods: Secondary analysis used baseline data from 113 mother-daughter (M-D) dyads from four sites participating in Stopping GDM, an online randomized trial to reduce risks of GDM. Perceived maternal SS was amounts (0=no support, to 5=a lot of support) and types of SS re: RH, healthy lifestyle behaviors, and seeking PC to prevent GDM (instrumental SS, e.g., help get birth control; informational SS, e.g., on pregnancy/GDM) . M-D independently completed online measures of perceived available maternal SS. We performed descriptive, within-dyad comparative/correlational analyses. Results: AIAN AYA (n=113; mean age 17±3yrs; BMI 29±8.3 kg/m2) and their mothers (n=113; age 44.7±9yrs; 45% had > 2-4 college; 44% married) . AYA reported moderately high levels of maternal SS: total (16±5; range:0-20) ; instrumental (12±4; 0-15) ; informational (4±2; 0-5) . Mothers reported high levels of SS to give their daughters: total (20±1; range:15-20) ; instrumental (15±1; 10-15) ; informational (5±0; 0-5) . Mothers reported significantly higher levels of SS to give their daughters compared to their daughters’ perception of available maternal SS (p Disclosure D. Charron-Prochownik: None. S.M. Sereika: None. A.F. Fischl: None. N. O'Banion: None. K.L. Gonzales: None. L. Chalmers: None. K.R. Moore: Consultant; Novo Nordisk. Funding RNR014831 grant

An adverse maternal in utero environment can program offspring for increased risk for metabolic disease. The aim of this study was to determine whether N-acetylcysteine (NAC), an anti-inflammatory antioxidant, attenuates programmed susceptibility to obesity and insulin resistance in high fat diet (HFD) offspring. CD1 female mice were acutely fed a standard breeding chow or HFD. NAC was added to the drinking water (1g/kg) of the treatment cohorts from embryonic day 0.5 (e0.5) until the end of lactation. NAC treatment normalized HFD-induced maternal weight gain and oxidative stress, improved the maternal lipidome and prevented maternal leptin resistance. These favorable changes in the in utero environment normalized postnatal growth, decreased white adipose tissue (WAT) and hepatic fat, improved glucose and insulin tolerance and antioxidant capacity, reduced leptin and insulin and increased adiponectin in HFD offspring. The lifelong metabolic improvements in the offspring were accompanied by reductions in pro-inflammatory gene expression in liver and WAT and increased thermogenic gene expression in brown adipose tissue (BAT). These results, for the first time, provide a mechanistic rationale for how NAC can prevent the onset of metabolic disease in the offspring of mothers who consume a typical Western HFDs.

In youth with T1D, mindfulness and parental involvement (i.e., shared responsibility) of diabetes self-management (DSM) behaviors are associated with positive diabetes-related outcomes. This study explored the mediating role of shared responsibility in the relationship of mindfulness with DSM and A1c. A cross-sectional study was conducted among 129 adolescents aged 12-18 years with T1D at a tertiary medical center. Adolescents completed a survey on mindfulness (Child Acceptance & Mindfulness Measure), shared responsibility (Diabetes Family Responsibility Questionnaire-Short) and DSM (Self-care Inventory). A1c was obtained from medical records. The PROCESS SPSS macro by Hayes (v3.5) was used to assess mediation. Unstandardized and standardized path coefficients (β), SE, p-value, and 10,000 bias-corrected bootstraps 95% CI reported. Results: Mindfulness had positive significant association with shared responsibility (a-path=0.974, SE=.045, β=.189, R2=.036, p=.032). Shared responsibility had significant association with DSM (b-path=0.055, SE=.017, β=.275, p=.0015). The direct (c’) and total (c) relationships between mindfulness and DSM were significant (c’=0.198, SE=.087, β=.193, p=.024; c=.251, SE=.088, β=.245, R2=.06, p=.005). The relationship between mindfulness and DSM was partially mediated by shared responsibility (ab=0.053, SE=0.031 bias-corrected bootstrapped 95% CI = [0.0059, 0.0119]). For the second mediational model, neither mindfulness nor shared responsibility was associated with A1c (p>.05). Mindfulness and shared responsibility had positive association with DSM but not A1c. Shared responsibility partially mediated the relationship between mindfulness and DSM, whereby youth with higher levels of trait mindfulness had greater shared responsibility and better DSM. Temporal inferences should be interpreted with caution. Interventions targeting both mindfulness and shared responsibility should be explored. Disclosure H. Abujaradeh: None. P. Viswanathan: None. S. M. Sereika: None. M. M. DiNardo: None. C. A. Feeley: None. D. Charron-Prochownik: None. Funding National Association of Pediatric Nurse Practitioners; Eta Chapter-Sigma Research Award; Swigart/Gold Doctoral Student Award; J. Wiggins Scholarship

Gestational diabetes mellitus (GDM) is the most common complication of pregnancy and contributes to increased risk for T2D in both the mother and offspring. American Indians are at higher risk of GDM and subsequent diagnosis of T2D than non-Hispanic white women. This project examined the experiences of American Indian mother-daughter (M-D) dyads as participants and the site coordinators who facilitated a GDM risk reduction and preconception counseling randomized controlled trial (RCT) to evaluate Stopping GDM (SGDM). The SGDM RCT included 4 visits over 9 months which dyads attended together but completed SGDM intervention (video and eBook) and questionnaires separately. SGDM content included GDM risk reduction (e.g., healthy nutrition), GDM risk awareness/health beliefs, preconception counseling, reproductive health communication, and family planning. For this study, dyads (n=22 dyads) were recruited from three of the five study sites and site coordinators from all sites participated (n=6). Mothers, daughters, and site coordinators were in separate focus groups. Focus groups were facilitated by trained qualitative researchers, conducted/recorded remotely using Zoom, transcribed verbatim, and analyzed using qualitative content analysis and Atlas.ti. Themes include: 1) SGDM provided valuable quality time and conversation about GDM and reproductive health among dyads; 2) GDM risk factors and risk reduction was largely new information for most dyads; 3) all sites experienced challenges to study engagement and recruitment; 4) recommendations for study improvement: personalized recruitment that is clinic-based and mother-focused; remote/asynchronous study visits; and significantly shorter content. These findings will be used to inform revisions of SGDM to improve the program and for a broader, more inclusive version of the program for other at-risk females. Disclosure S. A. Stotz: None. A. F. Fischl: None. M. A. Terry: None. H. Garrow: None. N. O’banion: None. L. Chalmers: None. K. R. Moore: None. D. Charron-prochownik: None. Funding National Institutes of Health (UL1TR001857 to D.C-P.); National Institute of Nursing Research (1R01NR014831-01A1 to D.C-P., K.R.M.)

Gestational Diabetes Mellitus (GDM) is the most common complication of pregnancy and potentially causes problemsfor both mother and baby, including risks of developing type 2 diabetes (T2D). Compared to other Americans, Indigenous youth have more risk factors and higher rates of GDM. We developed Stopping GDM a GDM risk reduction and reproductive health program for American Indian adolescent females. To further deepen the cultural strengths of the program we draw on constructs from Indigenous ways of knowing, such as Ancestral Knowledge System (AKS). We conducted a secondary analysis on an existing qualitative dataset collected during the Stopping GDM study using AKS as a secondary framework. Key constructs from AKS include: relationships, place-based knowledge, generational networks, holistic approaches, language, cultural heritage, and critical reflection. This dataset includes focus groups with AI adolescent girls (age 12-20) (n=13); their adult female caregivers (n=9); and AI women with a history of GDM or T2D (n=5) from two urban sites. All focus groups were moderated by a trained qualitative researcher with a notetaker and semi-structured moderator guide and analyzed using Atlas.ti. Four primary themes supported by the AKS framework constructs emerged: 1) the important and unique role of women in Native communities; 2) traditional ways as they relate to women, reproductive health, and wellness; 3) support for women’s wellness and reproduction; 4) social determinants as challenges for Indigenous communities in promoting healthy behaviors. These findings will be used to support expansion of Stopping GDM to increase its cultural relevance for a broader Indigenous priority audience which includes Native Hawaiian and Alaska Native communities. Disclosure D. Charron-prochownik: None. R. Soon: None. S. A. Stotz: None. A. F. Fischl: None. K. L. Gonzales: None. M. Mau: None. K. R. Moore: None. Funding National Institutes of Health (UL1TR001857 to D.C-P.); National Institute of Nursing Research (1R01NR014831-01A1 to D.C-P., K.R.M.)

Health-related social needs (HRSN), such as housing instability, food insecurity, and poor transportation or social support, adversely affect health. In diabetes, where evidence links health behaviors, which are influenced by social/environmental factors, to disease onset and progression, a deeper understanding of the degree to which specific HRSN, or multiple needs, affect health may be crucial to achieving one’s best health. HRSN for adults with Medicare Advantage coverage (n=33,690) who responded to an abridged version of the Accountable Health Communities screener developed by the Centers for Medicare and Medicaid Services were evaluated. Overall, 56% (n=18,925) of people with diabetes reported one or more HRSN. A higher percentage of people with diabetes screened positive for financial strain (47%), food insecurity (31%), and poor housing quality/safety (24%) compared to those without diabetes (38%, 24%, and 19%, respectively). As the HSRN burden increased, healthcare utilization and cost also increased while compliance with certain quality indicators decreased. Our findings highlight the interplay between clinical and social needs and indicate that an increased awareness and incorporation of patients’ HRSN into clinical care may be essential for achieving optimal health in patients with diabetes. As more practices move to value-based arrangements, data on HRSN, combined with proven interventions, will help drive better health outcomes. Disclosure S. Franklin: Employee; Self; Humana. A. Hagan: None. P. Hansen: Employee; Self; Humana. G. Haugh: Employee; Self; Humana. C. Long: Employee; Self; Humana.

Adolescents with T1D often experience stress leading to poor DSM and suboptimal glycemic control. Mindfulness, as a trait or learned skill, is a protective factor against stress and is associated with positive wellbeing. Yet, little is known about mindfulness in adolescents with T1D. This study describes self-reported mindfulness practices and compares mindfulness on DSM and A1c in adolescents with T1D. Adolescents (12-18 yrs) completed questions on mindfulness practices [having mindfulness experience (yes vs. no), types, and duration] and a valid measure of DSM (Self-care Inventory) during routine diabetes clinic. A1c was obtained from medical record. Data were analyzed using descriptive analyses and group comparative analyses were used to examine the association between mindfulness experiences, type and duration on DSM and A1c. Adolescents (n=128) were 59% male, 88% white, on average 15±2 yrs of age, mean diabetes duration of 7±4 yrs, mean moderate level of DSM of 57±8 (range:15-75), and A1c of 8.3±1.6%. About one third (30%; n=38) reported having mindfulness experience with 23 (61%) being formal (e.g., breathing, body scan, mindful meditation, mindful yoga); 19 (50%) being non formal (e.g., mindful walking); and 4 (11%) being religious. Almost half (45%, n=17) reported practicing mindfulness for < 3 mos, 5 (13%) for (3 - 12 mos), and 16 (42%) for > 1 yr. Several participants (n=8, 21%) reported using mindfulness mobile apps (e.g., Headspace, Calm, Pokémon Go) or YouTube. Adolescents with more than one type of mindfulness practice (e.g., formal with non formal or religious) and those with religious experience reported better DSM than those with one type of mindfulness practice [F(3, 34)= 5.2, p=0.005]. About a third adolescents have been exposed to some mindfulness practices. DSM was better among participants who reported practicing more than one type of mindfulness. Introducing mindfulness training tailored to adolescents with T1D could be beneficial. Disclosure H. Abujaradeh: None. D. Charron-Prochownik: None. B. Galla: None. S.M. Sereika: None. M. DiNardo: None. C.A. Feeley: None. P. Viswanathan: None. Funding National Association of Pediatric Nurse Practitioners; Sigma Eta Chapter; University of Pittsburgh School of Nursing

Adolescents and young adults (AYA) with DM have increased risk of poor outcomes. The DTP was created to equip AYA with knowledge, support, and skills to foster successful lifelong DM self-management. This 1-year (4 visits) program pairs clinical care with peer-group discussions led by a multidisciplinary team focused on informed decision making of issues relevant to AYA with DM. The purpose of this study was to characterize the population referred to DTP and evaluate concerns, program adherence and outcomes. Medical records were reviewed and surveys administered. To date 153 AYA were referred (51% females, 99% T1DM, age at 1st visit 18.8±1.4 yrs, age at onset 9.7±4.7 yrs, HbA1c 9±2%). In ranking concerns of 5 complications (retinopathy, neuropathy, reproductive health complications, nephropathy and hypertension) at the 1st DTP visit, 60% of males and 57% of females who completed the survey rated retinopathy as their number 1 or 2 concern. Reproductive health and hypertension were listed as their least concern by 43% of males and 42% of females respectively. In terms of program adherence, the majority (60%, n=92) completed DTP on schedule (1 year). Of these, 42% transferred to adult care, 52% continued care at the institution and 6% were lost to follow up. Of those who did not complete DTP over 1 year (40%), 25% transferred to adult care before DTP completion, 60% are completing DTP in more than 1 year, and 15% were lost to follow up. Those who transferred to adult care (irrespective of program completion time), versus those who did not, had lower HbA1c at all DTP visits (e.g., 1st visit: 8.1 ± 1.4% vs. 9.4 ± 1.7%, p=0.01). In terms of outcomes for those that completed the program, no differences were found in HbA1c from the 1st to 4th visit. In conclusion, AYA referred to DTP appear to be a high-risk population based on their HbA1c and suboptimal program adherence. This highlights the need for methods (e.g., telehealth) to continue to engage this population and ongoing self-management support. Disclosure I. Libman: Consultant; Self; Novo Nordisk A/S. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. A.F. Fischl: None. J. Finney: None. A.M. Diaz: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. D. Charron-Prochownik: None. D.J. Becker: None. Funding David Paul Diabetes Transition Care Research Initiative Fund

Introduction: Little research has focused on enhancing knowledge and health beliefs in female AYA at risk for GDM and their mothers, particularly in the AI/AN population. We examined the change in knowledge and health beliefs about GDM at the baseline visit between the intervention (n=60) and control (n=53) arms of the Stopping GDM Trial among AI/AN female AYA at risk for GDM (i.e., daughters) and their mothers. Methods: Grounded in the Expanded Health Belief Model and using a randomized controlled trial design, this investigation focused on the efficacy of a video viewed at the baseline visit of a culturally tailored online program to enhance knowledge and health beliefs to decrease GDM risk in 113 AI/AN female AYA (74% AI; on average 16.9±3.0 years old; 45% in grades 9-12) and their mother or an adult female (e.g., grandmother) (80% mother; 82% AI; on average 44.7±9.4 years old; 44% college educated). All completed established measures of knowledge and health beliefs (benefits, barriers, severity, susceptibility) before and after viewing the video. Data were analyzed using descriptive statistics and linear mixed modeling. Results: At the baseline visit daughters in the intervention group had greater mean increase in overall reproductive health and GDM knowledge (p=.010), and more specifically family planning knowledge (p=.003), compared to the control group. Daughters on average increased both diabetes prevention comprehensive (p=.048) and GDM (p Conclusions: These initial results support the use of culturally tailored behavioral interventions to improve knowledge and health beliefs to reduce GDM risk in AI/AN female AYA. Disclosure S.M. Sereika: None. K.R. Moore: None. S.A. Stotz: None. A.F. Fischl: None. L. Chalmers: None. H. Garrow: None. K.L. Gonzales: None. N. O’Banion: None. D. Charron-Prochownik: None. Funding National Institutes of Health (R01NR114831)

Nurses can be pivotal to providing diabetes education, including, preconception counseling (PC) to prevent pregnancy-related complications in women with diabetes. However, many health professionals, including nurses, have reported self-deficits in these areas due to a lack training or knowledge. Simulation is an effective educational strategy utilized in schools of nursing to enhance critical thinking, decision-making, skills building and increase knowledge. However, little is known about the effectiveness of using simulation to train nursing students in providing diabetes education and preconception counseling to patients. Therefore, this study examined the effectiveness of a newly developed diabetes education/PC simulation training program developed for nursing students. The sample was 30 junior level baccalaureate nursing students who completed pretest and posttest measures on their awareness and knowledge of diabetes, pregnancy and PC. We used the 45 min video of READY-Girls (Reproductive-health Education and Awareness of Diabetes in Youth for Girls) PC program during the simulation training session because it is a validated evidenced-based, theory-driven program that targets female adolescents, and is endorsed by the American Diabetes Association. They also observed a live 10 minute simulation of actors portraying a diabetic educator and a diabetic female adolescent and their clinical interaction. Data were analyzed using a paired t-test. The mean pretest score was 9.33, while the mean posttest score was 15.00 with a statistically significant gain (t = 15.89; p = .000). Therefore, it appears that PC simulation may be an effective educational strategy to train nursing students on caring for women with diabetes. Disclosure J.L. Thurheimer-Cacciotti: None. D. Charron-Prochownik: None.

Background: AYA women with T1D are vulnerable to poor glycemic control which could increase their risks of RH complications. ADA recommends starting preconception counseling (PC) at puberty. Purpose to explore concerns for and preventative behaviors regarding RH complications in AYA females with T1D. Methods: New AYA patients attending a diabetes transition clinic at a pediatric teaching hospital completed a short survey on concerns for diabetes-related complications and preventative actions taken: ranking their concerns on a scale 1=most important to 5=least important from a list of five complications. They identified any actions ever taken to prevent complications by a list of items and an open-ended response. This reports on female participant (n=49; ages 17-22) responses regarding RH complications at baseline prior to any peer-group information sessions. Descriptive analyses were used for quantitative and qualitative data. Open-ended data were clustered and analyzed to identify themes with 2 researchers reaching agreement. Results: Only 29% of AYA female participants (n=14) ranked RH complications as most important concern (rank of 1) and 12% (n=6) ranked it as important (rank of 2); while 20% (n=10) ranked RH complications as least important (rank of 5). Several participants (n=33) checked off one or more behaviors they have taken to prevent RH complications (e.g., control glucose, discussed family planning with health provider). Themes for ’other preventative actions’ remained broad, “healthy lifestyle” and “self-management.” Almost all (88%; n=29/33) believe RH complications can be prevented. Conclusion: Less than half of AYA females ranked RH complications as an important concern, which could reflect unawareness. Although most have taken some general preventive actions, enhancing other more specific behaviors to decrease their risks that were not identified could be targeted for future interventions through PC. Disclosure D. Charron-Prochownik: None. A.F. Fischl: None. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. J. Finney: None. H. Abujaradeh: None. D.J. Becker: None. A.M. Diaz: None. I. Libman: Consultant; Self; Novo Nordisk A/S. Funding David Paul Diabetes Transition Care Research Initiative Fund

To help maintain glycemic control and prevent complications for transitioning AYA with type 1 diabetes mellitus (T1D), a Diabetes Transition Program (DTP) was created at an academic children’s hospital to provide clinical care, peer support, information and skills building for self-advocacy and diabetes management. Peer-group sessions were facilitated by a multidisciplinary team on relevant issues. This abstract describes a novel educational approach to engaging group participation, discussion and further enhancing decision-making skills regarding complication risks; and to describe participant reaction from field/observation notes. Group sessions on complication and prevention were facilitated by a CDE nurse. Original sessions provided handouts with Q and A posed by CDE for discussion. A novel gaming approach was then instituted. In each session, participants were divided into 2 subgroups. Each subgroup was given two stacks of cards. One group matched cards having names of complications (i.e., cardiovascular problems) with cards having examples of screening tests and prevention strategies (e.g., BP, LDL). The other group matched complications with S and S of the complication (e.g., heart attack). Groups came together and shared results for each complication which initiated discussion. Observations of group dynamics were noted. DTP has had 153 patients (49% males, mean age 1st visit 18.8yrs, range 17-24yrs). Each group session averaged 5-6 AYA. Compared to the original format, group dynamic observations of the novel gaming approach include: increased peer-to-peer discussion, greater openness to share thoughts with group, increased critical thinking skills, complete participation. It appears that this novel gaming approach facilitated patient learning by stimulating participant-initiated discussion, peer-to-peer interaction and support, and interest in topic. More formal evaluation of this method is warranted. Disclosure J. Finney: None. D. Charron-Prochownik: None. J.T. Krall: Research Support; Self; Becton, Dickinson and Company. A.M. Diaz: None. I. Libman: Consultant; Self; Novo Nordisk A/S.

Adherence to recommended diabetes self-management (DSM) is essential for glycemic control. Little is known regarding the association between DSM adherence and glycemic control as adolescents transition to adulthood. This secondary analysis examined the association of DSM adherence and glycemic control in adolescence and its temporal association with DSM adherence and glycemic control reported as adults in women with T1D. Data from female adolescents who participated in a preconception counseling intervention trial were linked with data collected in adulthood via a retrospective survey. DSM adherence was assessed regarding following a diet plan, checking blood sugar, taking insulin, exercising regularly, and keeping appointments and summed as a score ranging 5 to 25, where higher scores suggest greater DSM adherence. Glycemic control was measured via self-report (scaled as 1=poor to 4=excellent) and finger stick A1c. Of the 30 T1D women followed (100% Caucasian, Age [M±SD]: 25.8±2.4 years, Age at T1D diagnosis: 8.6±4.8 years), as teens most reported being adherent to the five DSM activities on average "most of the time" (20.4±2.4), being in good to excellent control (n=20, 66.7%; 2.8±0.7), and having a mean A1c of 7.5±0.7%, with moderate correlations between DSM adherence and self-reported glycemic control (r=.50, p Disclosure S.M. Sereika: None. A.F. Fischl: None. D. Charron-Prochownik: None. Funding American Diabetes Association (1-11-CT-10, 7-02-CR-06 to D.C-P.)

Background: 50% of males with T1D report RH complications (e.g., erectile dysfunction, decreased libido) starting at age 25 years; precursors to more life-threatening complications and affect family planning. Glycemic control may prevent/delay RH complications. AYA males are vulnerable to poor glycemic control. These issues are rarely discussed during routine clinic visits. Raising RH awareness regarding metabolic control and preventing RH complications starting in this age group is imperative. Purpose: To examine the changes in knowledge and self-efficacy following a new educational/counseling intervention (READY-Guys) on diabetes and RH among AYA males enrolled in a large tertiary university-based children’s hospital transition clinic. Methods: Diabetes and RH was a teaching module for AYA patients. Fourteen AYA males (17-22 years) completed quantitative measures on RH knowledge and self-efficacy before and after receiving READY-Guys (Reproductive-health Education & Awareness of Diabetes in Youth for Guys); and open-ended qualitative questions for feedback on the RH intervention. A paired t-test compared pre to post RH knowledge and self-efficacy; content analysis was used for open-ended responses. Results: Both RH Knowledge (t=6.5, p Conclusion: Attending the RH session appeared to improve AYA male’s knowledge regarding diabetes and RH and their self-efficacy to initiate discussion with health professionals and to take actions to decrease their risks of RH complications. The new RH information was acceptable and informative. To start during adolescence was confirmed by participants. Group discussion sessions during a transition clinic provided a venue to raise awareness about RH. Disclosure A.F.R. Fischl: None. D. Charron-Prochownik: None. H. Abujaradeh: None. S.M. Sereika: None. J. Finney: None. A.M. Diaz: None. N. Charache: None. I. Libman: Consultant; Self; Novo Nordisk Inc. Funding David Paul Diabetes Transition Care Research Initiative Fund

AIAN women have a higher risk for GDM and subsequently type 2 diabetes (T2D) than non-AIAN white females. We adapted a validated diabetes preconception counseling (PC) program for AIAN girls at high risk for GDM and their mothers. This paper presents preliminary baseline data, prior to the intervention, of both the girls and their mothers enrolled in an RCT to evaluate changes in GDM risk-reduction awareness, knowledge, health beliefs and behaviors after the Stopping GDM intervention. Data were collected using a dyadic model; both AIAN girls and their AIAN mothers (adult female caregiver) participated. These findings are on 27 mother (M) - daughter (D) dyads (n=54) from 2 of 4 sites (Southwestern U.S.). D (ages 12-24 years) were at risk for GDM as defined by BMI ≥85thpercentile or family history of T2D, and did not have diabetes (HbA1c < 6.5%). M’s mean (±SD) age was 41.3±14.1 years and 56% (n=15) had at least some college education; D’s mean age was 16.3±2.9 years and 89% were students. M and D completed online questionnaires separately on awareness, knowledge and health beliefs regarding GDM and reproductive health and healthy lifestyle. One open-ended question on awareness of GDM revealed that participants were unaware of GDM or the daughters’ risks. Mean pre-intervention knowledge scores were low for both M and D on diabetes prevention (M: 76.4+14.3, range=54-100%; D: 58.2+12.4, range=27-82%) and reproductive health and GDM knowledge (M: 67.2+11.2, range=46-85%; D: 35.0+18.3, range=0-62%). D had moderate levels of self-efficacy for healthy living (53.2±14.6) and pregnancy planning (86.4±22.6). Most Ds reported no communication with healthcare professionals (HCP) or their Ms regarding GDM or PC [(with HCP=15%; 8%, respectively), (with M= 15%; 4%,)]. Both AIAN mothers and daughters lacked awareness and knowledge of the girl’s risk for developing GDM. Developing culturally relevant PC programs could help decrease these risks. Disclosure D. Charron-Prochownik: None. S.M. Sereika: None. S.A. Stotz: None. A.F. Fischl: None. N. O'Banion: None. J. Powell: None. M.L. Aspaas: None. S. Goudeau: None. S.J. Thorkelson: None. S. Beirne: None. K.R. Moore: None. Funding National Institute of Nursing Research (1R01NR014831-01A1)

Adolescent girls with diabetes are at risk for RH complications and unplanned pregnancies. Tight glycemic control with PC can reduce these risks. Social support from significant others has improved health outcomes in people with diabetes, and may help adolescent girls regarding RH. This secondary analysis: 1)described the amount (1=no help, to 7=a lot of help) and type of available SS (3 subscales: emotional, informational, and instrumental) perceived by adolescent females with diabetes toward RH behaviors and seeking PC; 2)examined the construct validity among total and subscale scores of a SS measure adapted for RH and diabetes; 3)examined the associations of SS with RH behaviors (e.g., birth control), seeking PC, and RH communication with healthcare providers (HCPs). Baseline data were used from 113 adolescent girls with diabetes (90% T1D; duration of diabetes of 9.3±3.9 years; average HbA1c 8.4±1.7%; mean±SD age of 16.2±1.6 years; 81% white, 20% sexually active), who participated in READY-Girls Trial testing the efficacy of a PC intervention to reduce RH complications among adolescents with diabetes. Teens completed measures on SS, RH behaviors, seeking PC, and communication with HCPs. Descriptive, correlational, and regression analyses were performed. Adolescents perceived on average moderately high levels of SS: total (5.5±1.5), emotional (5.5±1.6), instrumental (5.4±1.5), and informational (5.6±1.5); 31% had some communication with HCPs. There were significant associations between total SS and all its subscales (p Disclosure H. Abujaradeh: None. S.M. Sereika: None. D.J. Becker: Other Relationship; Self; Jaeb Center for Health Research, MannKind Corporation, Sanofi Research & Development. A.F. Fischl: None. D. Charron-Prochownik: None. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD-044097); Children’s Hospital of Pittsburgh (M01-RR-0084); Pediatric Clinical and Translational Research Center; National Center for Research Resources (UL1-RR-024153); National Institute of Nursing Research (P30-NR-03924)

Approximately half of males with T1D report RH complications (e.g., erectile dysfunction, decreased libido, orgasmic dysfunction) as early as 25 years old and/or 10 years after diagnosis. Tight glycemic control can prevent or delay complications, including those related to RH. Yet these sensitive topics are rarely discussed by HCPs. The purpose of this study was to collect qualitative data through a focus group conference call with 6 HCPs about their experiences caring for AYA males with T1D, and their perceptions of the need and recommendations for developing an evidence-based RH educational intervention. A semi-structured discussion guide was used to elicit responses about providing care for this population, experience with managing male RH complications, and their comfort talking to male teens about diabetes and sexual health. Responses were recorded and transcribed verbatim, clustered, and analyzed to identify major themes, using a qualitative descriptive method with 2 researchers discussing themes and reaching agreement. The 6 HCPs were 2 female pediatric diabetologists, 1 male pediatric diabetologist, 2 male adult diabetologists, and a male certified diabetes nurse educator. Following discussion, consensus was reached by all participants that RH was understudied and education was needed in this population. Major themes that emerged: “diabetes risk in the offspring,” “association of the risky behaviors associated with non-adherence in diabetes self-management”, “sex and diabetes” and “professional responsibility and obligation to initiate discussion”, and age to introduce these topics.” In conclusion, these HCP recommendations will inform the development of a RH program for AYA males with T1D. These suggestions and issues could impact the HCP’s ability to effectively advise and educate AYA males about reproductive/sexual health and diabetes. Disclosure A.F.R. Fischl: None. I. Libman: Consultant; Self; Novo Nordisk A/S. D.L. Rofey: None. D. Charron-Prochownik: None.

AIAN women have twice the risk compared to the general U.S. population of adolescent obesity, pregnancy, and GDM. Stopping GDM (SGDM), a GDM risk reduction intervention tailored for at-risk AIAN teens, is based on a validated preconception-counseling program, READY-Girls. Prior to starting a multi-tribal randomized controlled trial (RCT) to test SGDM’s effectiveness, a feasibility study was conducted in Denver, CO with AIAN participants (4 mothers, 5 daughters). Mother-daughter (M-D) dyads were recruited through an Urban Indian Health program. Daughters were at risk for GDM as assessed by BMI >85th percentile and did not have diabetes based on finger-stick HbA1c < 6.5%. Mother’s (M) mean age was 44.4±8.8 years and 100% had some college education; daughter’s (D) mean age was 15.9±2.7 years and 80% were In conclusion, we determined that the SGDM intervention is feasible and acceptable in AIAN M-D dyads. These findings will be used to finalize the SGDM education materials and data collection protocol for the upcoming full-scale RCT. Disclosure K.R. Moore: Advisory Panel; Self; Merck Foundation. S.A. Stotz: None. K.J. Nadeau: None. S.M. Sereika: None. Y. Garcia Reyes: None. H.R. Stein: None. D. Charron-Prochownik: None.

Latinas with diabetes are at a higher risk for reproductive health (RH) complications. READY-Girls is an evidence-based PC program recommended by the ADA for adolescent girls. PC should be culturally tailored for the Latina population. This reports on qualitative data, including markups of the existing READY-Girls book, that informed the tailoring of READY-Girls PC program. Key pages of READY-Girls book were given to Latina mothers (M) and their daughters (D) with diabetes in either English or Spanish [(18 D: 6 reviewed both, 12 English); (12 M: 4 reviewed both, 2 English, 6 Spanish)]. Daughters were 13 to 21 years old, 44% had T1D. Participants were given paper-and-pencil open-ended questions about readability, understanding and sensitivity to the Hispanic culture; and asked to markup the book by writing comments on the pages and using assigned symbols to communicate thoughts (e.g., * = liked this, ? = don’t understand, XX phrase = inappropriate). Responses to questions and markups were written verbatim, clustered and analyzed to identify major themes, using a qualitative descriptive method, 4 researchers discussed themes and reached consensus. Findings: 1) book was: a) easy to read, understand, and interesting; b) acceptable to Latina culture, but add topics, “talking with parents about being sexually active”, “resources to prevent teen pregnancy”, and c) taught the importance of PC. 2) Illustrations were: a) informative, but removing those of bodily changes during puberty could be less offensive to Latina culture; b) adding facial pictures. Conclusion: Markup methodology was effective in communicating thoughts about modifying the book and adapting it for Latinas. This methodology could enhance qualitative data collection especially when inquiring about sensitive topics such as reproductive health. Overall, M-D participants liked the program, found it useful and provided helpful suggestions for cultural modifications. Disclosure H. Abujaradeh: None. F.M. Peterson-Burch: None. E. Olshansky: None. K. Montgomery: None. D. Charron-Prochownik: None.

Tight glycemic control decreases risks of complications. Male and female AYA with T1D are vulnerable to poor glycemic control resulting in retinopathy (RET), neuropathy, nephropathy, high blood pressure (HBP), and RH complications. About half of males with T1D report RH complications (e.g., erectile dysfunction) as early as 25 years and up to 10% of women with T1D have pregnancy-related complications; however, these topics are rarely discussed. Purpose: To describe and compare concerns of diabetes-related complications, including adverse RH outcomes among male and female AYA with T1D. Methods: A diabetes transition care program for AYA with T1D at an academic children’s hospital provides care and small group discussion-education sessions on relevant topics (e.g., RH with diabetes, complications/prevention, risk behavior, self-care). Participants were given a survey prior to the program to gauge perceptions on T1D complications. Both female (n=19) and male (n=23) participants (aged 17-22 years) ranked concerns for complications from 1 (most) to 5 (least). Mann-Whitney U-tests were used to compare genders on complication rankings. Results: RET was the greatest concern for both females (n=7; 37%) and males (n=10; 44%). The second most frequently reported concern was RH for females (n=5; 26%) and HBP for males (n=5; 22%). The most frequently reported “least” concerning complication was RH for males (n=9; 39%) and HBP for females (n=11; 58%). A significant difference between genders was HBP (p=.02), where males tended to report greater concern. Conclusion: Retinopathy was an overall major concern. Gender differences in concerns were found for only HBP. No males ranked RH complications as a major concern. It is imperative to raise awareness and discuss concerns during adolescence. Initiating discussions with health professionals can empower AYA with T1D to maintain healthy lifestyles and prevent complications including RH. Disclosure A.F.R. Fischl: None. D. Charron-Prochownik: None. S.M. Sereika: None. D.L. Rofey: None. D.J. Becker: None. J. Finney: None. A.M. Diaz: None. I. Libman: Consultant; Self; Novo Nordisk A/S.