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Aim: To identify correlates of device uptake in people with insulin-requiring diabetes before and after interacting with DiabetesWise.org, a free, unbranded online resource. Methods: The sample included 458 participants (Mage=37.1, SD=9.73; 66% female; 81% type 1) with minimal diabetes device use at enrollment. Participants used DiabetesWise.org, had their activity tracked, and completed online surveys. Chi-square and t-tests evaluated factors associated with past device use and new device (CGM/pump) uptake and prescriptions at 1- and 3-months post-use. Results: Less than half (41%) the sample reported past CGM use. Past CGM use was associated with being female, younger age, type 1 (vs. type 2) diabetes, and receiving care in a large/academic medical center. By 1 month, 11% reported new prescriptions and 5% of participants reported new device uptake (all CGM starts) , which was associated with younger age. By 3 months, 16% reported new uptake and 20% reported new prescriptions (93% for CGM) , which were more common among those with type 1 diabetes. Conclusions: DiabetesWise.org promotes diabetes device uptake and starts are unhindered by the personal, medical, or system-level barriers to prior device use. One in five users reported new prescriptions/uptake of diabetes devices. These findings support DiabetesWise.org as an effective avenue to promote device access and equity. Disclosure J.J.Wong: None. S.Hanes: None. S.Nelmes: None. K.K.Hood: Consultant; Cecelia Health, Havas Health, Insulet Corporation, LifeScan Diabetes Institute. Funding The Leona M. and Harry B. Helmsley Charitable Trust; NIH K23-DK121771

Background: Loop is an open-source do-it-yourself (DIY) automated insulin delivery system that allows users unrivaled control over physiologic settings that effect future glucose prediction. Over 9,000 individuals have adopted Loop, but little is known about those who discontinue. Methods: Twenty Loop users (14 adults and 6 caregivers; 60% female, 85% white, 75% household income >$100k/year, and HbA1c 6.7±1.0%) participated in semi-structured interviews about their experiences with Loop following discontinuation. Qualitative data were transcribed, coded, and analyzed. Results: Prominent themes reflected the perception that the stress, effort and/or time required to set up Loop and achieve management goals exceeded potential benefits. Two quotes: “I couldn’t spend any more time trying to work on my settings and trying to make it better,” and “I know I could get an improvement with it, but the problem was the cost of it⋯I couldn’t concentrate anymore at work⋯it felt like fog in my brain.” Technical issues with component devices, connectivity issues, lack of technical support, cost (time, energy, supplies), fear of provider disapproval, concerns related to pregnancy, exercise, hypoglycemia and managing low insulin doses, and desire to try other new technologies were among other reasons for ending use. Participants indicated that improved technical assistance and expert guidance might lead to them to use Loop again in the future. Conclusions: For those who manage to set up Loop there are additional challenges, even among individuals with adequate glycemic control and access to various financial, social, and personal resources. Technical support and education specific to setting calculations could expand Loop benefits, alleviate burden, and support sustained use among new Loop users. Disclosure J. J. Wong: None. S. Suttiratana: Employee; Spouse/Partner; CVS Health. M. S. Lanning: None. A. Dunlap: None. S. Hanes: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool. D. Naranjo: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Background: Loop is an open-source AID system used by more than 9,000 people with type 1 diabetes. Understanding the pros and cons of Loop use may help improve disease management and support population level innovation. Methods: Focus groups illuminated 72 new and experienced users’ perspectives on Loop uptake, use and persistence. Participants were predominately white (95%), male (50%), privately insured (94%), reported annual household income ≥ $100K (73%) and education exceeding a bachelor’s degree (87%) with a mean HbA1c of 6.6±0.8%. Twenty discontinuers who stopped using Loop during the study (60% female, 85% white, 85% privately insured) completed interviews. Qualitative data, collected as part of the larger observational study, were analyzed and synthesized by a multidisciplinary team. Results: High frequency thematic content described experiences with: a) technical support and troubleshooting, b) decreased mental/behavioral burden, c) technical issues with parts of the system, d) glycemic control, e) personalizing settings, and f) providers while using Loop. Users also emphatically highlighted the effects of Loop on overnight experiences and the role that “Loop communities” played during use. Decreased burden was the most endorsed benefit characterized by less worry, stress, and cognitive effort; less time spent on diabetes management tasks, and more space to think about nondiabetes aspects of life. The most discussed drawback was having technical issues with any part of the system including challenges with insulin pumps, CGMs, infusion sites, signal loss, the app, and/or the algorithm. A range of provider attitudes and knowledge about Loop complicated users’ disclosure and experiences. Conclusions: This sample of Loop users reported benefits to quality of life and glycemic control that outweighed challenges of setting up system components and adjusting settings. Users reported being empowered by the customizability and educational effects of the open-source AID system. Disclosure S. Suttiratana: Employee; Spouse/Partner; CVS Health. J. J. Wong: None. M. S. Lanning: None. A. Dunlap: None. S. Hanes: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool. D. Naranjo: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

There are pervasive disparities in health outcomes for people living with diabetes based on socioeconomic status, race, and ethnicity. These longstanding disparities are magnified by the devastating impact of COVID-19 for underserved communities with diabetes. As part of a Project Extension for Community Healthcare Outcomes (ECHO™) Diabetes outreach program in Florida and California, over 15 participating Federally Qualified Health Centers (FQHC) were provided Diabetes Support Coaches (DSC) to facilitate patient engagement. DSCs hold invaluable expert knowledge as they live with diabetes, themselves, and reside in the geographic catchment areas they serve - combining a traditional Community Health Worker (CHW) role with peer support models. DSCs complete standardized training in health coaching and receive Diabetes Paraprofessional Level 1 certification through the American Association of Diabetes Care and Education Specialists (ADCES). DSCs offer one-on-one peer support for interested patients, create local resource guides for diabetes management, host community events, disseminate information about technologies like continuous glucose monitors (CGM), and assist with appointment reminders and other engagement activities. Patient encounters with DSCs are documented in REDCap® and pre/post-test evaluation for patients includes HbA1c, the Diabetes Distress Scale, use of diabetes technology, and social support density. Preliminary data from n=19 adults with T1D and T2D (9 Hispanic, 10 Non-Hispanic Black) participating with DSCs at two FQHCs in Miami show statistically significant improvement in HbA1c mean ± SD: -1.21 ± 1.49, 95% CI (-1.93, -0.49) p Disclosure A. F. Walker: None. S. L. Filipp: None. N. Cuttriss: Consultant; Self; Cecelia Health. L. G. Baer: None. L. Figg: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool. M. Basina: None. J. J. Wong: None. K. Yabut: None. D. M. Maahs: Advisory Panel; Self; Abbott Diabetes, Dompe, Eli Lilly and Company, Medtronic, Novo Nordisk, Consultant; Self; aditxt. M. J. Haller: Board Member; Self; SAB Biotherapeutics, Inc., Consultant; Self; MannKind Corporation, Other Relationship; Self; Janssen Pharmaceuticals, Inc., Sanofi. E. Sheehan: None. S. C. Westen: None. C. Anez-zabala: None. X. Roque: None. A. Bernier: None. L. Bain: None. M. J. Gurka: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Background: Access to psychosocial services is limited, especially during a pandemic. A Zoom-delivered family-based intervention for adolescents with type 1 diabetes has the potential to enhance access to psychosocial services. Methods: Nine families enrolled in a pilot of a 6-session online (Zoom) intervention for adolescents with type 1 diabetes and their parents during the COVID-19 pandemic. Qualitative and quantitative data were collected via online focus groups and surveys. Results: Teens’ ages ranged from 12-17 years (M=14.9, SD=1.76) and most self-identified as male (78%). All parents self-identified as female and most families self-identified as non-Hispanic white (78%). Qualitative results revealed that participants found the program to be generally helpful and would recommend the program to others. Perceived benefits included increased parental empathy toward teens, enhanced parental involvement in teens’ diabetes management, and decreased parent-teen conflict. Participants conveyed that these benefits were particularly impactful given increased family contact and tensions related to the COVID-19 pandemic. Identified areas for improvement included adding follow-up group sessions with parents to maintain program impact on parenting over time and to target teens in early adolescence, when family dynamics are more malleable. Quantitative results from paired t-tests of pre-post comparisons revealed no significant differences in teen or parental diabetes distress or depression (all p>0.05), but should be interpreted with caution due to small sample size. Conclusions: Adolescents with type 1 diabetes and their parents responded positively to this program and found it particularly relevant during the current pandemic. Zoom delivery of these programs may be instrumental in their feasibility, acceptability, and ultimately dissemination in the future. Disclosure J. J. Wong: None. M. S. Lanning: None. J. Ngo: None. C. A. Wu: None. S. Hanes: None. H. M. Linzmeyer: None. D. Naranjo: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1K23DK121771-01A1)

The Project Extension for Community Healthcare Outcomes (ECHO™) model addresses disparities by empowering primary care provider (PCPs), through tele-education, to meet the needs of underserved communities lacking access to subspecialty care. Given the rapid replication of this model, it is vital to understand the perspectives of participating PCPs to refine program implementation. Project ECHO™ Type 1 Diabetes (T1D) program was piloted in Florida and California with >15 Federally Qualified Health Centers (FQHC). PCPs completed pre/post-test surveys assessing knowledge and confidence in T1D care. Exit surveys and focus groups were conducted to understand their experiences (N=92 providers, 41 from FL and 51 from CA were queried). Qualitative analysis of open-ended survey feedback and thematic analysis of focus group data used the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies five domains that affect intervention implementation - including internal and external factors to the healthcare organization. Pre/post surveys demonstrated significant improvements in providers’ diabetes knowledge; mean ± SD change in score for an 11-item knowledge evaluation from pre/post: (1.0 ± 1.8, [Min: -2, Max: +5], p-value: 0.0003) and increase in overall confidence evaluated on a 4-point likert scale (0.6 ± 0.4 [Min: -0.1, Max: 1.6] p-value Disclosure A. F. Walker: None. S. L. Filipp: None. K. Turner: None. G. L. Zori: None. J. Maizel: None. N. Cuttriss: Consultant; Self; Cecelia Health. L. G. Baer: None. L. Figg: None. K. K. Hood: Consultant; Self; Cecelia Health, Cercacor, LifeScan Diabetes Institute. R. Lal: Consultant; Self; Abbott Diabetes, Biolinq, Capillary Biomedical, Inc., Morgan Stanley, Tidepool. M. Basina: None. M. J. Haller: Board Member; Self; SAB Biotherapeutics, Inc., Consultant; Self; MannKind Corporation, Other Relationship; Self; Janssen Pharmaceuticals, Inc., Sanofi. J. J. Wong: None. K. Yabut: None. D. Naranjo: None. E. Lewit: None. D. M. Maahs: Advisory Panel; Self; Abbott Diabetes, Dompe, Eli Lilly and Company, Medtronic, Novo Nordisk, Consultant; Self; aditxt. E. Sheehan: None. S. C. Westen: None. C. Anez-zabala: None. X. Roque: None. B. C. Fitzgerald: None. A. Bernier: None. M. J. Gurka: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Project ECHOTM (Extension for Community Healthcare Outcomes) is a hub-spoke telehealth outreach model that democratizes specialty knowledge to reduce disparities and improve health outcomes. Limited access to endocrinologists forces many primary care providers (PCPs) to manage patients with type 1 diabetes (T1D) without specialty support. As such, Stanford and the University of Florida partnered to develop and pilot “ECHO T1D”, a teleECHOTM clinic focused on T1D in California (CA) and Florida (FL), respectively. Our goal was to demonstrate the feasibility of ECHO T1D and improve PCPs’ abilities to manage patients with T1D. Primary care spokes were recruited targeting Federally Qualified Health Centers (FQHCs) where vulnerable T1D patient populations more likely rely on PCPs for care. In CA, 11 spokes enrolled with 37 clinics serving ∼900 patients with T1D who do not receive routine specialty T1D care. In FL, 12 spokes enrolled with 67 clinics serving ∼1,000 patients with T1D. Multidisciplinary hub team specialists were recruited and a 6-month curriculum was developed. Weekly 1-hour teleECHO sessions consisting of didactic presentations and case reviews were offered for 27 sessions. Weekly engagement of the 70 participating PCPs (69% in CA) ranged from 0 to 27 (mean 14) sessions and 65 completed both baseline and exit surveys. Baseline data demonstrated low confidence in providing T1D care, especially related to diabetes technology. Pre/post surveys demonstrated statistically significant improvements in provider confidence in T1D management and knowledge (p=0.02). PCPs who attended ≥ 50% sessions had the largest improvements. Over 90% of PCPs reported changes in medical practice (e.g., insulin and pump adjustments) and 95% would recommend the program to colleagues. The ECHO model can be applied to T1D to improve PCPs’ ability to manage patients with T1D. Future directions include evaluating influence on patient level outcomes and applying the model to insulin-requiring T2D patients. Disclosure N. Cuttriss: None. C. Anez-Zabala: None. L.G. Baer: None. S.L. Filipp: None. M. Basina: None. M.J. Gurka: None. L. Figg: None. M.J. Haller: Advisory Panel; Self; SAB Biotherapeutics, Inc. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. X. Roque: None. R. Lal: Consultant; Self; Abbott, Biolinq. S.C. Westen: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. M. Town: Other Relationship; Self; Insulet Corporation. C. Wang: None. J.J. Wong: None. K. Yabut: None. A.F. Walker: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Background: Psychosocial screening is recommended and increasingly common, but little is known about youths’ perspectives on screenings. Methods: One hundred and twenty-four adolescents (57.7% female) ages 12-21 years (M=16.2±2.3) completed routine, clinic-integrated screenings. K-means clustering derived profiles and ANOVA assessed correlates profiles. Results: Four distinct profiles emerged (Table 1). Profiles varied by depression (F=3.54, p=0.017), diabetes distress (F=3.27, p=0.036), and A1c values (F=4.03, p=0.009). Majority (72.6%) placed high importance on diabetes teams awareness about their emotions and reported no difficulties/discomfort (Embracers). Those uncomfortable with screening (Avoiders) were most depressed and had lowest A1C. Youth who endorsed difficulties with tablet and placed low importance about team awareness about their emotions (Skeptics) had relatively high depression but least diabetes distress. A small fourth group (Strugglers; n=3) must be interpreted with caution due to size. No differences were found for age, gender, diabetes duration/type, race/ethnicity, self-rated global health, or anxiety. Conclusions: Most youth responded favorably to in-clinic psychosocial screenings. Those less satisfied may have increased mental health risk and may benefit from technical support and an emphasized rationale for screenings. Disclosure J.J. Wong: None. S. Hanes: None. M.S. Lanning: None. M.L. Tanenbaum: None. D. Naranjo: None. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ.

Primary care providers (PCPs) manage type 1 diabetes (T1D) and complex diabetes for people who lack access to multispecialty care. Project ECHOTM (Extension for Community Healthcare Outcomes) is a low-dose, high frequency workforce development hub-spoke model that leverages telehealth to connect multidisciplinary specialists (“hub”) with PCPs across regional clinic sites (“spokes”). Applying the ECHO model, we piloted the model for T1D (Project ECHO T1D) in the states of California (CA) and Florida (FL) targeting PCPs managing adult and pediatric patients with T1D. Weekly hour-long teleECHOTM sessions were led by each hub in CA and FL over a 6 month pilot period. Each session included 1 to 2 case presentation. Prior to each teleECHO session, PCPs uploaded de-identified case presentations for discussion via REDCap®. Recommendations were provided by other participants and the multidisciplinary hub teams. Characteristics of case presentations were tracked in CA and FL. During the 6 month intervention, 47 new and follow-up cases were presented in CA and 45 in FL. Middle age adults (33.9±17.4 years-old, 20% pediatric) with poorly controlled diabetes (HbA1c 9.6±2.2% in CA and 10.4±2.8% in FL) were frequent cases. Common thematic questions submitted by PCPs in CA and FL, respectively, included: insulin dose adjustments (49%, 47%), social concerns (37%, 47%), behavioral health (29%, 34%), diabetes devices (44%, 13%), and diabetes education (15%, 38%). Patients commonly had depression (29.3%, 28.1%), recent hospitalizations (27%, 17%) and ER visits (33%, 26%) in the past year. Greatest barriers to care were social support (34%, 28%), financial (29%, 22%), diabetes knowledge (22%, 25%), attitudes and beliefs (27%, 16%) and psychiatric issues (20%, 19%). Findings illustrate the complexity of diabetes being managed by PCPs and the need for healthcare delivery innovation in diabetes education to support PCPs and primary care clinics who manage patients with complex diabetes who lack access to diabetes specialty care. Disclosure N. Cuttriss: None. C. Anez-Zabala: None. L.G. Baer: None. S.L. Filipp: None. M. Basina: None. M.J. Gurka: None. L. Figg: None. M.J. Haller: Advisory Panel; Self; SAB Biotherapeutics, Inc. K.K. Hood: Research Support; Self; Dexcom, Inc. Speaker’s Bureau; Self; LifeScan, Inc., MedIQ. X. Roque: None. R. Lal: Consultant; Self; Abbott, Biolinq. S.C. Westen: None. D.M. Maahs: Advisory Panel; Self; Eli Lilly and Company, Insulet Corporation, Medtronic, Novo Nordisk A/S. Consultant; Self; Abbott, Sanofi. Research Support; Self; Bigfoot Biomedical, Dexcom, Inc., Roche Diabetes Care, Tandem Diabetes Care. M. Town: Other Relationship; Self; Insulet Corporation. C. Wang: None. J.J. Wong: None. K. Yabut: None. A.F. Walker: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

Background: Members of our group previously reported that monetary reinforcement of SMBG related behaviors shows robust increases in frequency of SMBG and modest decreases in A1c among youth with type 1 diabetes (T1D). In these secondary data analyses, we explored effects on psychosocial functioning. Methods: Sixty youth ages 12-21 (Mage=15.58, SD=2.31) with T1D, A1c 7.5-13%, and Results: Generalized linear models showed no significant time x condition effects. In t-tests at discrete follow-ups, compared to the control group, the reinforce group had significantly lower youth-reported diabetes related family conflict at 12 weeks (22.39 vs. 25.11, p=.043) and significantly higher negative affective responses to out-of-range glucose results at 24 weeks (13.62 vs. 11.71, p=.047). Conclusion: Monetary reinforcers targeting SMBG behaviors may produce transitory decreases in youth perceptions of family conflict and transitory iatrogenic increases in youth’s negative affective responses to out-of-range glucose results. The timing of changes in family conflict, negative affect, and previously reported changes in A1c suggest that psychosocial changes may reflect youth responses to A1c as well as to reinforcers per se. For broader effects, the intervention could include psychosocial components that seek to directly maintain decreased family conflict and mitigate negative affect related to increased awareness of glucose control. Disclosure J.J. Wong: None. A. Addala: None. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute. J. Wagner: None. E. Cengiz: Advisory Panel; Self; Abvance, ADOCIA, MannKind Corporation, Novo Nordisk Inc. Speaker's Bureau; Self; Novo Nordisk Inc. E.M. Tichy: None. K. Weyman: None. D. Naranjo: Advisory Panel; Spouse/Partner; Eli Lilly and Company. Speaker's Bureau; Spouse/Partner; Johnson & Johnson Diabetes Institute. Other Relationship; Self; Abbott. Funding National Institutes of Health

Background: CGM has glycemic and psychosocial benefits. The current study sought to evaluate the specific impact of introducing CGM soon after diagnosis of T1D. Methods: A sample of 55 youth recently diagnosed with T1D were randomized to either an intervention (start Dexcom G5 CGM within 1 month of diagnosis) or control (monthly blinded CGM use) condition. HbA1c data and youth and parent surveys were collected at baseline, 13 and 26 weeks and glucose levels were measured via blinded or unblinded CGM. T-tests were used to compare groups based on glycemic and psychosocial outcomes. Results: Participant ages ranged from 3-18 (mean 11.1 ± 3.6years). On average, youth in the intervention group spent less time in hypoglycemia at 13 (2.0% vs. 7.5%, p=0.002) and 26 (1.9% vs. 4.9%, p=0.056) weeks and had elevated scores on the Diabetes Self Management Profile at week 13 (54.5 vs. 43.9 p=0.021) and more openness with glucose monitoring at weeks 13 (15.0 vs. 12.2, p=0.057) and 26 (16.42 vs. 12.12, p=0.014). Conversely, intervention group youth reported worse quality of life (QoL) at 13 weeks (8.5 vs. 3.0, p=0.020). At 26 weeks, the intervention group had slightly higher diabetes distress among youth (32.2 vs. 25.4, p=0.089) but lower diabetes distress among parents (42.5 vs. 50.9, p=0.050). Adding to prior reports from this study, these results show reduced hypoglycemia, improved attitudes toward diabetes technology, and satisfaction with glucose monitoring as well as decreased parent reported youth QoL. Conclusion: Introducing CGM soon after diagnosis appears to have substantial benefits, including prevention of hypoglycemia and bolstering youth self-management practices and openness to glucose monitoring. Given that early CGM initiation may negatively impact QoL in youth with T1D, as indicated by both youth and parent report, youth with T1D may benefit from education around use of CGM as well as psychosocial support for those with lower QoL. Disclosure J.J. Wong: None. S. Clay: None. G.P. Forlenza: Advisory Panel; Self; Dexcom, Inc. Consultant; Self; Medtronic MiniMed, Inc., Tandem Diabetes Care. Research Support; Self; Dexcom, Inc., Insulet Corporation, Medtronic MiniMed, Inc., Tandem Diabetes Care. S. Hanes: None. R. Wadwa: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Beta Bionics, MannKind Corporation, Novo Nordisk Inc., Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Other Relationship; Self; Dexcom, Inc. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson & Johnson Diabetes Institute. Funding Dexcom, Inc.