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The incidence of type 1 diabetes (T1D) is rising in all age groups. T1D is associated with chronic microvascular and macrovascular complications but improving glycemic trends can delay the onset and slow the progression of these complications. Utilization of technological devices for diabetes management, such as continuous glucose monitors (CGM) and insulin pumps, is increasing, and these devices are associated with improvements in glycemic trends. Thus, device use may be associated with long-term prevention of T1D complications, yet few studies have investigated the direct impacts of devices on chronic complications in T1D. This review will describe common diabetes devices and combination systems, as well as review relationships between device use and cardiovascular outcomes in T1D.Findings from existing cohort and national registry studies suggest that pump use may aid in improving cardiovascular risk factors such as hypertension and dyslipidemia. Furthermore, pump users have been shown to have lower arterial stiffness and better measures of myocardial function. In registry and case-control longitudinal data, pump use has been associated with fewer cardiovascular events and reduction of cardiovascular disease (CVD) and all-cause mortality. CVD is the leading cause of morbidity and mortality in T1D. Consistent use of diabetes devices may protect against the development and progression of macrovascular complications such as CVD through improvement in glycemic trends. Existing literature is limited, but findings suggest that pump use may reduce acute cardiovascular risk factors as well as chronic cardiovascular complications and overall mortality in T1D.

To evaluate the potential for glycaemic, renal and vascular benefits of bromocriptine quick release (BCQR) in adolescents and adults with type 1 diabetes.Forty adolescents and 40 adults with type 1 diabetes aged 12-60 years old were enrolled in a double-blind, placebo-controlled, random order crossover study of 4 weeks of treatment in the morning with BCQR (titrated weekly from 0.8 mg to 1.6 mg to 3.2 mg, minimum dose 1.6 mg). Study assessments after each phase included blood pressure (BP), lipids, peripheral arterial stiffness and autonomic function, mixed meal tolerance test, continuous glucose monitoring (CGM), creatinine, estimated glomerular filtration rate, estimated insulin sensitivity, insulin dose and indirect calorimetry.Adolescents displayed baseline hyperglycaemia, insulin resistance, metabolic dysfunction and increased renal filtration compared with adults. In both age groups, continuous glucose monitoring measures, estimated insulin sensitivity and insulin dose did not differ with BCQR treatment. In adolescents, BCQR decreased systolic BP, diastolic BP and triangular index and increased serum creatinine. In adults, systolic BP, mean arterial pressure, systemic vascular resistance, and mixed meal tolerance test glucose and glucagon-like peptide 1 areas under the curve were lower, and the orthostatic drop in systolic BP was greater with BCQR.Greater hyperglycaemia, insulin resistance, metabolic dysfunction and renal hyperfiltration in adolescents argues for increased attention during this high-risk age period. Although BCQR had little impact on glycaemia or insulin sensitivity, initial vascular and renal responses suggest potential benefits of BCQR in adolescents and adults with type 1 diabetes requiring further study.

OBJECTIVE Understanding mechanisms underlying rapid estimated glomerular filtration rate (eGFR) decline is important to predict and treat kidney disease in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS We performed a case-control study nested within four T1D cohorts to identify urinary proteins associated with rapid eGFR decline. Case and control subjects were categorized based on eGFR decline ≥3 and RESULTS The cohort study included 1,270 participants followed a median 8 years. In the discovery set, only cathepsin D peptide and protein were significant on full adjustment for clinical and laboratory variables. In the validation set, associations of cathepsin D with eGFR decline were replicated in minimally adjusted models but lost significance with adjustment for albuminuria. In a meta-analysis with combination of discovery and validation sets, the odds ratio for the association of cathepsin D with rapid eGFR decline was 1.29 per SD (95% CI 1.07–1.55). In complementary human cohorts, urine cathepsin D was associated with tubulointerstitial injury and tubulointerstitial cathepsin D expression was associated with increased cortical interstitial fractional volume. In mouse proximal tubular epithelial cell cultures, advanced glycation end product–BSA increased cathepsin D activity and inflammatory and tubular injury markers, which were further increased with cathepsin D siRNA. CONCLUSIONS Urine cathepsin D is associated with rapid eGFR decline in T1D and reflects kidney tubulointerstitial injury.

Context Interventions that decrease mean glucose have reduced rates of micro- and macrovascular complications in type 1 diabetes (T1D). However, the difference in cardiovascular risk between people with T1D and the general population endures, suggesting that factors beyond hemoglobin A1C (HbA1c) normalization drive cardiovascular outcomes. Objective To determine whether various HbA1c metrics predict anatomic cardiovascular disease (CVD) risk factors and/or CVD events in people with T1D. Methods We used linear regression to analyze the relationship of several HbA1c metrics to anatomic CVD risk factors and then used Cox regression to model their relationship to incident CVD events in the CACTI Study (ClinicalTrials.gov Identifier: NCT00005754). Results In linear regression models adjusted for age, sex, and T1D duration, baseline Hba1c (b = 0.3998, P = 0.0236), mean HbA1c (b = 0.5385, P = 0.0109), and HbA1c SD (b = 1.1521, P = 0.0068) were each positively associated with square root transformed coronary artery calcium volume. Conversely, only mean HbA1c (b = 1.659, P = 0.0048) positively associated with pericardial adipose tissue volume. In survival models adjusted for age, sex, and T1D duration, baseline HbA1c [hazard ratio (HR): 1.471, 95% CI: 1.257-1.721], mean HbA1c (HR: 1.850, 95% CI: 1.511-2.264), time-varying HbA1c (HR: 1.500, 95% CI: 1.236-1.821), and HbA1c SD (HR: 1.665, 95% CI: 1.022-2.711) each independently predicted CVD events over 14.3 ± 5.2 person-years of follow-up. Conclusions/interpretation We found that various HbA1c metrics positively correlated with CAC volume and independently predicted incident CVD events in the CACTI T1D cohort. These associations with CVD events persisted for baseline HbA1c, mean HbA1c, and time-varying HbA1c even after adjustment for numerous CVD risk factors.

The inflammatory potential of diet, assessed by Empirical Dietary Inflammatory Pattern (EDIP), may play a crucial role in the development of metabolic syndrome (MetS). However, limited research on this relationship is available. We hypothesized that EDIP is positively associated with MetS and its components. This longitudinal study included 1,177 participants (526 with type 1 diabetes mellitus (T1DM) and 651 without) from the Coronary Artery Calcification in Type 1 Diabetes study. Dietary assessment and anthropometric and biochemical measurements were assessed at baseline and 14-year follow-up. MetS status was defined using the Harmonization criteria. EDIP scores were computed based on a food frequency questionnaire. Generalized linear mixed models were applied and subgroup analyses were performed by diabetes status. Mean age of study participants was 38 years and 48% were male at baseline. EDIP was positively associated with MetS (β(T3 versus T1)=0.81, p

Aim To evaluate two methods of transition from an insulin pump to multiple daily injections (MDI) using long-acting insulin degludec (IDeg). Materials and methods After a 1-week run-in period, adults with type 1 diabetes for longer than 1 year and HbA1c 48-69 mmol/mol (6.5%-8.5%), who had been using an insulin pump at least for 6 months, were randomly transitioned to either standard of care (discontinued insulin pump and started IDeg in 1:1 dose) or overlap (IDeg 1:1 at pump basal dose, but pump continued for the first 48 hours with a gradual basal reduction; 50% from 0-24 hours, 75% from 24-48 hours and then pump discontinued). Participants used blinded Dexcom G6 and the IDeg dose was not changed during the trial. Primary (% time above 180 mg/dL) and secondary (% time in 70-180 mg/dL and below 70 mg/dL) outcomes were compared between the two groups during 7 days of randomization. Results Age, gender, diabetes duration and basal/bolus insulin doses were similar between patients randomized to standard of care (n = 17) or overlap (n = 13) transition. Compared with overlap transition, the standard of care group spent 4.8% more time in hyperglycaemia (least square mean 4.8% [95% CI -3.3%, 12.9%]) and 5.3% less time in range (-5.3% [-12.6%, -2.0%]), without a significant difference in hypoglycaemia (0.5% [-2.3%,3.4%]). No treatment-related adverse events were noted in either group. Conclusion The overlap transition method may result in a significant improvement in time-in-range without increasing hypoglycaemia during the first week of transition from an insulin pump to MDI using IDeg in adults with type 1 diabetes.

OBJECTIVE To determine whether the use of an inhaled insulin would improve HbA1c. METHODS This study was performed in 20 type 2 diabetes mellitus (T2DM) participants with HbA1c values ≥7.5 (58) to ≤11.5% (102 mmol/mol) on a variety of glucose-lowering regimens. Prandial Technosphere insulin (TI) was rapidly titrated based on a treatment algorithm using postprandial blood glucose to calculate premeal doses. A 2-week baseline period was followed by 12 weeks of active treatment with TI. The primary outcome was change in HbA1c. Secondary outcomes included glucose time in range (time in range: 70-180 mg/dL) obtained by a blinded continuous glucose monitoring during the baseline period and at the end of 12 weeks. Goals were to assess how to rapidly and safely initiate TI intensification, determine dosing requirements, and establish an effective dose range in uncontrolled T2DM. RESULTS Mean HbA1c decreased by -1.6% (-17 mmol/mol) from 9.0% (75 mmol/mol) at baseline to 7.4% (57 mmol/mol) at 12 weeks (P < .0001). Mean time in range increased from 42.2% to 65.7% (P < .0002). Mean prandial doses of TI were 18 or 19 units for all meals. Time below range was 1.1% baseline and 2.6% post treatment (P = .01). CONCLUSION Treatment with inhaled TI dosed using a simple algorithm improved glycemic control measured by both HbA1c and time in range, with low rates of hypoglycemia. These data add significantly to understanding TI in the management of T2DM patients for whom prandial insulin is a consideration.

Several studies have identified improvements in the risks of cardiovascular disease in adults following a Mediterranean dietary pattern. However, data are scarce on its association with coronary artery calcification (CAC) and pericardial adiposity (PAT) in US adults with and without diabetes. To address this gap, we conducted a case-control study using baseline data from the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study [n = 1255; Type 1 Diabetes (T1D): n = 563; non-Diabetes Mellitus (non-DM): n = 692]. Participants completed a validated food frequency questionnaire, fasting (12 h overnight fast) biochemical analyses, and a physical examination including anthropometric measures. CAC and PAT were measured using electron beam-computed tomography. Logistic regression models were used to examine the associations of the Mediterranean-Style Dietary Pattern Score (MSDPS) with CAC (presence or absence), and linear regression models were applied to PAT analyses. In all of the adjusted models, no significant associations with CAC were found. For PAT, an increasing MSDPS was consistently associated with its lower volume in models adjusted for age, sex, diabetes status, total calories, and body mass index (all p < 0.05). The association between MSDPS and PAT was attenuated after adjusting for serum lipids and physical activity. In conclusion, the baseline data from the CACTI study show that a greater adherence to MSDPS is associated with a lower PAT volume and provide evidence that the Mediterranean dietary pattern is associated with lower cardiovascular risk markers.

Introduction: Interventions that decrease mean glucose have reduced rates of type 1 diabetes (T1D) vascular complications, but the difference in cardiovascular disease (CVD) risk between people with T1D and the general population endures. This suggests that factors beyond hemoglobin A1c (HbA1c) normalization may drive T1D CVD outcomes. HbA1c variability is an established predictor of T1D microvascular disease, but thus far only the FinnDiane Study has implicated it as a risk factor for T1D CVD events. No studies have examined the relationship of HbA1c variability to both CVD risk factors and events in a prospective T1D cohort. Methods: We used multivariable logistic regression to analyze the Coronary Artery Calcification in Type 1 Diabetes (CACTI) T1D cohort (N=597) . Primary outcomes were square root-transformed coronary artery calcium (CAC) volume and CVD events. CVD events were defined as myocardial infarction, coronary artery bypass grafting, angioplasty, or cardiovascular death. HbA1c variability was defined as a 1-standard deviation increment in HbA1c and calculated as standard deviation of all HbA1c values for each subject. Results: After adjustment for age, sex, and T1D duration, HbA1c variability predicted both CVD events (HR: 1.562, 95% CI: 1.052-2.318, P=0.0269) and CAC volume (rpartial= 0.3346, P Conclusion: HbA1c variability may be a risk factor for both coronary atherosclerosis and CVD events in T1D, and the appropriate care strategy for this population may include maintaining an HbA1c value over time that is both at-target and stable. Disclosure W.B.Horton: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. Funding National Institutes of Health (R01DK116731) National Institutes of Health (R01HL113029)

Type 1 Diabetes (T1D) treatment involves engaging in multiple complex and burdensome self-management behaviors daily. The purpose of this study was to examine the relationship between diabetes burden, self-management behaviors, and A1C. Caregivers of 77 adolescents with T1D (age=14.9±1.9 years, A1C=9.8±1.6%, T1D duration=6.8±3.5 years, 45.5% male) participating in a RCT that provided integrated behavioral intervention to improve A1C completed a short version of Problem Areas in Diabetes-Parent Revised (PAID-PR) at the baseline visit prior to beginning intervention. The Immediate Burden subscale of PAID-PR was used to assess diabetes burden. Objective self-management behaviors were calculated using data downloaded from adolescents’ T1D devices. As caregiver burden increased, so did the frequency of self-management behaviors of carbohydrate entries per day (r=0.365, p Higher T1D self-management is associated with lower A1C, but this may come with a cost- greater feelings of burden due to T1D management. Family interventions to promote teamwork and assist caregivers and adolescents to appropriately distribute responsibility for T1D management may allow for continued high engagement while reducing burden. Disclosure H.K.O'donnell: None. A.C.Himelhoch: None. T.B.Vigers: None. G.T.Alonso: None. S.Majidi: None. L.Pyle: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. R.Wadwa: Advisory Panel; Dompé, Consultant; Beta Bionics, Inc., Other Relationship; Tandem Diabetes Care, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. K.A.Driscoll: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)

Introduction: Cardiovascular disease (CVD) is the leading cause of death in people with T1D, and women with T1D are disproportionately affected. However, few studies have examined how T1D affects vascular health in women across the lifespan. Methods: Women ages 18-79 with (N=309) and without T1D (n=351) were examined cross-sectionally for markers of CVD: pulse wave velocity (PWV) , augmentation index (AiX) , pulse height (PH) , brachial artery distensibility (BrachD) , subendocardial viability index (SVI) , and carotid intima thickness (cIMT) . Menopausal status was self-reported. Body composition was measured by Dual Xray Absorptiometry. CVD markers were examined by diabetes status and age using linear regression models adjusted for menopausal status. Results: Age did not differ in women with and without diabetes (49 ± 12 vs. 50±14 years, p=0.32) . Women with T1D had higher systolic blood pressure (SBP) , cIMT, PWV and PH, and lower BrachD and SVI than non-diabetic women (Table 1) . Changes in blood pressure, cIMT, AiX, and SVI with age differed by diabetes status, as demonstrated by a significant interaction. While SBP and Aix were increased more in women with T1D at younger ages, cIMT and SVI worsened with age to a greater extent in T1D. Conclusions: Women with T1D have worse CVD markers than women without diabetes across the lifespan, with more arterial stiffness at younger ages and more atherosclerosis and lower SVI later in life. Disclosure C.J.Chartier-logan: None. A.C.Alman: None. V.Shah: Advisory Panel; Medscape, Sanofi, Consultant; Dexcom, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc.

Introduction: People with type 1 diabetes (T1D) have an increased risk of developing cardiovascular disease. Endothelial cell dysfunction is thought to be a factor in this increased risk but underlying cellular mechanisms related to vasodilation, inflammation and oxidative stress are unknown. Methods: Participants with T1D (n= 25) and non-T1D (n=20) were categorized into groups of high (≥80) or low ( Results: As shown in table 1, eNOS and NADPH were lower and NFκβ and Nitrotyrosine [NT] were higher in T1D compared to non-T1D participants with low CAC. Among T1D, PWV was higher in those with high vs. low CAC. Among non-T1D participants, eNOS was lower and NT and ER-α were lower in those with high vs. low CAC. Conclusions: T1D is associated with adverse endothelial proteins that may contribute to endothelial dysfunction and vascular disease. Disclosure H.K.Wise: None. A.Keshawarz: None. K.Moreau: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc.

Introduction: Poorer outcomes in acute and late complications of type 1 diabetes (T1D) persist among racial/ethnic minorities, and technology adoption may be lower in these groups. Technologies such as continuous glucose monitors (CGM) and insulin pumps (CSII) enhance diabetes management and improve glycemic control. We examined differences in use of diabetes technology by race/ethnicity among patients 12 and older followed at the Barbara Davis Center who had T1D for at least 1 year. Methods: Use of CGM and/or CSII vs. neither was examined in 5,539 patients by racial/ethnic groups: Non-Hispanic White (NHW, n=3,945) , Black (n=161) , Hispanic (n=719) and Other racial groups (OR, n=714) . General liner models compared HbA1c and technology use by race/ethnicity. Results: Black, Hispanic and OR patients were younger, had shorter T1D duration, higher HbA1c and less use of technology. In linear models adjusted for age, diabetes duration and visits over the past year, use of technology was associated with lower HbA1c in each race/ethnic group. However, among technology users, minority patients had higher HbA1c compared to NHW patients. Conclusion: HbA1c was highest and diabetes technology use lowest among Blacks and Hispanics. Efforts to increase technology use for diabetes management in these populations may result in greater glycemic control and ultimately the reduction of acute and late complications of diabetes. Disclosure B.Conway: None. V.Shah: Advisory Panel; Medscape, Sanofi, Consultant; Dexcom, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk. C.Geno rasmussen: None. A.Gerard gonzalez: n/a. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. Funding NIH grant P30-DK116073

Insulin resistance (IR) increases risk for cardiovascular disease and mortality in people with type 1 diabetes (T1D) . We previously found associations between plasma lipids, metabolites and IR; whether these associations differ in people with and without T1D is not well understood. We analyzed targeted plasma lipidomics and untargeted plasma metabolomics in 25 premenopausal women aged 18-45 yrs (12 with T1D and 13 without diabetes [non-DM]) who had a hyperinsulinemic euglycemic clamp to measure glucose infusion rate (GIR) . After stratifying by diabetes, women were classified by tertiles of GIR. We used sparse partial least-squares discriminant analysis to predict and moderated t-tests to compare most IR vs. most insulin sensitive (IS) tertile. Among women with T1D, 3 lipids, 4 amino acids, 3 peptides, 3 xenobiotics, 1 carbohydrate, and 1 nucleotide were lower and 1 lipid and 1 fatty acid were higher in the most IS tertile (Table) . Among non-DM women, 4 lipids, 1 cofactor, 1 fatty acid, and 1 phosphatidylethanolamine were lower and 1 nucleotide and 1 lipid were higher in the most IS tertile. None of the top features were the same in the T1D and non-DM groups. Plasma lipids and metabolites were differentially associated with IR in women with and without T1D. Future work should validate these findings in a larger sample of women and men, and explore how these biomarkers relate to IR and metabolism in T1D. Disclosure T.B.Vigers: None. L.Pyle: None. I.E.Schauer: None. B.C.Bergman: Research Support; Eli Lilly and Company. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. Funding American Diabetes Association (7-13-CD-10) ; National Heart, Lung, and Blood Institute (grant HL61753 and HL113029) , JDRF Diabetes Foundation (grant 17-2013-313) , DERC Clinical Investigation Core (grant P30 DK57516) , NIH-M01-RR00051, NIH P30-DK116073

Fear of hypoglycemia (FOH) is not consistently correlated with A1C in youth with T1D, but few studies have taken other psychosocial variables into account. This study examined T1D responsibility as a moderator of the relationship between FOH and A1C. N=1youth ages 10-18 yrs (45.5% male; age=14.7±1.9 yrs; A1C=9.9±1.6%; T1D duration=6.5+3.4 yrs) completed the Maintain High Blood Glucose subscale of the Children’s Hypoglycemia Fear Survey (assesses behavioral manifestations of FOH) and Diabetes Family Responsibility Questionnaire (assesses distribution of T1D responsibility between child and caregiver) . Higher scores indicate greater FOH and caregiver responsibility, respectively. The main effect of T1D responsibility on A1C was not significant (p>0.05) , whereas the main effect of Maintain High Blood Glucose was (p=0.03) . Responsibility moderated the relationship between Maintain High Blood Glucose and A1C; child’s FOH had less of an effect on A1C if the caregiver had higher responsibility (B=-0.41, p=0.04; R2 =0.038, p Children who maintain their blood glucoses higher than recommended due to high FOH should have more parent involvement in their T1D care to minimize the deleterious impact of their fears on A1C. Future research should examine the Maintain High Blood Glucose subscale and other psychosocial moderators specifically in relation to glycemic outcomes. Disclosure E.R.Shaffer: None. H.K.O'donnell: None. G.T.Alonso: None. S.Majidi: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. R.Wadwa: Advisory Panel; Dompé, Consultant; Beta Bionics, Inc., Other Relationship; Tandem Diabetes Care, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. K.A.Driscoll: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113363)

Introduction: Women with type 1 diabetes (T1D) are at increased risk for cardiovascular disease (CVD) , and menopause increases CVD risk. However, little is known about menopause and CVD risk in T1D. Methods: Women with (N=64) and without T1D (n=63) ages 47-55 years were examined for CVD risk factors and surrogate CVD markers: pulse wave velocity (PWV) , augmentation pressure (AP) and pulse height (PH) , brachial artery distensibility (BrachD) , and subendocardial viability index (SVI) . Body composition was measured by Dual Xray Absorptiometry. Menopausal status was determined by self-report. CVD markers were examined by diabetes and menopausal status using linear regression models adjusted for age. Results: Mean ± SD age was 51±2.5 years in women with T1D and 51 ± 2.4 years in women without diabetes (p=0.32) . The percentage postmenopausal did not differ (30% vs. 32%, p=0.8) between T1D and nondiabetes women. As shown in the table, women with T1D had higher systolic blood pressure and measures of arterial stiffness (PWV, AP, PH, and BrachD) and lower SVI than women without diabetes. Menopause was associated with a greater loss in fat free mass and a greater increase in PWV and AP among women with T1D compared to women without diabetes. Conclusions: Women with T1D have worse CVD markers, and menopause is associated with greater increases in arterial stiffness and loss in lean body mass than in nondiabetes women, independent of age. Disclosure H.K.Wise: None. E.Malecha: None. C.J.Chartier-logan: None. L.Pyle: None. A.Keshawarz: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. Funding American Diabetes Association (7-13-CD-10)

Background: Spirometry assessed pulmonary function has been shown to be mildly reduced in type 1 diabetes (t1d) and while this reduction appears to be chronic it doesn’t appear to be progressive. This suggests that functional reduction may not be a microvascular complication of t1d despite the enormous capillary bed in the lungs. CT imaging of the lungs of people with t1d evaluated for pulmonary function is essentially unexplored. We examined CT imaging of participants with and without t1d to explore lung morphology as it relates to t1d. Methods: The CACTI study conducted CT imaging of the chest as well as pulmonary function testing via spirometry (PFT) . Imaging included the majority of the lungs but does not include the apexes or bases. These lung fields were assessed in a systematic way by a single clinician for incident and these observations were text mined in order to capture the most frequently observed morphologies. PFT results are reported as % predicted values for forced expiratory volume 1 second (FEV1%p) and Forced Vital Capacity (FVC%p) . Results: 525 CT scans (2t1d, 316 control) were matched to PFT and compared for each of the most common morphologies (nodules (66) , calcified nodes (25) , emphysema (19) , atelectasis (28) , ground glass (13) , airway thickening (34) and granulomatous disease (28) were the most frequently observed) . Participants with t1d had lower FEV1%p (85.9%p vs. 94.4%p, p Conclusions: People with t1d have reduced pulmonary function but CT scans of the central lungs do not show morphological changes that may explain this reduction. Disclosure G.L.Kinney: None. R.B.Conway: None. K.Young: None. Y.Li: Employee; Vertex Pharmaceuticals Incorporated. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc.

Glycemic control significantly affects the risk for developing adverse gestational health outcomes in pregnancies affected by type 1 diabetes (T1D) . Utilizing continuous glucose monitoring (CGM) in T1D pregnancies has been shown to improve maternal glucose control. We examined the effect of CGM use in meeting HbA1c goals by trimester in T1D pregnancies in a real-world setting.We did a retrospective chart view to identify T1D pregnancies managed at the Barbara Davis Center (BDC) for T1D with either CGM therapy (n=82) or self-monitoring of blood glucose (SMBG) (n=78) over a 6.5-year period (1/1/14 to 8/31/20) . CGM use was defined as >60% wear in the 2nd and 3rd trimesters. HbA1c goals were defined as ≤6.5% in Trimester 1 (T1) and ≤6% in Trimester 2 (T2) and Trimester 3 (T3) , per guidelines by the American Diabetes Association. Baseline characteristics and HbA1c were obtained from the electronic medical record system.CGM users had a significantly higher rate of commercial insurance use (Table) , while other baseline characteristics were similar between groups. CGM users were more likely to meet HbA1C goals in all trimesters (Table) . More than half of SMBG users did not meet HbA1C goals in any trimester (Table) .CGM use significantly increased the likelihood of meeting trimester-specific HbA1c goals in each trimester throughout pregnancy among women with T1D in this real-world study. Disclosure E.Malecha: None. V.Gao: None. E.Westfeldt: n/a. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. S.Polsky: Advisory Panel; Medtronic, Other Relationship; diaTribe, Research Support; Dexcom, Inc., Eli Lilly and Company, Leona M. and Harry B. Helmsley Charitable Trust, Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi-Aventis U.S. Funding National Institutes of Health (P30-DK116073)

Background: Global vascular dysfunction is well-recognized in youth with type 1 diabetes (T1D) , accentuating lifetime cardiovascular event risk and making therapeutic strategies to mitigate vascular dysfunction a high priority. In the BCQR-T1D study, we tested the hypothesis that BCQR, a medication used in obese adults with type 2 diabetes, would improve vascular health in T1D youth. Methods: BCQR-T1D was a placebo-controlled, random-order, double-blinded, cross-over study investigating cardiovascular and metabolic impacts of BCQR in T1D. Youth were randomized 1:1 to phase-1: 4-weeks of BCQR or placebo after which blood pressure (BP) , peripheral vascular stiffness by brachial artery distensibility (BrachD) , and central aortic stiffness by pulse wave velocity (PWV) , relative area change (RAC) and distensibility from phase-contrast MRI, were performed. Following a 4-week washout period, phase 2 was performed in identical fashion with the alternate treatment. Results: Forty-two adolescents (mean age 15.9 years, HbA1c 8.6%, BMI %ile 71.4, T1D duration 5.8 years) with T1D were enrolled. Compared to placebo, BCQR therapy decreased systolic (∆ = -5 mmHg, p Conclusions: BCQR improved BP, central and peripheral aortic stiffness and pressure hemodynamics in T1D adolescents over 4 weeks vs. placebo, even if normal weight, supporting future longer-term studies. Disclosure M.Schäfer: None. I.E.Schauer: None. K.J.Nadeau: None. L.Browne: None. U.Truong: None. P.Bjornstad: Advisory Panel; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Horizon Therapeutics plc, LG Chem, Lilly, Novo Nordisk, Consultant; AstraZeneca, Bristol-Myers Squibb Company. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. A.Baumgartner: None. K.S.Hunter: None. J.Reusch: Advisory Panel; Medtronic. A.J.Barker: None. Funding JDRF BROM QR THERP3-SRA-2015-125-M-R

To examine the associations of dietary patterns and nutrients with coronary artery calcification (CAC) and pericardial adiposity (PAT) in adults with and without type 1 diabetes. We conducted a six-year longitudinal analysis of data from Coronary Artery Calcification in Type 1 Diabetes study [n = 1255; T1D: n = 563; non-DM: n = 692] collected at baseline, year 3 and year 6. Participants completed a validated food frequency questionnaire, a physical examination, and fasting (12 h overnight fast) biochemical analyses. CAC and PAT were measured using electron beam computed tomography. Dietary patterns were identified using factor analysis. Generalized estimating equations were used to examine associations of dietary patterns and nutrients with CAC and PAT in models adjusted for traditional cardiovascular risks. The ‘starchy veggies, meats and alcohol pattern’ was associated with significantly increased risk of CAC presence in all adjusted models; an increasing trend was observed with CAC progression. Increasing intake of dietary proteins and total fats were also associated with higher risk of the presence and/or progression of CAC in adjusted models (all p

Objective: Understanding mechanisms underlying rapid estimated glomerular filtration rate (eGFR) decline is important to predict and treat kidney disease in type 1 diabetes (T1D). Research Design and Methods: We performed a case-control study nested within four T1D cohorts to identify urinary proteins associated with rapid eGFR decline. Cases and controls were defined by eGFR decline >3 and 2/year, respectively. We used targeted liquid chromatography-tandem mass spectrometry to measure 38 peptides from 20 proteins implicated in diabetic kidney disease. Significant proteins were investigated in complementary human cohorts and in mouse proximal tubular epithelial cell cultures. Results: The cohort study included 1270 participants followed a median 8 years. In the discovery set, only cathepsin D peptide and protein were significant on full adjustment for clinical and laboratory variables. In the validation set, associations of cathepsin D with eGFR decline were replicated in minimally-adjusted models but lost significance with adjustment for albuminuria. In a meta-analysis combining discovery and validation sets, the odds ratio for the association of cathepsin D with rapid eGFR decline was 1.29 per SD (95%CI 1.07-1.55). In complementary human cohorts, urine cathepsin D was associated with tubulointerstitial injury, and tubulointerstitial cathepsin D expression was associated with increased cortical interstitial fractional volume. In mouse proximal tubular epithelial cell cultures, advanced glycation end product-bovine serum albumin increased cathepsin D activity and inflammatory and tubular injury markers, which were further increased with cathepsin D siRNA. Conclusion: Urine cathepsin D is associated with rapid eGFR decline in T1D and reflects kidney tubulointerstitial injury.

Atherosclerotic CVD is the major cause of death in patients with type 1 diabetes mellitus (T1DM). Alterations in the HDL proteome have been shown to associate with prevalent CVD in T1DM. We therefore sought to determine which proteins carried by HDL might predict incident CVD in patients with T1DM. Using targeted MS/MS, we quantified 50 proteins in HDL from 181 T1DM subjects enrolled in the prospective Coronary Artery Calcification in Type 1 Diabetes study. We used Cox proportional regression analysis and a case-cohort design to test associations of HDL proteins with incident CVD (myocardial infarction, coronary artery bypass grafting, angioplasty, or death from coronary heart disease). We found that only one HDL protein-SFTPB (pulmonary surfactant protein B)-predicted incident CVD in all the models tested. In a fully adjusted model that controlled for lipids and other risk factors, the hazard ratio was 2.17 per SD increase of SFTPB (95% confidence interval, 1.12-4.21, P = 0.022). In addition, plasma fractionation demonstrated that SFTPB is nearly entirely bound to HDL. Although previous studies have shown that high plasma levels of SFTPB associate with prevalent atherosclerosis only in smokers, we found that SFTPB predicted incident CVD in T1DM independently of smoking status and a wide range of confounding factors, including HDL-C, LDL-C, and triglyceride levels. Because SFTPB is almost entirely bound to plasma HDL, our observations support the proposal that SFTPB carried by HDL is a marker-and perhaps mediator-of CVD risk in patients with T1DM.

Type 1 diabetes (T1D) has been associated with increased risks of atherosclerotic cardiovascular disease, and poor glycemic control and oxidative stress play a major role in its pathology. There is a lack of data on the role of dietary antioxidant micronutrients, including vitamins and trace elements, in glycemic control in T1D. The aim of this study is to examine associations of dietary intakes of micronutrients with glycemic status. We report data from a cross-sectional analysis from the coronary artery calcification in type 1 diabetes (CACTI) study ( n = 1257 ; T1D: n = 568 ; nondiabetic controls: n = 689 ) collected between the years 2000 and 2002. Participants completed a validated food frequency questionnaire, a physical examination, and biochemical analyses. Linear regression was used to examine the associations of dietary antioxidant micronutrients with HbA1c and estimated insulin sensitivity (eIS) in models adjusted for relevant covariates and stratified by diabetes status. In adults with T1D, we observed higher dietary manganese intake associated with higher eIS in the model adjusted for age, sex, diabetes duration, and total calories. In nondiabetic controls, higher intake of manganese associated with lower HbA1c and higher eIS values that persisted in models adjusted for all relevant covariates. On the other hand, dietary copper revealed a positive association with HbA1c in models adjusted for all covariates, except BMI and plasma lipids. No associations were noted for vitamins C and E and dietary carotenoids in either group. These findings reveal dietary antioxidant micronutrients, especially trace elements such as copper and manganese deserve special attention in glycemic control in adults with T1D as well as in nondiabetic controls.This trial is register with NCT00005754.

Context Cardiovascular disease (CVD) is a major cause of mortality in adults with type 1 diabetes. Objective We prospectively evaluated CVD risk factors in a large, contemporary cohort of adults with type 1 diabetes living in the United States. Design Observational study of CVD and CVD risk factors over a median of 5.3 years. Setting The T1D Exchange clinic network. Patients Adults (age ≥ 18 years) with type 1 diabetes and without known CVD diagnosed before or at enrollment. Main Outcome Measure Associations between CVD risk factors and incident CVD were assessed by multivariable logistic regression. Results The study included 8,727 participants (53% female, 88% non-Hispanic white, median age 33 years [interquartile ratio {IQR} = 21, 48], type 1 diabetes duration 16 years [IQR = 9, 26]). At enrollment, median HbA1c was 7.6% (66 mmol/mol) (IQR = 6.9 [52], 8.6 [70]), 33% used a statin, and 37% used blood pressure medication. Over a mean follow-up of 4.6 years, 325 (3.7%) participants developed incident CVD. Ischemic heart disease was the most common CVD event. Increasing age, body mass index, HbA1c, presence of hypertension and dyslipidemia, increasing duration of diabetes, and diabetic nephropathy were associated with increased risk for CVD. There were no significant gender differences in CVD risk. Conclusion HbA1c, hypertension, dyslipidemia and diabetic nephropathy are important risk factors for CVD in adults with type 1 diabetes. A longer follow-up is likely required to assess the impact of other traditional CVD risk factors on incident CVD in the current era.

OBJECTIVE To evaluate long-term glycemic outcomes of continuous glucose monitoring (CGM) initiation within the first year of type 1 diabetes diagnosis. RESEARCH DESIGN AND METHODS Patients with type 1 diabetes (N = 396) were divided into three groups: 1) CGM (CGM use within 1 year of diabetes diagnosis and continued through the study), 2) no-CGM (no CGM use throughout the study), and 3) new-CGM (CGM use after 3 years since diabetes diagnosis). Patients were followed up to 7 years. RESULTS A1c was significantly lower in the CGM compared with the no-CGM group throughout 7 years of follow-up (least squares mean A1c values: 6 months, 7.3% vs. 8.1%; 1 year, 7.4% vs. 8.6%; 2 years, 7.7% vs. 9.1%; 3 years, 7.6% vs. 9.3%; 4 years, 7.4% vs. 9.6%; 5 years, 7.6% vs. 9.7%; 6 years, 7.5% vs. 10.0%; and 7 years, 7.6% vs. 9.8%; for all, P < 0.001) adjusting for age at diagnosis, sex, and insulin delivery method. CONCLUSIONS CGM initiation within first year of type 1 diabetes diagnosis results in long-term improvement in A1c.

Pregnancies complicated by type 1 diabetes (T1D) experience high levels of glycemic variability, which may be associated with adverse maternal and neonatal outcomes. Therefore, strategies that help pregnant women with T1D manage their glycemic control are of great interest.We examined associations with or without remote monitoring of Continuous Glucose Monitor (CGM) data by friends and family with indices of glycemic control and glycemic variability during pregnancies complicated by T1D in a pilot non-randomized trial (Participants using CGM Share had lower estimated HbA1c levels over time (In this non-randomized pilot study, use of CGM Share was associated with improvements in several indices of glycemic control and glycemic variability.

To determine differences in hip geometry in adults with type 1 diabetes (T1D) compared with healthy adults without diabetes.In this cross-sectional study, 43 adults with T1D (mean age 56 years, 84 % female, 92 % White, mean duration of diabetes of 39 years, A1c of 7.8 %) and 40 adults without diabetes (mean age 60 years, 80 % female, 77 % white) who had hip dual-energy x-ray absorptiometry (DXA) scans from previous studies were included. Areal bone mineral density (aBMD) and measures of hip structural properties at the narrow neck, intertrochanteric and femoral shaft regions of the left proximal femur were analyzed between adults with T1D and controls using linear models controlled for age, sex, and body mass index.There were no significant differences in DXA-based aBMD at the hip (0.769 ± 0.132 vs. 0.900 ± 0.139 g/cmAdults with T1D have several significant differences in proximal femur morphology compared with controls. These morphological differences may adversely affect the mechanical integrity of the proximal femur, thereby contributing to an increased risk of fracture in the event of a fall.

Objective To assess the accuracy of a breath ketone analyzer to detect ketosis in adults and children with type 1 diabetes. Research design and methods This is a proof-of-concept, prospective study comparing breath ketone analyzer and blood ketone meter to detect ketosis. Results A total of 500 measurements from 19 adults and children with type 1 diabetes were analyzed. There was a significant association between the breath ketone analyzer and blood ketone meter results in non-fasting adults (p = 0.0066), but not in children (p = 0.4579). In adults, a cut-off of 3.9 PPM on the breath ketone analyzer maximized the Youden Index with an AUC of 0.73. This cut-off for the breath ketone analyzer had 94.7% sensitivity and 54.2% specificity to detect ketosis (≥0.6 mmol/L in blood ketone meter). Conclusions The breath ketone analyzer may be considered as a non-invasive screening tool to rule out ketosis in adults with type 1 diabetes.

OBJECTIVES Patients with type 1 diabetes (T1D) exhibit modest lipid abnormalities as measured by traditional metrics. This study aimed to identify lipidomic predictors of rapid decline of kidney function in T1D. RESEARCH DESIGN AND METHODS In a case-control study, 817 patients with T1D from three large cohorts were randomly split into training and validation subsets. Case was defined as >3 mL/min/1.73 m2 per year decline in estimated glomerular filtration rate (eGFR), while control was defined as RESULTS At individual lipids, free fatty acid (FFA)20:2 was directly and phosphatidylcholine (PC)16:0/22:6 was inversely and independently associated with rapid eGFR decline. When examined by lipid class, rapid eGFR decline was characterized by higher abundance of unsaturated FFAs, phosphatidylethanolamine (PE)-Ps, and PCs with an unsaturated acyl chain at the sn1 carbon, and by lower abundance of saturated FFAs, longer triacylglycerols, and PCs, PEs, PE-Ps, and PE-Os with an unsaturated acyl chain at the sn1 carbon at eGFR ≥90 mL/min/1.73 m2. A multilipid panel consisting of unsaturated FFAs and saturated PE-Ps predicted rapid eGFR decline better than individual lipids (C-statistic, 0.71) and improved the C-statistic of the clinical model from 0.816 to 0.841 (P = 0.039). Observations were confirmed in the validation subset. CONCLUSIONS Distinct from previously reported predictors of GFR decline in type 2 diabetes, these findings suggest differential incorporation of FFAs at the sn1 carbon of the phospholipids’ glycerol backbone as an independent predictor of rapid GFR decline in T1D.

In exploratory analyses, we evaluated glycemic variability (GV) and gestational outcomes in pregnant women (n = 28) with type 1 diabetes (T1D). Gestational age at delivery was higher for women with lower glycemic measures, including estimated HbA1c (eHbA1c) (0.14% decrease in HbA1c per 1-week greater gestational age, P = 0.0035), mean sensor glucose (−3.9 mg/dL P = 0.0039), time spent >140 mg/dL (−3.1%, P = 0.0029), and higher time in range (TIR) of 63–140 mg/dL (3.2%, P = 0.0029). Third trimester measured HbA1c was significantly associated with gestational age at delivery (P = 0.0081). Preeclampsia was associated with less TIR in first (50.5% vs. 69.9%, P = 0.0034) and second trimesters (47.1% vs. 66.7%, P = 0.0025), but not with measured HbA1c. There were significant differences in other markers of GV (continuous overall net glycemic action, high blood glucose index, J-index, mean amplitude of glycemic excursions) with infant birth weight and gestational age at delivery. Thus, multiple markers of glycemia and GV were associated with gestational health outcomes in T1D pregnancies in this pilot study. Clinical Trial Registration number: NCT02556554.

In exploratory analyses, we evaluated glycemic variability (GV) and gestational outcomes in pregnant women (n = 28) with type 1 diabetes (T1D). Gestational age at delivery was higher for women with...

Objective: We evaluated two methods for successful transition from insulin pump to multiple daily injections (MDI) using long-acting insulin degludec (IDeg) in adults with type 1 diabetes (T1D). Methods: After 1 week of run-in-period, adults with T1D > 1 year, using insulin pump for > 6 months, and A1c between 6.5% and 8.5% were randomly transitioned from insulin pump to MDI using either standards of care (stopped insulin pump and started IDeg in 1:1 dose) or overlap (IDeg in 1:1 dose and insulin pump basal were overlapped for first 48 hours; 50% and 75% basal reduction for 24 and 24-48 hours, respectively). Participants wore blinded Dexcom G6 and IDeg dose was not changed during the trial. Percent time in range (70-180 mg/dL) and time below range ( Results: 17 adults (age 35.7±9.1 years, A1c 7.5±0.5%, diabetes duration 21.6±11.8 years, 53% females) were randomized to standard of care, and 13 adults (age 38.2±9.5, A1c 7.2±0.6%, diabetes duration 20.5±13.0, 46% females) were randomized to overlap. Compared to standard of care, patients on overlap transition spent greater time in normoglycemia without increasing hypoglycemia (Figure 1). Conclusion: Overlap of IDeg and insulin pump for first 48 hours results in better glycemic control without increasing hypoglycemia during transition to MDI using IDeg in adults with T1D. Disclosure V. Shah: Advisory Panel; Self; Medscape, Sanofi, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi, vTv Therapeutics. H. K. Akturk: Consultant; Self; American Diabetes Association, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, IM Therapeutics, MannKind Corporation, REMD Biotherapeutics, Senseonics, Speaker’s Bureau; Self; American Diabetes Association. H. Joseph: None. N. Schneider: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. Funding Novo Nordisk

The WHO and CDC have issued guidance documents on COVID-19 avoidance behaviors. People susceptible to severe disease, such as people with diabetes, should strictly follow these recommendations. We conducted a survey of Covid-19 avoidance behaviors in individuals with and without type 1 diabetes (T1D). We invited participants with and without T1D who are part of complications research cohorts at the Barbara Davis Center to answer an online survey regarding their exposure to COVID-19 and their behaviors to reduce their risk of infection. A total of 321 participants (162 without diabetes [non-DM], 159 with T1D) completed the initial survey. The average ± SD age was 55±12 years (range 29 to 83 years), and 65% of participants were female. The reported prevalence of an illness like COVID-19 was 20% in adults with T1D and 27% in non-DM adults (p=0.13). Participants with T1D were less likely to report hand washing, avoiding gatherings, canceling travel, wearing a mask, avoiding touching people, wiping down surfaces and following government guidelines (Table). In multivariate analysis, factors significantly associated with fewer protective behaviors included younger age, male sex, and T1D (p=0.0005). Despite being at high risk for severe Covid-19 disease, adults with T1D were less likely to report behaviors known to reduce the risk of contracting this illness. These data suggest a need for further education in this high-risk population. Disclosure C. J. Chartier-logan: None. E. Eikermann: None. H. K. Wise: None. E. Malecha: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc.

Prolonged T1D and suboptimal glycemic control contributes to diabetic peripheral neuropathy, which may occur with impairing psychological symptoms. This study examined the association between neuropathy and depressive symptoms in adults with T1D. Neuropathy was assessed using the Michigan Neuropathy Screening Instrument history and physical assessment (clinical scores >2 indicate neuropathy) in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study. Depressive symptoms were assessed by the Beck Depression Inventory (BDI-II; scores >14 indicate clinically elevations). Neuropathy was detected in 22% of participants with T1D (N=364; 55% female; age=51±9 years; T1D duration=38±9 years) and elevated depressive symptoms in 10%. Participants with neuropathy were older and had longer T1D duration and higher BDI-II scores; they were more likely to have elevated depressive symptoms. In logistic regression models adjusted for age, sex, T1D duration, and A1C, neuropathy was associated with a 7-fold increased odds of elevated depressive symptoms (OR [95% CI] = 7.5 [3.1-17.9, p Disclosure S. E. Wetter: None. K. A. Driscoll: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. Funding National Institutes of Health (R01HL113029)

The coronavirus 2019 (Covid-19) pandemic has caused disruption to medical care and loss of employment and medical insurance for some people with chronic diseases such as diabetes. Further, people with diabetes are at increased risk for severe Covid-19 disease. Our goal was to examine the prevalence of anxiety and depression symptoms related to the Covid-19 pandemic in adults with type 1 diabetes (T1D). Psychosocial surveys were sent to 3,653 adults with T1D from the Adult Clinic at the Barbara Davis Center. Survey responses were collected from 899 adults from this population between September and October of 2020; 65% of respondents were women, and the age range was 18-95 years. Overall, 5% of participants reported testing positive for the virus or having Covid-19 symptoms but not being tested. As shown in the table, overall 49% of adults reported depressive symptoms and 74% reported experiencing anxiety related to Covid-19. Women with T1D were more likely to report Covid-19 related depression and anxiety symptoms, despite similar infection rates in both sexes. Further, women were more likely than men to express concerns about obtaining diabetes care and paying for diabetes supplies during the pandemic. The Covid-19 pandemic has resulted in a high prevalence of depression and anxiety symptoms in adults with T1D, particularly among women. These data suggest a potential area for intervention to improve psychosocial health. Disclosure E. Malecha: None. K. A. Driscoll: None. V. Shah: Advisory Panel; Self; Medscape, Sanofi, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi, vTv Therapeutics. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. C. Geno rasmussen: None.

Background: People with type 1 diabetes (T1D) have a greater risk of developing cardiovascular diseases than people without diabetes. Inflammation plays a key role in atherosclerosis and diet has been known to modify inflammation. However, little is known about this association in T1D. Methods: We conducted a six-year longitudinal analysis of data from Coronary Artery Calcification in Type 1 Diabetes study [n=1255; T1D: n=563; non-DM: n=692] collected at baseline, year 3 and year 6. Participants completed a validated food frequency questionnaire, a physical examination, and fasting (12h overnight fast) biochemical analyses. Biomarkers of inflammation and atherosclerosis [C-reactive protein (CRP), fibrinogen, plasminogen activator inhibitor-1 (PAI-1), homocysteine (hcy) and adiponectin] were determined in serum samples at three time points. Dietary patterns were identified using factor analysis. Generalized estimating equations were used to examine associations of dietary patterns with inflammation in models adjusted for traditional cardiovascular risks. Results: In a multivariate model, increasing intake of carbohydrates and total fats were positively associated with CRP [β (95% CI): 0.013 (0.003, 0.023) and 0.025 (0.011, 0.039), respectively) and fibrinogen (0.007 (0.005, 0.010) and 0.010 (0.006, 0.014), respectively) when adjusted for age, sex, time, total calories, and diabetes status. Dietary fiber revealed an inverse association with CRP [-0.014 (-0.021, -0.007)], PAI-1 [-0.009 (-0.015, -0.003)], and hcy [-0.002 (-0.005, 0.000)], and a positive association with adiponectin [0.005 (0.000, 0.009)]. A dietary pattern characterized by ‘veggies, meats and alcohol’ was positively associated with adiponectin [0.022 (0.001, 0.043)]. Conclusions: Dietary carbohydrates and total fats were associated with biomarkers of inflammation and atherosclerosis, while fiber revealed protective associations in adults with and without T1D. Disclosure A. Basu: None. L. Chien: None. A. C. Alman: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. Funding National Institutes of Health (R01HL61753)

Psychosocial screening is not standard care in adults with T1D despite ADA recommendations. Depression interferes with daily life and physical health outcomes. The purpose of this study was to examine depressive symptoms, self-management behaviors, and A1C in adults with T1D. Adults with T1D (N=899; 65% females; 25±14 years of age; 18-95 years) completed the Patient Health Questionnaire-8 (PHQ-8; □15 clinically elevated) and the Diabetes Self-Management Questionnaire (DSMQ); A1C was self-reported. DSMQ Total score and subscales with higher scores indicating higher engagement in self-management. Women were significantly more likely to have clinically elevated symptoms of depression (10% men and 16% women; P=0.02). Higher PHQ-8 scores were associated with lower DSMQ Total score and subscales in both men and women, but A1C only in women. There was a significant sex by PHQ-8 interaction for A1C and the DSMQ Glucose Management subscale (Table). Women with clinically elevated depressive symptoms had an average A1C that was 1.3% higher than women without elevated symptoms. Women with T1D with higher levels of depressive symptoms do not meet ADA recommended A1C Disclosure C. Geno rasmussen: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. H. K. Wise: None. V. Shah: Advisory Panel; Self; Medscape, Sanofi, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi, vTv Therapeutics. K. A. Driscoll: None. Funding National Center for Advancing Translational Sciences (UL1TR002535)

Pregnancies associated with T1D have increased risks of adverse maternal and fetal outcomes, though continuous glucose monitoring (CGM) has been associated with significant reductions in the latter. We examined the clinical effectiveness of CGM in T1D pregnancies in a real-world setting. We retrospectively identified T1D pregnancies managed with either CGM therapy (n=81) or self-monitoring of blood glucose (SMBG) (n=77) over a 6.5-year period (1/1/14 to 8/31/20) at the Barbara Davis Center (BDC) for T1D and at obstetric practices in Colorado and Wyoming for obstetric care. CGM use was defined as ≥60% wear in the 2nd and 3rd trimesters of pregnancy. Baseline characteristics and maternal/fetal outcomes data were obtained from the BDC electronic medical record system and the vital statistics departments of Colorado and Wyoming. We used student’s t-test for continuous variables and chi-squared test for categorical variables to compare outcomes between groups. At baseline, a significantly higher proportion of CGM users were commercially insured and CGM users had a lower HbA1C at the first pregnancy visit (Table 1). CGM users had significantly lower levels of mean HbA1C in all trimesters, infants with lower mean birth weights (grams and percentile) and lower rates of large-for-gestational-age infants (Table 2). CGM use was associated with significantly improved maternal glucose control and neonatal outcomes in T1D pregnancies. Disclosure V. Gao: None. L. Sher: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. E. Malecha: None. E. Westfeldt: None. P. Sullivan: Research Support; Self; Dexcom, Inc. S. Polsky: Advisory Panel; Self; Medtronic, Consultant; Self; National Institutes of Health, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, JDRF, Medtronic, National Institute of Diabetes and Digestive and Kidney Diseases, Sanofi US, T1D Exchange. Funding Dexcom, Inc. (IIS-2019-096)

Cannabis use is known to increase DKA risk in adults with T1D. We evaluated diabetes self-management, glycemic control, and its relationship with DKA risk in T1D by cannabis use. Adults with T1D followed at the Barbara Davis Center were invited for a survey between September and October of 2020. Information on demographics, cannabis use (CUDIT-R), self-reported DKA in the past year, self-reported A1c, and diabetes self-management (DSMQ) were collected using validated questionnaires. Of 905 respondents, 238 reported using cannabis (26.2%). Cannabis users were younger (mean±SD 31±12 vs. 37 ±15 y, p Disclosure D. Giese: None. G. L. Kinney: None. C. Geno rasmussen: None. J. K. Snell-bergeon: Stock/Shareholder; Self; GlaxoSmithKline plc. V. Shah: Advisory Panel; Self; Medscape, Sanofi, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk, Sanofi, vTv Therapeutics.