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Purpose The COVID-19 pandemic led to rapid adoption of telemedicine for the care of youth with type 1 diabetes (T1D). We assessed the utility of a primarily virtual care model by comparing glucometrics from a pediatric sample with T1D using continuous glucose monitoring (CGM) both before and during the pandemic. Methods Pediatric patients aged 1 to 17 years with T1D duration ≥ 1 year if ≥ 6 years old or ≥ 6 months if Results Our sample comprised 555 young people (46% male, 87% White, 79% pump-treated), mean age 12.3 ± 3.4 years, T1D duration 5.9 ± 3.5 years, baseline glycated hemoglobin A1c 8.0 ± 1.0% (64 ± 10.9 mmol/mol). Diabetes visit frequency increased from 3.8 ± 1.7 visits/prepandemic period to 4.3 ± 2.2 visits/pandemic period (P Conclusions Children and adolescents with T1D using CGM before and during the pandemic showed an overall increase in visit frequency using primarily telemedicine-based care and improved CGM glucometrics. Further research is needed to understand factors associated with successful use of telemedicine for pediatric T1D.

The coronavirus disease 2019 (COVID-19) pandemic likely affected youth with type 1 diabetes (T1D). We used electronic health record-extracted data to compare continuous glucose monitoring (CGM) metrics during 1 year of the pandemic with those of the previous year. The sample comprised CGM users, aged 1 to

Aims: The COVID-19 pandemic has caused strain on hospital systems and potential delay in diagnosis of type 1 diabetes (T1D). Outpatient diagnosis and treatment of metabolically stable young persons with new-onset T1D have been shown to be equivalent to inpatient. We describe an approach to outpatient management of newly diagnosed T1D during the COVID-19 pandemic using an interdisciplinary team, telemedicine, and diabetes technologies including rapid implementation of continuous glucose monitoring (CGM). Methods: Following the onset of the COVID-19 pandemic, new-onset cases of T1D were tracked. After laboratory confirmation of diagnosis and metabolic stability, patients and families were referred for ambulatory initiation of insulin therapy and diabetes education. These cases were reviewed using data extracted from the electronic health record, comments from multidisciplinary team members, and cloud-based glucose data. Results: We report on seven young people with new-onset T1D without diabetic ketoacidosis from April to June 2020, during the COVID-19 pandemic. Ages ranged 9–23 years with presenting hemoglobin A1c (HbA1c) values 10–14.5%. Initial evaluation was generally face-to-face, followed by frequent telemedicine visits. Five patients had a family history of T1D. Two patients had access to at-home HbA1c kits prompting evaluation in the absence of symptoms. Four patients required emergency department evaluation. Five patients presented with ketosis. All patients were prescribed CGM at the first visit, most starting within 1 month. Conclusions: Technology is extraordinarily useful for the care of young persons with new-onset T1D in the ambulatory setting during the COVID-19 pandemic. Large observational studies are needed to better understand outcomes of an outpatient, technology-focused approach.

Adolescents with type 1 diabetes are vulnerable to suboptimal glycemic control, generally due to insufficient self-care behaviors (1,2). Because they have some of the highest rates of mobile communication technology use (3), this modality may hold promise for providing reminders or encouragement to adolescents to engage in self-care. However, the effects of text messaging interventions on self-care and glycemic outcomes are mixed, with some reports favoring improvements in teen self-care behaviors such blood glucose monitoring frequency or medication adherence (4–7). In an alternative attempt to reach this high-risk age-group, researchers have explored the use of financial incentives to promote self-care behaviors, which yielded some glycemic benefit in the short term (8,9). However, there is limited research on the combination of a financial incentive and a mobile health intervention (10,11) and the potential benefits that could accrue from blending these approaches. Nonetheless, use of either a unimodal or a bimodal intervention requires that adolescent recipients remain engaged with the program. In this report, we describe adolescent engagement during a 6-month study of a psychoeducational text messaging intervention that incorporated financial incentives. The primary study included adolescents with type 1 diabetes in suboptimal control and showed a potential increase in self-reported self-care in those receiving the intervention as intended (10). This analysis of the primary study’s intervention group described patterns of adolescent engagement with the intervention and identified factors associated with responsiveness. We also evaluated the potential impact of engagement on glycemic outcomes and self-care. This study analyzed 6 months of data from teenagers with type 1 diabetes receiving an incentivized text messaging intervention aimed at increasing education and support for diabetes self-care. Youths were eligible for inclusion if they were 12–18 years of age, had a duration of type 1 diabetes of …

The pandemic required altering care delivery to a hybrid model of telehealth and in-person visits. We evaluated if SES disparities during the pandemic impacted clinical visit adherence and CGM device use in youth with T1D. Retrospective EHR captured data on youth with T1D, ≤18 years old, with ≥1 clinical visit both pre-pandemic (9/15/18-3/15/20) and during the pandemic (4/1/20-12/22/21) . Patient addresses were geocoded to link with census tract SES measures from the 20American Community Survey. Low education status defined as ≥30% of residents having HS or lower education and low income as median household income ≤$40,000. Poisson and logistic regression models assessed appointment adherence and CGM device use, respectively, during the pandemic vs. pre-pandemic. Models were adjusted for age, gender, baseline A1c, and T1D duration. In both periods, 689 youth (age 13.8±3.3 years; male 49%; T1D duration 7.4 ±3.6 years) had clinical encounters. There were more visits in the pandemic vs. pre-pandemic (8 [IQR 5-11] vs. 6 [IQR 5-9], p Disclosure A.Adam: None. C.Chen: None. S.Ojukwu: None. T.Kaushal: None. L.J.Tinsley: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc.

Introduction: The impact of the Covid-pandemic on diabetes device uptake and use in youth with T1D is unclear. We assessed demographic, diabetes, and SES characteristics associated with diabetes technology (pump, CGM) use in youth with T1D, aged ≤18 years, pre- and during the pandemic. Methods: EHR provided ∼18 months of data pre- and during the pandemic. Pump and CGM use were defined as device use at ≥50% of visits. Geocoding provided census tract-specific SES measures from the 20American Community Survey. Logistic regression models analyzed the probability of device use vs. non-use in the pre- and pandemic periods by geocoded SES status, adjusted for age, gender, baseline A1c, and T1D duration. Results: Pre-pandemic sample had 734 youth (male 49%, aged 13.8±3.3 years, T1D duration 7.3±3.4 years) ; pandemic sample had 800 youth (male 51%, aged 13.4±3.7 years, T1D duration 6.6±3.9 years) ; 689 were in both periods. Pre- and during pandemic, respectively, there were 25% and 22% device non-users; 19% and 21% pump only; 13% and 16% CGM only; 43% and 41% both. Pre-pandemic baseline A1c differed by the 4 device use groups: non-users 9.1±1.7%; pump 8.5±1.2%; CGM 8.2±1.2%; both 8.1±1.0%; p Conclusion: During the pandemic, there remained decreased uptake and less continued use of diabetes device in lower SES patients. Further work is needed to decrease the inequality gap. Disclosure C.Chen: None. A.Adam: None. S.Ojukwu: None. T.Kaushal: None. L.J.Tinsley: None. L.K.Volkening: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. Funding National Institutes of Health (P30DK036836,T32DK007260)

Objective: YA use social media (SM) frequently. Diabetes-focused SM posts may offer support for those with T1D. This qualitative study sought to explore perspectives of YA with T1D on diabetes-focused SM posts. Methods: Semi-structured interviews were conducted through videoconferencing with YA with T1D (age 18-25 years, T1D duration 1 year) . Ten diabetes-focused Instagram posts were selected, encompassing major topic areas identified in previous SM literature (e.g., humor, venting) . Participants viewed posts with captions and provided their perspectives. Interview transcripts were coded and evaluated using thematic analysis. Results: Fifteen YA participated (age 22±1.9 years, 86% white, 33% male, T1D duration 12±5.7 years, A1c 8.1±1.6%, 80% pump use, 100% CGM use) . All participants reported using SM at least once daily, but very few reported viewing or posting diabetes content. YA reactions to posts encompassed four major themes: 1. Perception of personal relevance: many participants noted whether posts applied to them. While many posts were described as “relatable,” others were suggested to be more useful soon after diagnosis or in contrast to participants’ own self-care behaviors. 2. Reduced isolation with T1D: many participants reported the posts made them feel “not alone;” some noted their lack of friends with T1D and mentioned benefits of community. 3. Frustration about living with T1D: some participants expressed anger or annoyance with diabetes, especially about hyperglycemia and cost of insulin. 4. Appreciation of public displays of T1D self-care: many participants valued openness with self-management in posts, although some expressed hesitancy in self-displays. After viewing and discussing all posts, some participants reported they may seek out diabetes-focused SM in the future when they had not previously. Conclusions: SM may be a source of community, support, and reduced isolation for YA with T1D. Further research is needed to assess SM as a means to improve self-care in this group. Disclosure T.Kaushal: None. L.A.Branka: None. K.Wentzell: None. P.V.Commissariat: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. Funding NIH/NIDDK (K12DK094721,P30DK036836)

Aim: Despite disruptions caused by the COVID-pandemic, prior studies suggest some improvements in glycemic control. We investigated whether this improvement was equitable and seen across socioeconomic status (SES) groups in youth with T1D. Method: Using EHR-extracted visit and CGM data, we geocoded patient addresses linked with census-tract derived education from the 20American Community Survey and a composite measure of SES, the Neighborhood Deprivation Index (NDI) . Analyses included youth ≤18 years old using CGM with T1D duration ≥6 months (age Results: The pre-pandemic sample had 641 youth (52% female, age 12.5±3.5, T1D 6.2±3.5 yrs) and the pandemic sample had 650 youth (52% female, age 13.5±3.6, T1D 6.8±3.8 yrs) ; 86% were common to both samples. Addresses allowed for geocoding of 98%; 44% of youth lived in low education census tracts where ≥30% of adults in the census tract had no more than a high school education. Mean CGM-derived glucose management indicator (GMI) improved during the pandemic for both those living in lower (8.07±0.05% pre vs. 7.91±0.% during, p Conclusion: Equitable improvements in CGM metrics during the pandemic was evident in youth with T1D. Future studies can assess how changes in healthcare delivery during the pandemic can reduce disparities and sustain benefits to all patients. Disclosure S.Ojukwu: None. A.Adam: None. T.Kaushal: None. L.J.Tinsley: None. L.K.Volkening: None. C.Chen: None. L.M.Laffel: Advisory Panel; Medtronic, Roche Diabetes Care, Consultant; Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompé, Insulet Corporation, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk, Provention Bio, Inc. Funding National Institutes of Health (K12DK094721, P30DK036836)

Aim: The COVID-19 pandemic called for rapid deployment of telehealth. To assess utility of telehealth in pediatric T1D, we compared CGM glucose values in youth with T1D using CGM before and during the pandemic. Methods: The EHR provided visit frequency and CGM metrics. Data during pandemic (3/16/20 to 10/29/20) were compared with data from the same calendar months in 2019. Youth (N=469) using CGM and seen in both periods were included based on pre-pandemic characteristics: age 1-18 yr, T1D duration ≥6 mo (if age Results: Youth (46% male) had a mean age 12.4±3.5 yr, T1D duration 6.1±3.6 yr, HbA1c 7.8±0.9%; 80% were pump-treated. Pre-pandemic, 0.1% of visits were telehealth, increasing to 99.6% during pandemic. Mean number of visits during each 7-mo period increased from 2.5 in 2019 to 2.7 in 2020 (p=.006). CGM metrics generally improved during the pandemic period (Table). Those whose visit frequency increased with telehealth had the greatest improvement in CGM glucose, from 192±72 to 183±67 (p Conclusions: Telehealth allowed increased visit frequency and improved CGM glucose metrics, supporting non-inferiority and potential benefit of telehealth for youth with T1D using CGM. Disclosure T. Kaushal: None. L. J. Tinsley: None. L. K. Volkening: None. C. Turcotte: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. Funding National Institutes of Health (K12DK094721, P30DK036836)

Aim: COVID-19 caused disruption with potential for changes in lifestyle and T1D care behaviors, especially for youth. We compared CGM-derived glucometrics during the COVID-19 pandemic with the previous year in a clinic-based pediatric sample with T1D using CGM. Method: We used EHR-extracted data to compare CGM metrics during the pandemic (3/16/20 -10/29/20) with the same calendar months in 2019. The sample comprised youth using CGM, aged 1-18 years, with T1D duration ≥6 months (age Results: The pre-pandemic sample comprised 578 youth (53% female, age 12.4±3.5, T1D 6.2±3.5 years). The pandemic sample comprised 605 youth (54% female, age 13.4±3.6, T1D 6.8±3.8 years). Over 80% of youth were common to both samples. Mean CGM glucose was 7 mg/dL lower during the pandemic (186±35) vs. pre-pandemic (193±33) (p 110% (Figure). The 7-12y age group showed the largest shift in GMI: 8.0 pre- vs. 7.7% during pandemic (p=.003). Conclusion: There was a beneficial shift in glucose levels from pre to during the pandemic. Future studies are needed to assess how changes in healthcare during the pandemic may have improved glycemic outcomes. Disclosure T. Kaushal: None. L. J. Tinsley: None. L. K. Volkening: None. L. Ambler-osborn: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. Funding National Institutes of Health (K12DK094721, P30DK036836)

Purpose The purpose of this study was to determine the feasibility and functionality of MyDiaText™, a website and text messaging platform created to support behavior change in adolescents with type 1 diabetes (T1DM) and to evaluate user satisfaction of the application. Methods This study was a nonrandomized, prospective, pilot trial to test the feasibility and user interface with MyDiaText, a text message system for 10- to 17-year-old youths with newly diagnosed T1DM. Feasibility was evaluated by assessing for the user’s ability to create a profile on the website. Functionality was defined by assessing whether a subject responded to at least 2 text messages per week and by their accumulating points on the website. User satisfaction of the text messaging system was assessed using an electronic survey. The 4 phases of this study were community engagement—advisory sessions, screening and enrollment, intervention, and follow-up. Results Twenty subjects (14 male, 6 female) were enrolled. All subjects were able to create a profile, and of these, 86% responded to at least 2 text messages per week. A survey administered during follow-up showed that users enjoyed reading text messages, found them useful, and thought the frequency of messages was appropriate. Conclusion MyDiaText is a feasible, functional behavioral support tool for youth with T1DM. Users of the application reported high satisfaction with text messages and the reward system.

AIMS Conversations about diabetes complications with adolescents and parents can be difficult and emotionally charged. To better inform conversations between providers and families, we sought adolescent and parent perspectives regarding their knowledge of long-term complications (LTCs), where they receive this information, and what they would like to learn from clinicians. METHODS Adolescents with type 1 diabetes and parents of adolescents with type 1 diabetes participated in semistructured interviews querying knowledge of LTCs, sources of information, and preferred ways for providers to discuss LTCs. Interview transcripts were coded and categorized into central themes by content analysis. RESULTS Participants included 22 adolescents (17.4 ± 1.7 years of age, diabetes duration 9.7 ± 4.0 years) and 25 parents (41–60 years of age, 84% mothers). Five themes related to complications were identified: 1) “Limited Adolescent Knowledge of Complications,” 2) “Discussing Complications Is Important but Not Now or Not for Me,” 3) “Outside Sources Overestimate Risk,” 4) “Avoid Scare Tactics” and 5) “Emphasize Prevention.” Adolescent and parent perspectives were similar, although parents showed greater understanding of complications. CONCLUSION When discussing complications, individualized, factual, positive, and prevention-focused conversations may be better received by adolescents with type 1 diabetes and their families.

Background: Among digital health interventions, TM can be a useful tool in teens with T1D. However, attrition remains a major issue, with engagement decreasing over time. We aimed to describe patterns of engagement in an incentivized TM intervention and to assess impact of engagement on A1C in teens with T1D and suboptimal control randomized to the TM arm. Methods: Of 165 teens (12-18 years old, T1D duration >1 year, A1C ≥8%) recruited into a 6-month RCT, 83 were assigned to TM intervention and received daily educational/motivational TMs using the MyDiaText™ platform. Socio-demographic and clinical data were obtained from medical record review. Participants were rewarded biweekly for the most consecutive TM responses. TM response rate (RR) was defined as number of responses/total messages received. High RR was defined as >50%. Paired t-tests, ANOVA, and Pearson correlation were used in statistical analysis. Results: At entry, teens (57% males, 52% white) had a mean(±SD) age of 16±2 years, T1D duration 7±4 years; 55% were pump-treated, 65% used CGM, and A1C was 10±1.9%. Clinical concerns for depression were seen in 28%. The mean overall RR was 58.6%(±28.9%), and the high RR group included 66% of participants. High and low RR groups did not differ by sex, race, age, T1D duration, use of technology, baseline A1C, or clinical depression. Over the 6 months, A1C improved significantly to 9.2±1.8% (p=0.00), with 35% improving by ≥1%. High responders were twice as likely to improve A1C by ≥1% than low responders (p=0.18). There was a significant decline in RR over time (r2=0.9, p=0.00). Conclusions: In teens with T1D and suboptimal control, socio-demographic factors did not predict engagement with a financially incentivized TM intervention. However, high responders tended to improve their A1C, likely due to increased engagement in self-care. There remains a need to create a digital health intervention that maintains engagement over extended periods for teens with T1D. Disclosure T. Kaushal: None. T. Lipman: None. L.E. Katz: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. Funding National Institutes of Health (P30DK036836, K12DK094721, 2T32DK063688)

Background: Diabetes increases cardiovascular disease (CVD) risk, yet many youth with T1D are not effectively managed for hypertension (HTN) or hyperlipidemia (HPL). Lifestyle management remains 1st-line pediatric therapy, creating a need for effective clinical interventions. As digital health and financial incentives may help motivate behavior change, we sought to test feasibility of a scalable digital health intervention to motivate heart healthy behaviors in youth with T1D. Methods: We recruited 44 teens (ages 14-19 years; T1D duration ≥6 months; and either HTN, HPL, overweight/obesity, or A1C ≥8%) into a 3-month pilot RCT. Teens were randomized 1:1 to intervention (INT) or control (C) groups. INT received educational/goal-setting modules and bi-weekly team challenges using a smartphone with participants earning points leading to financial rewards; C group received educational/goal-setting modules after 3 months. Primary outcome was the Adolescent Food Habits Checklist (AHFC), a 23-item questionnaire (higher score = healthier food habits), administered at baseline and after 3 months. Participants completed a satisfaction survey after the RCT. Results: At entry, the sample was 30% male, 88% non-Hispanic white, aged 17±1.6 (X±SD) yrs with T1D duration 8.7±3.3 yrs; 82% were pump-treated, 63% used CGM, A1C was 9.3±1.6%; BMI %ile was 84±17, BP 106±9/66±6, LDL 99±33 mg/dL. Groups only differed in BMI %ile (INT 90 vs. C 77, p Conclusions: An intervention with educational materials supplemented by a smartphone app using a point-based financial reward structure was feasible and acceptable for teens with T1D at increased CVD risk. Further research is needed to assess durability of the intervention and its impact on CVD risk factors. Disclosure T. Kaushal: None. C.O. Charmant: None. L.K. Volkening: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. M. Katz: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. Funding National Institutes of Health (5K12DK094721-09, P30DK036836, K23HL125976)

Background: Adolescence is associated with suboptimal diabetes control, with average HbA1C levels of 9.0%. Adolescents are highly engaged in mobile technology; over half report sending text messages at least daily. Text messaging (TM) is most commonly used technology in adolescents with type 1 diabetes (T1D). Pilot studies have demonstrated TM to be a useful tool in diabetes education. MyDiaText™ is a website and TM platform created to support behavior change in adolescents with T1DM. Enrollment in a randomized controlled trial (RCT) using MyDiaText™ began in August 2018. Objective: To report the baseline characteristics, self-care behaviors, and engagement in a TM intervention for T1D education and support in a diverse population. Methods: Subjects were recruited from the CHOP Diabetes Center. Enrollment criteria for the trial included: 12-18 years, >1 year from diagnosis and point-of-care HbA1C > 8%. Adolescents selected an AADE7™ Self-Care Behavior (SCB) goal on which to focus. Those in the intervention group received daily educational and motivational text messages. Self-Care Inventory (SCI), 14 questions scored 1-5, and HbA1C were obtained at baseline. Engagement index, defined as number of responses/total messages received, was calculated by the application. Results: There were 107 subjects (average age = 15.8 years {45.8% M, 52.3% F, 1.9% other; 60 (56.1%) W, 33 (30.8%) B, 10 (9.3%) mixed race and 4 (3.7%) other; 11 (10.2%) identified as Hispanic}) enrolled. “Monitoring” was most common SCB selected, 45 subjects (42.4%). Mean (range) baseline HbA1C was 10.0% (8.0-14.1). Mean baseline SCI score was 3.36 (1.07-5.0). Engagement was 60% or greater for 74% of subjects in treatment arm. Conclusions: A diverse population of adolescents with T1D and suboptimal control preferred text messaging support for blood glucose monitoring and demonstrated high engagement in MyDiaText™. Further analyses will determine the efficacy of MyDiaText™ on diabetes outcomes. Disclosure T. Kaushal: None. L.E. Katz: None. M.E. Marowitz: None. J. Joseph: None. D.P. Ritter: None. T.H. Lipman: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (2T32DK063688-11-12 to L.E.K.)

Introduction In many centers, children with diabetic ketoacidosis (DKA) receive care either in an endocrinology ward or a pediatric intensive care unit (PICU). We conducted a quality improvement (QI) initiative to reduce potentially avoidable PICU admissions of children with DKA without increasing endocrinology ward-to-PICU transfers. Methods A survey of providers demonstrated opportunities to increase awareness of institutional criteria for PICU admissions of children with DKA. We created an electronic health record (EHR) dot-phrase, prepopulated with these criteria, and placed a note in the EHR for all patients with DKA as a reference for all providers. An EHR-based data report was created to monitor the disposition of DKA patients and the use of the dot-phrase (process measure). The primary outcome measure was the potentially avoidable PICU admissions for patients with DKA. Endocrinology ward-to-PICU transfers were tracked as a balancing measure to ensure safe disposition. Results After the implementation of the dot-phrase, use was variable, but averaged 33.4% over 1 year. The percentage of DKA admissions classified as potentially avoidable PICU stays decreased from 4.1% to 0.5%, with a concurrent decrease in the total percentage of PICU admissions for DKA from 19.1% to 8.4%. The percentage of endocrinology ward-to-PICU transfers also declined from 0.8% to 0%. Conclusions A novel EHR-based intervention increasing awareness and documentation of established pediatric DKA management guidelines can be used to safely reduce PICU admissions for DKA without increasing the rate of endocrinology ward-to-intensive care unit transfers.

Maternal history of thyroid disease can cause congenital hypothyroidism due to thyroid-stimulatng hormone (TSH) blocking antibodies. No guidelines exist regarding testing beyond the newborn screen. TSH and T4 levels exhibit significant fluctuations after birth which complicates testing. A total of 561 newborns with thyroid function testing done for maternal history of thyroid disease in the newborn nursery were identified retrospectively via chart review, and thyroid disease status was assessed in 352. Newborn screening data were also obtained. Of these infants, 7 had hypothyroidism with 3 having negative newborn screens. No cases of neonatal graves were identified. The 3 infants with negative newborn screens had TSH levels ranging from 6.58 to 28.4 prior to treatment with levothyroxine. All required treatment beyond age 3 years, despite trial off levothyroxine. Infants with maternal history of thyroid disease may require additional testing beyond the newborn screen. However, providers can consider delaying test until after thyroid levels are more stable.