217-OR: The Supporting Emerging Adults with Diabetes (SEAD) Program—An Adult-Based Clinical Model That Improves Glycemic Control and Diabetes Technology Uptake in Underserved Young Adults (YA) with Type 1 Diabetes (T1D)

Background: Underserved YA with T1D transitioning from pediatric to adult care experience adverse outcomes, which stem from simultaneously unmet social, glycemic, and health system navigation needs. We developed a multidisciplinary clinical program called SEAD to address these challenges. In this analysis, we compared outcomes in YA with TID who were enrolled in SEAD to comparable YA in non-SEAD usual care.

Methods: The SEAD model was integrated into routine adult diabetes care at Montefiore in 2019, offering equal access to all YA with T1D aged 18-35 years old. SEAD provides YA-centered care, ongoing T1D education, diabetes technology support, psychological focus, and equity-based social need screening and referrals. We collected data prospectively on YA receiving care in SEAD vs. non-SEAD at Montefiore from 2019-2022 for a priori program evaluation, using multivariate linear regression to compare primary glycemic outcomes and Kaplan-Meier analysis for secondary technology outcomes, adjusted for age, sex, race/ethnicity, DKA, and complications.

Results: We included 416 YA with T1D (SEAD n=244, non-SEAD n=172): mean age 23 ± 4y, 49% F, 35% Black, 47% Hispanic, 73% Medicaid-insured (no baseline differences, p>0.05). Compared to non-SEAD care, YA in SEAD care experienced double the HbA1c improvement with a cumulative effect size of -0.9% vs. -0.45% over the 3-year study period [SEAD: -0.30%/yr (-0.43, -0.18); non-SEAD: -0.15%/yr (-0.27, 0.04)], and had higher likelihood of accepting insulin pump (HR 1.96, [1.24, 3.12]) and CGM therapy (HR 1.63, [0.97, 2.72]).

Conclusion: Integration of the SEAD model into adult diabetes care to offer YA-centered T1D and social needs support improved glycemic control and diabetes technology uptake for underserved YA with T1D, compared to usual care. Cumulative effects over time could change YA trajectories into adulthood.