54-LB: The Kids Are Not Alright—Capturing the Need for Effective Intervention for Adolescents with Elevated A1C

Background: Adolescents with T1D and elevated A1c are at high risk of acute and chronic complications. While behavioral health interventions have demonstrated promise in optimizing A1c, real-life clinical practice indicates uncertainty regarding which youth will show improvement, extent of improvement, and factors predicting complications over time.

Methods: This 5-site longitudinal study enrolled caregivers (n=218) of youth aged 12-17 yrs (M=14.6 ±1.6 yrs) with T1D for >1 year and ≥ one A1c >10% in past year. Data included admissions, ED visits, and A1c one year pre- through 6 months post-enrollment. Family members reported on baseline functioning across multiple domains. Inferential tests (e.g., chi square, nonparametric) examined change over time in A1c and utilization as well as predictors of future ED visits.

Results: Acute utilization did not change over time. A1c post enrollment significantly decreased from 11.1% ±1.5% to 10.9% ±2.1% (p=.03), but absolute change was minimal. 40.2% of youth did not have an A1c value available post enrollment. Caregiver reports of higher diabetes distress, higher conflict with healthcare providers, and lower social support were associated with risk of future ED visits (p<.01).

Conclusion: Findings indicate strong need for systematic psychosocial screening and more intensive tailored behavioral intervention efforts for this youth with elevated A1c.