Fewer than 20% of adolescents and young adults (AYA) with diabetes achieve optimal glycemic control. The use of diabetes technology, including insulin pumps and continuous glucose monitors (CGM), are associated with improved outcomes; however, there are inequities in technology use. The University of Washington (UW) AYA Diabetes Program aims to address disparities in AYA with diabetes by providing tailored education and access to multidisciplinary specialists, including a social worker and psychologist. We examined the impact of the UW AYA Diabetes Program on change in diabetes technology use among AYA and assess whether this varied by sex, race/ethnicity, and health insurance. The study included participants seen in the UW AYA Diabetes Program between 2017-2021. For each binary outcome of insulin pump use and CGM use, we calculated proportions and 95% CIs (confidence intervals) using generalized linear models. We assessed for possible effect modification by sex, race/ethnicity, and health insurance. In this cohort of 453 patients (51% male, 87% non-Hispanic White, 27% public insurance, 55% CGM and pump use) there was evidence of effect modification by health insurance type for both pump and CGM use (p=0.01 and 0.03 respectively) but not by sex or race/ethnicity. Baseline CGM use was significantly lower among public vs private insurance participants (38%, 95% CI: 29-46%; vs 61%, 95% CI: 56-66%) but not after 6-months of program participation (58%, 95% CI: 45-72% vs. 74%, 95% CI: 68-80%). Pump use was also lower at baseline among publicly-insured AYA (29%, 95% CI: 20-37%; vs. 67%, 95% CI: 62-72% for privately-insured). However, by 12-months, pump use for publicly-insured AYA had increased and was no longer statistically significant (44%, 95% CI: 30-59% vs. 64%, 95% CI: 56-72% for privately-insured). We found that the UW AYA Diabetes Program proved to be successful in mitigating baseline disparities and increasing diabetes technology use in AYA with diabetes.

Adolescents with type 1 diabetes (T1D) are at risk for poor physical and psychosocial outcomes. Diabetes-related family conflict has previously been associated with youths' glycemic control (HbA1c). However, less is known about how family conflict associates with other health outcomes. This project aimed to explore correlations between adolescent and parent reported family conflict with diabetes-distress, depressive symptoms, resilience, and health-related quality of life (HRQOL) for both adolescent and parent. Eligible patients were enrolled in a two-site randomized controlled psychosocial intervention study. Participants were ages 13-18 with T1D for over a year and elevated levels of diabetes distress. At baseline, patients and their parent completed measures of: diabetes-specific family conflict (DFCS), HRQOL (T1DAL), diabetes distress (PAID-T), depressive symptoms (PHQ-8), and resilience (CD-RISC). HbA1c was pulled from participants medical charts. Descriptive statistics were used to summarize demographic variables, and bivariate correlation analyses were used to investigate the association between DFCS and the other psychosocial variables. Adolescents (N= 131; 53.4% female, 6.1% identified as another gender, 78.6% White, 9.9% Black, 2.3% Asian, 3.1% American Indian/Alaskan Native, and 80.9% Non-Hispanic, average age 15.38  1.5) DFCS scores correlated with more diabetes-distress (r=0.386, p<0.001), depressive symptoms (r=0.334, p<0.001), and less HQOL (r= -0.303, p<0.001). Parents’ (N=131; 79.4% White, 9.2% Latino/Mexican 6.1% Black, 2.3% Asian, 0.8% other, 79.4% private insurance) DFCS scores correlated with higher youth A1C (r=0.280, p<0.001), higher parent diabetes distress (r= 0.479, p <0.001), and lower parent resilience (r= - 0.200, p = 0.022) and HQOL (r = -0.369, p < 0.001). Both parent and patient reports appear to be an important area of further investigation for determining correlates of poor physical and psychosocial wellbeing in this high-risk group. While further investigation is needed, screening for family conflict may be important in clinical procedure, as it may become a future target for intervention.