1301-P: Factors Predicting Diabetes Distress over 18 Months in Teens with Type 1 Diabetes (T1D)

Background: Teens with T1D are burdened by physical, social, and emotional challenges that can lead to diabetes distress, impacting self-care and health outcomes. We assessed diabetes distress and associated factors in teens with T1D over 18 months.

Methods: At baseline, 6, 12, and 18 months, teens (N=301), ages 13-17 years, completed the Problem Areas in Diabetes Survey - Pediatric version (PAID-Peds), a validated 20-item survey measuring diabetes distress over the past month. Higher scores (range 0-100) indicate more distress; ≥41 = high distress. Mixed linear models assessed factors associated with changing diabetes distress over time.

Results: At baseline, teens (49% male, 78% white) were 15.0±1.3 (M±SD) years old with T1D duration 6.5±3.7 years; 84% were from 2-parent families. Youth checked BG 4.5±1.9 x/day; 59% were pump-treated; A1c was 8.5±1.1%. At baseline, 45% of teens endorsed high diabetes distress and females were disproportionately affected (54% vs. 36% of males, p<.01). In follow-up, 75% of teens with high baseline distress and 24% of teens with low baseline distress endorsed high distress at ≥50% of follow-up time points. High baseline distress strongly predicted subsequent distress (OR 9.6 [95% CI: 5.6, 16.5], p<.0001). Female sex and increasing A1c predicted increasing distress. In teens with high baseline distress, decreasing BG monitoring predicted increasing distress. In those without high baseline distress, only increasing A1c predicted increasing distress. Factors such as zBMI, race, family structure, household income, parental education, pump use, or use of continuous glucose monitors did not predict distress over time.

Discussion: A substantial proportion of teens with T1D experience high diabetes distress. Rising A1c is a major factor associated with worsening diabetes distress over time. Interventions targeting teens with diabetes distress and/or increasing A1c may positively impact self-care and simultaneously help to manage distress and improve A1c.