(PS6-B34) Medical Technologies and Psychological Adjustment in Youth with Type 1 Diabetes: Implications for Treatment Outcomes

Youth with type 1 diabetes (T1D) are at increased risk for anxiety and depressive symptoms related to chronic illness management. These symptoms may be exacerbated during a global health emergency, which can lead to drastic lifestyle changes that complicate T1D care. Furthermore, youth with T1D may experience increased stress during a pandemic given their elevated risk for infection and morbidity. Poorer psychological adjustment may lead to neglect and/or avoidance of treatment adherence behaviors, resulting in worse T1D treatment outcomes (i.e., blood glucose levels; HbA1c). Advanced medical technologies, such as continuous glucose monitors (CGM) and insulin pumps, have become increasingly available in the past decade and have been linked to improved emotional health and HbA1c among youth with T1D. These technologies can reduce the psychological burden of daily T1D care by simplifying some aspects of T1D management. In turn, better psychological adjustment may facilitate increased treatment adherence and better health outcomes. Therefore, the effectiveness of medical technologies in T1D treatment may be partly attributed to improved emotional wellbeing. However, the relations between use of medical technologies, psychological adjustment, and HbA1c in pediatric T1D care remain unclear. The current study drew data from a sample of youth with T1D to examine whether psychological adjustment mediated the association between use of advanced medical technologies and HbA1c. Youth with T1D (n = 101; M age = 12.02, SD = 2.43, range = 8-16 years) and their caregivers were recruited from an academic medical center in the Northeastern U.S. Caregivers rated levels of their children’s anxiety and depressive symptoms. Youth’s HbA1c values and CGM/insulin pump usage were abstracted from electronic medical records. A mediation model was applied to explore the pathway from use of medical technologies (i.e., none = 0, insulin pump or CGM only =1, both =2) to HbA1c via psychological adjustment, while accounting for family income, parent education level, child age, and T1D duration. Multiple regression analyses showed that both greater use of medical technologies, β =-0.36, SE = 0.08, p < .001, and better parent-reported youth psychological adjustment, β =0.22, SE = 0.08, p = .008, were associated with better T1D outcomes (i.e., lower HbA1c). However, use of medical technologies was not significantly related to better youth adjustment, β =-0.15, SE = 0.13, p = .246. Results suggest that both psychological adjustment and use of medical technologies may play an important role in youth T1D treatment outcomes. Anxiety and depressive symptoms and use of CGM and/or insulin pumps may serve as useful targets for intervention for this population. These insights may be especially useful during global health emergency situations that can intensify challenges of T1D management.