1632-P: HbA1c: A Limited Guide to Understanding Diabetes Distress (DD)

Introduction and Objective: HbA1c is often used as a singular marker to flag DD and the need for intervention. Using it alone, however, may overlook other patient characteristics linked to DD. Holding HbA1c constant, we examined whether age, sex, and race were associated with T1D adults’ reported DD. Our goal was to add clinically useful context beyond HbA1c to support patient-led conversations about DD and guide individualized care. Methods: Adults with T1D (≥18) at a diabetes clinic completed the T1-DDAS during routine care (N=1,309). The T1-DDAS includes a Core scale (DD intensity) and 10 Source scales, reflecting specific aspects of living with and managing T1D (e.g., Shame, Management Difficulties, Lack of Resources). Using hierarchical regression for each scale, HbA1c was entered at Step 1; age, sex, and race (White and non-White) at Step 2; and 2- and 3-way interactions as Steps 3 and 4, respectively. Results: Holding HbA1c constant, females reported significantly higher distress than males on all scales (b=0.115 to 0.414, all p≤0.01), with younger age associated with higher distress on Core, Financial Worries, and Interpersonal Challenges (b=-0.004 to -0.011, all p≤0.003). Non-Whites reported significantly greater Shame than Whites (b=-0.165, p=0.007). Across several scales, age-by-sex interactions indicated that the female-to-male gap was significantly larger at younger than older ages (b=-0.007 to -0.010, p=0.033 to 0.002). Sex-by-race interactions emerged for Management Difficulties (b=0.292, p=0.045) and Lack of Resources (b=0.301, p=0.032), with predicted values highest for White females on Management Difficulties and non-White males on Lack of Resources (both lowest for White males). Conclusion: These findings reveal a rich tapestry of unique contributors linked to DD, independent of HbA1c. When HbA1c was held constant, T1-DDAS profiles differed across age, sex, and race, underscoring the value of patient context and all scale scores to guide patient-led conversations about their needs. Disclosure R.D. Tweet: Other - honorarium; Obesity and Weight Management Stigma Training via ADA Webinar; Ended; Lilly. L. Wilson: Research Support; Current; Eli Lilly and Company, Rezolute Bio, Dexcom, Inc. F. Joarder: None. L. Fisher: Advisory Panel; Ended; Eli Lilly and Company.