1986-P: Patient-Reported Factors Associated with Inadequate Glycemic Control amongst Younger Adults Newly Diagnosed with Type 2 Diabetes

Introduction and Objective: Younger onset of type 2 diabetes (T2D) confers an increased risk of micro- and macro-vascular complications. Younger adults are less likely to meet evidence-based, risk-reducing treatment targets, with differences apparent within a year of diagnosis. The objective of this study is to identify patient-reported factors associated with not meeting recommended glycemic targets at one-year post-diagnosis. Methods: We conducted a prospective survey of Kaiser Permanente Northern California members ages 21-44 years recently diagnosed with T2D. Individuals with likely type 1 diabetes (T1D) or gestational diabetes were excluded. The survey focused on patient-reported measures that could not be readily accessed via EHR data, including psychosocial (diabetes distress, depression, life chaos), care experience (visit modality preference, provider experience), and sociodemographic characteristics (income, food insecurity). Suboptimal 1-year glycemic control was defined as an HbA1c ≤ 7% at 1-year post-diagnosis. Chi-square, t-tests, and one-way ANOVA were used to examine associations with 1-year HbA1c. Results: A total of 610 participants responded to the survey, and of those with follow-up A1c values (n=547), 32.9% had an A1c >7% at 1-year. Amongst those with inadequate control, there were higher percentages of reported food insecurity (38.9% vs. 25.1%, p-value 0.004), life chaos scores (2.58 vs. 2.40, p-value 0.003), PHQ-8 scores (7.2 vs. 5.8, p-value 0.005), and lower percentages of comfort with virtual care (80.6% vs. 88.0%, p-value 0.039). Conclusion: Patient-reported psychosocial, care experience, and sociodemographic factors were associated with suboptimal early glycemic control among a survey group of younger adults with T2D. These findings highlight risk factors present early in the disease course that could inform the targeting of care and highlight the need for comprehensive T2D care that addresses social determinants of health and patients' care experience from the outset.