2924-LB: Effectiveness of a Diabetes Navigator in Improving Uptake and Optimization of Advanced Diabetes Technologies in Type 1 Diabetes: A Randomized Controlled Trial

Introduction and Objective: Advanced diabetes technologies (ADT) improve glycemic control, yet there are many barriers to their use. We sought to determine if the assistance of a diabetes navigator could increase uptake and sustained use of ADTs. Methods: This randomized controlled trial enrolled children (5-20 years) and adults (21-75 years) with type 1 diabetes. Patients were assigned a Diabetes Technology Utilization Score (DTUS), with higher scores indicating better ADT use. Patients with DTUS ≤3 and a plan to optimize ADT use were randomized to either navigator or usual care. Usual care received standard diabetes care from the diabetes team, and navigator arm received usual care and a dedicated diabetes navigator to assist them for 6 months. The primary outcome was increase in DTUS at 3 months, assessed by chi-square test. Results: The study included 74 children [median age 15years, 42% female, 50% non-Hispanic black, 5.4% Hispanic, 35.1% commercial insurance, median diabetes duration 5.4 years (IQR:3.0, 8.1), median HbA1c 9.9% (IQR:8.4,10.6)] and 74 adults [median age 35.5years, 40.5% female, 29.7% non-Hispanic black, 5.4% Hispanic, 73% commercial insurance, median diabetes duration 16.6 years (IQR:9.1,26.9), median HbA1c of 8.1% (IQR:7.3,9.2)]. Of the 148 patients, 58.8% progressed in technology use, but there was no significant difference between groups (64.4% vs 53.3%; p=0.17). Patients that were new to ADTs had 2.2 times the odds of increase in DTUS compared to those using technology sub-optimally(p=0.048). Higher baseline HbA1c was associated with lower odds of DTUS increase (OR=0.77, p=0.02). Conclusion: Although 59% of study participants progressed in their technology usage, the diabetes navigator did not significantly improve uptake of ADT. Patients new to technology were more likely to progress in ADT use, highlighting the importance of early discussions of technology use. Disclosure N. Parimi: None. Y. Valdez: None. E.A. Brown: None. A. Sidhaye: None. R. Wolf: Research Support; Current; Lilly Diabetes. Research Support; Ended; Novo Nordisk. Research Support; Current; Sanofi. Consultant; Current; Sanofi. N. Mathioudakis: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health under Award Number R01DK134955 to RMW and NM.