2089-P: Hemoglobin A1c Trajectories from Diabetes Onset in Youth with Type 2 Diabetes (T2D)

Introduction and Objective: Distinct A1c trajectories in youth with type 1 diabetes are associated with specific outcomes. Whether such trajectories exist in youth with T2D is unknown. We aimed to identify A1c trajectories after T2D onset in youth. Methods: Youth with T2D aged 8-20 years and diagnosed between 2011 and 2025 were identified from electronic medical records at a tertiary care center. Clustering analysis using A1c trajectory features (baseline, mean, slope, and change) identified patterns over 5 years after diagnosis. Demographic and clinical characteristics were compared across trajectories, and multivariable regression analyses identified predictors of diabetic complications. Results: The cohort included 2,449 youth (41.8% male, 58.3% Hispanic, 28.1% African American) with mean A1c at diagnosis of 8.7%. Three A1c trajectories were identified (Figure). Compared to the low A1c trajectory, the intermediate and high trajectories included higher proportions of African American and male youth (p<0.001, both). Youth in these trajectories were more likely to require insulin at 2 and 5 years after diagnosis (p<0.001, both). Belonging to the high A1c trajectory was among the strongest predictors of diabetic ketoacidosis. Conclusion: Distinct A1c trajectories occur after T2D onset in youth and are associated with demographic and clinical differences. Early identification of high-risk youth may help guide monitoring and targeted interventions. Disclosure A. Kadi: None. D. Palacios: None. S. Aras: None. L. Sobhi: None. H. Chen: None. Z. Liu: None. M.J. Redondo: Advisory Panel; Current; Sanofi. Other - Data Safety Monitoring committee; Current; Lilly. M. Tosur: None. Funding National Institutes of Health (3 U24 DK097771-12S1)