Predictors of Engagement in Clinical Care: CoYoT1 to California

Background: Current type 1 diabetes (T1D) care models do not effectively engage racially and ethnically diverse Adolescents and Young Adults (AYA) indicating a need for new approaches. Objective: To assess clinical and demographic predictors of care engagement among diverse AYA with T1D. Methods: In an ongoing 15-month randomized controlled 2x2 trial with pragmatic care assignment, 53 AYA ages 16-25 received either quarterly usual T1D care (in-person or via telehealth (TH)), or CoYoT1 Care, which includes bimonthly T1D group sessions via TH and quarterly patient-centered care provider visits (in-person or via TH). Participant engagement was measured by the proportion of clinic visits attended out of all offered to date, per participant, including all currently enrolled. Predictors of engagement included: pre-trial clinic attendance, care group assignment (CoYoT1 or usual care), demographic, and clinical variables. All were entered into a multiple linear regression model, then reduced via stepwise regression. Results: Participation in CoYoT1 Care was associated with a 12% greater attendance rate (p=0.006) relative to usual care. Participants who retained their pre-trial care providers during the study attended clinic visits 7% more frequently than those randomized to a new provider (p=0.06). Participants’ who identified as African American (p=0.001) or Multi-racial (p=0.002) attended clinic visits at least 16% more frequently than participants from other groups; Latinx ethnicity was not associated with more or less frequent attendance. Females attended clinic visits 10% less frequently than non-females (p=0.006). Baseline A1c was also negatively associated with attendance rate, with each percentage increase in A1c associated with a 2% reduction in attendance rate (p=0.01). Conclusion: CoYoT1 Care successfully engaged patients from diverse backgrounds. The model warrants further investigation to identify which intervention components most promote engagement. Disclosure J. J. Flores garcia: None. J. Raymond: None. M. W. Reid: None. E. Pyatak: None. D. Fox: None. J. L. Fogel: None. E. Salcedo-rodriguez: None. D. I. Bisno: None. D. Miller: None. A. Mittal: None. Funding The Donaghue Foundation