Body Mass Index Moderates the Association between Diabetes Distress and Objective Self-Management Behaviors in Adolescents with Type 1 Diabetes

High diabetes distress is associated with elevated A1C in adolescents with T1D; however, no studies have examined the relationship between diabetes distress and objective measures of self-management behaviors. Whether adolescent diabetes distress and BMI are associated is also unclear. This cross-sectional study examined the relationship between diabetes distress and average daily blood glucose (BG) readings, carbohydrate entries, and insulin boluses administered as well as the interaction of diabetes distress and BMI Z-score (zBMI) on these behaviors in 1adolescents (M age 14.7±1.9 years, 47.7% male, M zBMI 0.51±0.88 kg/m2) . Objective self-management behaviors were assessed via diabetes device downloads prior to beginning intervention for a RCT. BG data was available for the full sample, while carbohydrate and bolus analyses reflect pump users only (n=78) . In separate multiple hierarchical regressions, diabetes distress, zBMI, and their interaction accounted for significant variance in average daily carbohydrate entries (R2=0.21, p<0.001) and boluses administered (R2=0.20, p<0.001) but not BG readings. Main effects of distress were not significant. zBMI moderated the relationship between diabetes distress and average daily carbohydrate entries (p<0.01) and boluses administered (p<0.05) ; those with higher zBMI and higher distress engaged in fewer daily self-management behaviors while those with higher zBMI and lower distress entered carbohydrates and bolused more frequently. This is the first study to demonstrate a relationship between diabetes distress and BMI in the context of objectively measured self-management behaviors in youth with T1D. Although separate interventions exist to improve self-management or diabetes distress, none address them together while also intervening on weight. Decreasing diabetes distress could be an especially important intervention target for youth with high BMI. Disclosure P.Trojanowski: None. H.K.O'donnell: None. T.B.Vigers: None. G.T.Alonso: None. S.Majidi: None. L.Pyle: None. J.K.Snell-bergeon: Stock/Shareholder; GlaxoSmithKline plc. R.Wadwa: Advisory Panel; Dompé, Consultant; Beta Bionics, Inc., Other Relationship; Tandem Diabetes Care, Inc., Research Support; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care, Inc. K.A.Driscoll: None. Funding National Institutes of Health (7DP3DK113363-02)