Time In Glucose Range Research Articles

SARS-CoV-2 booster vaccination does not worsen glycemia in people with type 1 diabetes using insulin pumps: an observational study.

Despite an increased risk for adverse outcomes from SARS-CoV-2 infection among individuals with type 1 diabetes (T1D), vaccine hesitancy persists due to safety concerns including dysglycemia. The impact of booster vaccination on individuals using automated insulin delivery (AID) systems remains unclear. We used continuous glucose monitoring (CGM) data from 53 individuals with T1D using insulin pump therapy who received their third and/or fourth COVID-19 vaccination. CGM data from the 14 days before and 3 and 7 days after each vaccination were compared. The primary outcome was glucose time in range (TIR) (70-180mg/dL) 3 and 7 days post-vaccination compared with the 14 days prior. Secondary outcomes included other CGM metrics such as time below range (< 70mg/dL), time above range (> 180mg/dL), mean glucose, co-efficient of variation and average total daily insulin. The cohort comprised 53 adults (64% women, 64% AID), totaling 74 vaccination periods (84% Pfizer-BioNTech boosters), mean ± SD age 40.0 ± 15.9 years, duration of diabetes 26.0 ± 15.4 years. There was no significant difference between pre-vaccination TIR (61.0%±18.5) versus 3 (60.5%±22.8) and 7 days post-vaccination (60.2%±21.8; p = 0.79). Level 1 hypoglycemia, time in range 54-69mg/dL, was lower 3 (1.1%±1.7) and 7 days post-vaccination (1.1%±1.6), compared with 14 days pre-vaccination (1.4%±1.4; p = 0.021). The study provides evidence that SARS-CoV-2 booster vaccination does not acutely worsen glycemia in people with T1D receiving insulin pump therapy.

Glucagon-like-peptide-1 agonist therapy in adults with cystic fibrosis

Glucagon-like-peptide-1 (GLP-1) agonists are commonly used to improve glycemic control and promote weight loss in individuals with type 2 diabetes mellitus (T2DM) and/or obesity. However, there is a paucity of evidence regarding GLP-1 agonist use in people with cystic fibrosis (pwCF). We present 11 people with CF (males: 3, females: 7; age range 24–47; BMI range 25.7–43.7) treated with GLP-1 agonists (semaglutide: 9,tirzepatide: 2) for variable duration (1–50 months). All experienced weight loss on GLP- 1 agonist therapy (median change in weight = -7.2 kg; change in BMI [kg/m2] = -0.9 to -8.1). Eight pwCF showed improvement in percent predicted forced expiratory volume in 1 second (ppFEV1) [change = -5 to + 18] and nine pwCF showed improvement in percent predicted forced vital capacity (ppFVC) [change= +1 to + 26]. Of the 7 pwCF with CFRD, all reduced their insulin quantity (mean, 31.5 % decrease in total daily insulin dose), and glucose time in range improved for most (mean, +11 % increase from baseline). Four pwCF stopped using GLP-1 agonists: 2 due to severe nausea/vomiting, 1 due to lack of perceived benefit, and 1 due to change in insurance coverage. This report is the largest published series to date of pwCF treated with GLP-1 agonist therapy. With the addition of GLP-1 agonists, all individuals experienced weight loss and a reduction in daily insulin dose, and most had improvement in pulmonary function. Future multi-center studies are needed to corroborate the efficacy and safety of these agents in the CF population.

Effectiveness of Blood Glucose Time in Range to Reduce Risk of Blood Glucose Extrusion and Improve Blood Glucose Metrics in Type 1 Diabetic Patients.

With evolving diabetes technology, continuous glucose monitoring (CGM) and time in range have been advanced as critical measurements to assess complications. They have shown improvement in A1C levels and decreased episodes of blood glucose extrusion. This study aimed to assess the awareness and utilization of blood glucose time in range and its effectiveness in reducing the risk of blood glucose extrusion and improving blood glucose metrics among patients with type 1 diabetes mellitus. A retrospective study included 342 patients who met the inclusion criteria and were using the CGM, aiming for a TIR of 70% daily. Glycemic control was followed using TIR data, blood glucose extrusion frequency (including hyperglycemia and hypoglycemia events), active sensor time, average blood glucose, and glucose management indicator (GMI) levels. A total of 342 individuals participated in this study, the majority of whom were below 18 years of age (62.3%). The hypoglycemic frequency was significantly increased compared to the baseline, and most participants experienced hypoglycemia events (p = 0.0001). The incidences increased over time, with 90.9% and 93% having hypoglycemia at 60 and 90 days (p = 0.0001), respectively. The active scan and sensor time were not followed, which led to the blood glucose target not being achieved, with no improvement throughout the study. Consequently, no improvement occurred in glycemic control. CGM technology has been promising and proven effective in improving glycemic. However, our study did not show these benefits as expected, which could be explained by the underutilization and improper use of the CGM.

Effectiveness and safety of an artificial intelligence-based medical decision support system for adjusting insulin pump settings in children with type 1 diabetes mellitus: randomized controlled trial

BACKGROUND: Previously, we presented the process of developing a clinical decision support system (CDSS) for adjusting insulin pump (IP) settings in children with type 1 diabetes mellitus (T1D) and assessing the agreement of the recommendations it generates with the expert opinion. The CDSS demonstrated satisfactory forecasting of glucose profile and agreement rates between recommendations CDSS and experts.AIM: To evaluate the effectiveness and safety of using CDSS in children with T1D, testing the hypothesis of non-inferiority (with a limit of -5%) of relative increase of glucose time in range (TIR) over 6 months.MATERIALS AND METHODS: The trial included 80 children with T1D, divided into two comparable groups of 40 children using the minimization method. Patients in the main group received recommendations for adjusting the IP settings from a physician who uses the CDSS; patients in the control group received recommendations from a physician (control group). Patients were observed for 6 months with remote consultations once a month (7 consultations in total) and monitoring of glycated hemoglobin (HbA1c) at 1, 4 and 7 consultations. The primary outcome is the difference in group mean relative changes in TIR (%), secondary outcomes are TIR (%), HbA1c concentration. RESULTS: The trial was completed by 63 patients 32 in the main group, 31 in the control group. The difference in the mean relative increase in TIR at the 7th consultation in the groups was 3.02%, one-sided 95% CI (-4.55%; inf ). Thus, the lower bound of this CI is greater than the noninferiority limit of -5%, and the noninferiority hypothesis can be accepted. There were no statistically significant differences between groups for all outcomes. The dynamics of the indicators were positive in the main group and had a statistical tendency towards positive changes in the control group.CONCLUSION: The use of CDSS was no less effective in terms of the TIR than the management of the patient by a physician. The use of CDSS in clinical practice can help in regular and frequent monitoring of children with T1D, and standardize at a high level the approach to correction of IP parameters, supplemented with CGM.

Effectiveness of the flash glucose monitoring system in preventing severe hypoglycemic episodes and in improving glucose metrics and quality of life in subjects with type 1 diabetes at high risk of acute diabetes complications

AimsTo assess the effectiveness of the intermittent-scanned continuous glucose monitoring (isCGM) system in preventing severe hypoglycemic episodes and in improving glucose parameters and quality of life.MethodsFour hundred T1D individuals were enrolled in a prospective real-word study with an intermittently scanned continuous glucose monitoring device during the 12-months follow-up. The primary endpoint was the incidence of severe hypoglycemic events.Results82% of subjects were naïve to the use of the device (group A) and 18% were already wearing the system (group B). The cumulative incidence of severe hypoglycemia (SH) at 12 months was 12.06 per 100 person-year (95% CI: 8.35–16.85) in group A and 10.14 (95% CI: 4.08–20.90) in group B without inter-group differences. In group A there was a significant decrease in SH at 12 months compared to 3 months period (p = 0.005). Time in glucose range significantly increased in both groups accompanied with a significant decrease in glucose variability. HbA1c showed a progressive significant time-dependent decrease in group A. The use of the device significantly improved the perceived quality of life.ConclusionThis study confirmed the effectiveness of the isCGM in reducing hypoglycemic risk without glucose deterioration, with potential benefits on adverse outcomes in T1D individuals.Trial registration: ClinicalTrials.gov registration no. NCT04060732.

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study.

Continuous glucose monitoring (CGM) introduces novel indicators of glycemic control. This cross-sectional study, based on the Swedish National Diabetes Register, examines 27,980 adults with type 1 diabetes. It explores the relationships between HbA1c (glycated hemoglobin) and various CGM-derived metrics, including TIR (time in range, representing the percentage of time within the range of 4-10mmol/l for 2weeks), TAR (time above range), TBR (time below range), mean glucose, standard deviation (SD), and coefficient of variation (CV). Pearson correlation coefficients and linear regression models were utilized for estimation. The analysis included 46% women, 30% on insulin pump, 7% with previous coronary heart disease and 64% with retinopathy. Mean ± SD values were age 48 ± 18years, diabetes duration 25 ± 16years, HbA1c 58.8 ± 12.8mmol/mol, TIR 58.8 ± 19.0%, TAR 36.3 ± 20.0%, TBR 4.7 ± 5.4%, mean sensor glucose 9.2 ± 2.0mmol/l, SD 3.3 ± 1.0mmol/l, and CV 36 ± 7%. The overall association between HbA1c and TIR was -0.71 (Pearson's r), with R2 0.51 in crude linear regression and 0.57 in an adjusted model. R2values between HbA1c and CGM mean glucose were 0.605 (unadjusted) 0.619 (adjusted) and TAR (unadjusted 0.554 and fully adjusted 0.568, respectively), while fully adjusted R2values were 0.458, 0.175 and 0.101 between HbA1c and CGM SD, CGM CV and TBR, respectively. This descriptive study demonstrates that the degree of association between HbA1c and new and readily available CGM-derived metrics, i.e., time in range (TIR), time above range (TAR), and CGM mean glucose, is robust in assessing the management of individuals with type 1 diabetes in clinical settings. Metrics from CGM that pertain to variability and hypoglycemia exhibit only weak correlations with HbA1c.

Plant-Based Meat Analogs and Their Effects on Cardiometabolic Health: An 8-Week Randomized Controlled Trial Comparing Plant-Based Meat Analogs With Their Corresponding Animal-Based Foods

BackgroundWith the growing popularity of plant-based meat analogs (PBMAs), an investigation of their effects on health is warranted in an Asian population. ObjectivesThis research investigated the impact of consuming an omnivorous animal-based meat diet (ABMD) compared with a PBMAs diet (PBMD) on cardiometabolic health among adults with elevated risk of diabetes in Singapore. MethodsIn an 8-wk parallel design randomized controlled trial, participants (n = 89) were instructed to substitute habitual protein-rich foods with fixed quantities of either PBMAs (n = 44) or their corresponding animal-based meats (n = 45; 2.5 servings/d), maintaining intake of other dietary components. Low-density lipoprotein (LDL) cholesterol served as primary outcome, whereas secondary outcomes included other cardiometabolic disease-related risk factors (e.g. glucose and fructosamine), dietary data, and within a subpopulation, ambulatory blood pressure measurements (n = 40) at baseline and postintervention, as well as a 14-d continuous glucose monitor (glucose homeostasis-related outcomes; n = 37). ResultsData from 82 participants (ABMD: 42 and PBMD: 40) were examined. Using linear mixed-effects model, there were significant interaction (time × treatment) effects for dietary trans-fat (increased in ABMD), dietary fiber, sodium, and potassium (all increased in PBMD; P-interaction <0.001). There were no significant effects on the lipid-lipoprotein profile, including LDL cholesterol. Diastolic blood pressure (DBP) was lower in the PBMD group (P-interaction=0.041), although the nocturnal DBP dip markedly increased in ABMD (+3.2% mean) and was reduced in PBMD (-2.6%; P-interaction=0.017). Fructosamine (P time=0.035) and homeostatic model assessment for β-cell function were improved at week 8 (P time=0.006) in both groups. Glycemic homeostasis was better regulated in the ABMD than PBMD groups as evidenced by interstitial glucose time in range (ABMD median: 94.1% (Q1:87.2%, Q3:96.7%); PBMD: 86.5% (81.7%, 89.4%); P = 0.041). The intervention had no significant effect on the other outcomes examined. ConclusionsAn 8-wk PBMA diet did not show widespread cardiometabolic health benefits compared with a corresponding meat based diet. Nutritional quality is a key factor to be considered for next generation PBMAs.This trial was registered at https://clinicaltrials.gov/as NCT05446753.

Abstract MP33: Investigating the Link Between Glucose Patterns Assessed by Continuous Glucose Monitoring With Cognitive Impairment in Older Adults With Diabetes

Introduction: There are no studies in older adults with type 2 diabetes that examine the link between day-to-day glucose patterns and cognitive dysfunction. Continuous glucose monitoring (CGM) is a minimally invasive technology that can assess glucose every 1-15 minutes and characterize nuanced patterns in glucose. Hypothesis: CGM can provide a comprehensive picture of glycemic variability in people with cognitive dysfunction. Methods: We conducted a cross-sectional study of participants with diabetes in the Atherosclerosis Risk in Communities (ARIC) Study (Visit 9, 2021-2022). ARIC participants wore a CGM (Abbott Libre Pro) and underwent cognitive testing in three cognitive domains (memory, executive functioning, and language). Scores were standardized and averaged to give a global cognitive z-score. We compared HbA1c and clinically used CGM parameters (mean glucose, coefficient of variation, percent time in glucose range of 70-180 mg/dL, and percent time above 180 mg/dL) across quartiles of cognitive z-scores, adjusting for age and sex. We calculated p-values for trends from linear or quantile regression treating the median of cognitive Z-score in each quartile as a continuous variable. Results: We included 383 participants with diabetes (mean age, 83 years). Across categories of cognitive functioning, participants in the lowest cognitive functioning categories had significantly higher HbA1c, glucose variability, and less percent time spent with glucose in range (70-180 mg/dl) (Figure) . There was no clear trend in CGM mean glucose (p=0.15) (Figure, Panel B) . Conclusions: Cognitive dysfunction was associated with an increased burden of glycemic dysregulation assessed through CGM and HbA1c. Our results suggest CGM may be a useful complement to HbA1c for monitoring glycemic control in this population. Figure: Hemoglobin A1c (HbA1c) and continuous glucose monitoring (CGM) metrics across quartiles of cognitive Z-scores in older participants with diabetes in the ARIC Study (2021-2022)

Low-Dose Sulfonylurea Plus DPP4 Inhibitor Lower Blood Glucose and Enhance Beta-Cell Function Without Hypoglycemia.

Low-dose sulfonylureas (SUs) have been found to augment the classical incretin effect, increase glucose sensitivity and late phase incretin potentiation. To evaluate potential synergy between low-dose SU plus a dipeptidyl peptidase 4 (DPP4) inhibitor. Unblinded randomized crossover study at the Clinical Research Centre, University of Dundee. Thirty participants with T2DM (HbA1c < 64 mmol/mol) were treated with diet or metformin. Participants completed 4, 14-day blocks in a random order: control, gliclazide 20 mg (SU), sitagliptin 100 mg (DPP4 inhibitor [DPP4i]), or combination (SUDPP4i). A mixed meal test was conducted after each intervention. The primary outcome was the effect of treatment on beta-cell glucose sensitivity. Secondary outcomes included frequency of glucose <3 mmol/L on continuous glucose monitoring, subanalyses by genotype (KNCJ11 E23K), gender, and body mass index. SU combination with DPP4i showed additive effect on glucose lowering: mean glucose area under the curve (mean 95% CI) (mmol/L) was control 11.5 (10.7-12.3), DPP4i 10.2 (9.4-11.1), SU 9.7 (8.9-10.5), SUDPP4i 8.7 (7.9-9.5) (P < .001). Glucose sensitivity mirrored the additive effect (pmol min-1 m-2 mM-1): control 71.5 (51.1-91.9), DPP4i 75.9 (55.7-96.0), SU 86.3 (66.1-106.4), SUDPP4i 94.1 (73.9-114.3) (P = .04). The additive effect was seen in men but not women. Glucose time in range <3 mmol/L on continuous glucose monitoring (%) was unaffected: control 1 (2-4), DPP4i 2 (3-6), SU 1 (0-4), SUDPP4i 3 (2-7) (P = .65). Low-dose sulfonylurea plus DPP4i has a potent glucose-lowering effect through augmentation of beta-cell function. A double-blind randomized controlled trial would formalize efficacy and safety of this combination, which may avoid negative aspects of SU.

Factors associated with maternal hyperglycaemia and neonatal hypoglycaemia after antenatal betamethasone administration in women with diabetes in pregnancy.

Bespoke glycaemic control strategies following antenatal corticosteroids for women with diabetes in pregnancy (DIP) may mitigate hyperglycaemia. This study aims to identify predictive factors for the glycaemic response to betamethasone in a large cohort of women with DIP. Evaluation of a prospective cohort study of 347 consecutive DIP pregnancies receiving two doses of 11.4 mg betamethasone 24 h apart between 2017 and 2021 and treated with the Pregnancy-IVI intravenous insulin protocol. Regression modelling identified factors associated with maternal glycaemic time-in-range (TIR) and maternal insulin requirements following betamethasone. Factors associated with neonatal hypoglycaemia (glucose <2.6 mmol/L) in infants born within 48 h of betamethasone administration (n = 144) were investigated. The mean maternal age was 31.9 ± 5.8 years, with gestational age at betamethasone of 33.5 ± 3.4 weeks. Gestational diabetes was present in 81% (12% type 1; 7% type 2). Pre-admission subcutaneous insulin was prescribed for 63%. On-infusion maternal glucose TIR (4.0-7.8 mmol/L) was 83% [IQR 77%-90%] and mean on-IVI glucose was 6.6 ± 0.5 mmol/L. Maternal hypoglycaemia (<3.8 mmol/L) was uncommon (0.47 h/100 on-IVI woman hours). Maternal glucose TIR was negatively associated with indicators of insulin resistance (type 2 diabetes, polycystic ovary syndrome), late-pregnancy complications (pre-eclampsia, chorioamnionitis) and the 1-h OGTT result. Intravenous insulin requirements were associated with type of diabetes, pre-eclampsia and intrauterine infection, the 1-h OGTT result and the timing of betamethasone administration. Neonatal hypoglycaemia was associated with pre-existing diabetes but not with measures of glycaemic control. An intravenous infusion protocol effectively controls maternal glucose after betamethasone. A risk-factor-based approach may allow individualisation of therapy.

Determination of Glucose-Independent Racial Disparity in HbA1c for Youth With Type 1 Diabetes in the Era of Continuous Glucose Monitoring.

The magnitude and importance of higher HbA1c levels not due to mean blood glucose (MBG) in non-Hispanic black (B) versus non-Hispanic white (W) individuals is controversial. We sought to clarify the relationship of HbA1c with glucose data from continuous glucose monitoring (CGM) in a young biracial population. Glycemic data of 33 B and 85 W, healthy youth with type 1 diabetes (age 14.7 ± 4.8 years, M/F = 51/67, duration of diabetes 5.4 ± 4.7 years) from a factory-calibrated CGM was compared with HbA1c. Hemoglobin glycation index (HGI) = assayed HbA1c - glucose management index (GMI). B patients had higher unadjusted levels of HbA1c, MBG, MBGSD, GMI, and HGI than W patients. Percent glucose time in range (TIR) and percent sensor use (PSU) were lower for B patients. Average HbA1c in B patients 8.3% was higher than 7.7% for W (P < .0001) after statistical adjustment for MBG, age, gender, insulin delivery method, and accounting for a race by PSU interaction effect. Higher HbA1c persisted in B patients when TIR was substituted for MBG. Predicted MBG was higher in B patients at any level of PSU. The 95th percentile for HGI was 0.47 in W patients, and 52% of B patients had HGI ≥ 0.5. Time below range was similar for both. Young B patients have clinically relevant higher average HbA1c at any given level of MBG or TIR than W patients, which may pose an additional risk for diabetes complications development. HGI ≥ 0.5 may be an easy way to identify high-risk patients.

Hybrid Closed Loop Therapy in Adults With Type 1 Diabetes and Above-Target HbA1c: A Real-World Observational Study.

We explored longitudinal changes associated with switching to hybrid closed loop (HCL) insulin delivery systems in adults with type 1 diabetes and elevated HbA1c levels despite the use of intermittently scanned continuous glucose monitoring (isCGM) and insulin pump therapy. We undertook a pragmatic, preplanned observational study of participants included in the National Health Service England closed loop pilot. Adults using isCGM and insulin pump across 31 diabetes centers in England with an HbA1c ≥8.5% who were willing to commence HCL therapy were included. Outcomes included change in HbA1c, sensor glucometrics, diabetes distress score, Gold score (hypoglycemia awareness), acute event rates, and user opinion of HCL. In total, 570 HCL users were included (median age 40 [IQR 29-50] years, 67% female, and 85% White). Mean baseline HbA1c was 9.4 ± 0.9% (78.9 ± 9.1 mmol/mol) with a median follow-up of 5.1 (IQR 3.9-6.6) months. Of 520 users continuing HCL at follow-up, mean adjusted HbA1c reduced by 1.7% (95% CI 1.5, 1.8; P < 0.0001) (18.1 mmol/mol [95% CI 16.6, 19.6]; P < 0.0001). Time in range (70-180 mg/dL) increased from 34.2 to 61.9% (P < 0.001). Individuals with HbA1c of ≤58 mmol/mol rose from 0 to 39.4% (P < 0.0001), and those achieving ≥70% glucose time in range and <4% time below range increased from 0.8 to 28.2% (P < 0.0001). Almost all participants rated HCL therapy as having a positive impact on quality of life (94.7% [540 of 570]). Use of HCL is associated with improvements in HbA1c, time in range, hypoglycemia, and diabetes-related distress and quality of life in people with type 1 diabetes in the real world.

Association between time in range 70-180 mg/dl in early stage and severity with in patients acute pancreatitis

BackgroundIt is not well understood whether glucose control in the early stage of acute pancreatitis(AP) is related to outcome. This study aimed to investigate the association between blood glucose time in range (TIR) of 70–180 mg/dL in the first 72 h(h) on admission and the progression of AP.MethodsIndividuals admitted with AP to the Gastroenterology Department of the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University between January 2017 and December 2021 were included and retrospectively evaluated. The percentage of TIR between 70 and 180 mg/dL in the first 72 h was calculated. According to the progress of AP at discharge, patients were divided into mild pancreatitis(MAP), and moderately severe acute pancreatitis (MSAP), or severe acute pancreatitis (SAP) groups. We examined the association between TIR or TIR ≥ 70% and AP severity using logistic regression models stratified by a glycosylated hemoglobin (HbA1c) level of 6.5%. Receiver operating characteristic (ROC) curves were generated to assess the ability of the TIR to predict MSAP or SAP.ResultsA total of 298 individuals were included, of whom 35 developed MSAP or SAP. Logistic regression analyses indicated that TIR was independently associated with the incidence of more serious AP (odds ratio [OR] = 0.962, 95% CI = 0.941–0.983, p = 0.001). This association remained significant in individuals with HbA1c levels ≤ 6.5% (OR = 0.928, 95% CI = 0.888–0.969, p = 0.001). A TIR ≥ 70% was independently associated with reduced severity only in people with well-antecedent controls (OR = 0.238; 95% CI = 0.071–0.802; p = 0.020). TIR was not powerful enough to predict the severity of AP in both patients with poor antecedent glucose control (AUC = 0.641) or with HbA1c < 6.5% (AUC = 0.668).ConclusionsTIR was independently associated with severity in patients with AP, particularly those with good antecedent glucose control.

338-OR: Increased Glucose Time in Range following Active vs. Sedentary Days in Newly Diagnosed Youth with T1D—4T Exercise Results

The 4T Exercise Study started newly diagnosed youth with T1D on CGM and physical activity (PA) trackers ~1-month post diagnosis. We examined real-world PA patterns and glycemia in youth with T1D during the first year post diagnosis. A physically active day was identified as ≥10 mins of continuous moderate-to-vigorous intensity PA, with moderate-intensity (MOD) defined as 3-6 metabolic equivalents (METS) and high-intensity (HIE) as &amp;gt;6 METS. All other days were deemed as sedentary (SED) days. CGM data 24h after exercise were used to compute percent time below range (TBR; &amp;lt;70 and TBR2; &amp;lt;54 mg/dL), time in range (TIR; 70-180 mg/dL), and time above range (TAR; &amp;gt;180 and TAR2; &amp;gt;250 mg/dL). A total of 45 youth (age: 13 [IQR 12, 15] years, 38% female, 40% non-Hispanic White, 76% private insurance) wore activity trackers 13 [IQR: 8, 16] hours daily. Compared to SED days, higher intensity PA levels were associated with higher TIR (70% SED vs 72% with MOD, P=0.2; 76% with HIE, P=0.001) and lower TAR (28% SED vs 24% with MOD, P=0.08; 21% with HIE, P&amp;lt;0.001), but no difference in TBR (2.8% SED vs 3.6% following MOD, P=0.2; 3.7% following HIE, P=0.14). Overall, higher levels of PA in youth with new onset T1D was associated with over an hour of increased TIR per day, without significant increases in TBR. Exercise education soon after diagnosis is an opportunity to improve care and establish safe and healthy PA habits. Disclosure D.P.Zaharieva: Advisory Panel; Dexcom, Inc., Research Support; Hemsley Charitable Trust, International Society for Pediatric and Adolescent Diabetes, Insulet Corporation, Speaker's Bureau; American Diabetes Association, Ascensia Diabetes Care, Medtronic. D.M.Maahs: Advisory Panel; Medtronic, LifeScan Diabetes Institute, MannKind Corporation, Consultant; Abbott, Research Support; Dexcom, Inc. V.Ritter: None. M.Riddell: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Indigo Diabetes, Consultant; Lilly Diabetes, Eli Lilly and Company, Jaeb Center for Health Research, Speaker's Bureau; Dexcom, Inc., Novo Nordisk, Sanofi, Stock/Shareholder; Supersapiens, Zucara Therapeutics. A.Addala: None. F.K.Bishop: None. P.Prahalad: None. M.Desai: None. K.K.Hood: Consultant; Cecelia Health. D.Scheinker: None. Funding National Institutes of Health (P30DK116074); Stanford Diabetes Research Center (R18DK122422 to D.M.M.); Dexcom, Inc.; Lucile Packard Children’s Hospital Auxiliaries Endowment; The Leona M. and Harry B. Helmsley Charitable Trust (G-2002-0425); Internationa

607-P: The Impact of Telenutrition vs. In-Person Nutrition Consultations on Glycemic Control in People with Type 1 Diabetes—Data from Saudi Arabia

Background: Telehealth has the potential to improve accessibility to nutrition clinics, particularly in parts of the world where the number of certified nutritionists is limited. Here, we evaluate the impact of utilizing telehealth for nutrition consultations on glycemic control and patients satisfaction when managing people with type 1 diabetes (PwT1D). Methods: A retrospective analysis of data from 137 PwT1D referred to the nutrition clinic at King Saud University to learn carb counting (2021-2022). Participants were divided into 2 groups: 1) Telenutrition group (those who had 4 virtual &amp; 2-3 in-person visits) (n=107) and 2) In-person group (those who had 6-7 in-person &amp; no virtual visits) (n=30). Changes in hemoglobin A1C and CGM metrics from baseline to month 3 (i.e. end of the study (EOS)) were compared between the groups. At the EOS, participants were asked to fill out a satisfaction survey. Results: The reduction in A1c from baseline to EOS was comparable in both groups (1.2% and 1.1%, in the Telenutrition and In-person groups, respectively, both p&amp;lt;0.01). Likewise, the glucose time in range (TIR) increased from 53.9% at baseline to 58.5% at the EOS (p&amp;lt;0.01) in the telenutrition group and from 49.1% at baseline to 54.7% at the EOS (p=0.13) in the in-person group. This was accompanied by a significant reduction in the prandial insulin doses from baseline to EOS by 32% in the telenutrition group and 28% in the in-person group (both p&amp;lt;0.01). Majority (98%) of those who attended the telenutrition clinic reported satisfaction with the quality of healthcare provided and 97% reported that their experience with the telenutrition clinic was as satisfying or more satisfying than that in the in-person clinic. Conclusion: Telenutrition clinic is as effective in improving glycemic control in people with T1D as the traditional “in-person” nutrition clinics, and its utilization may improve patients' satisfaction and accessibility to certified nutritionists Disclosure M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Almuammar: None.

909-P: Predictors of Successful Fasting and Attaining Glycemic Targets during the Month of Ramadan among People with Type 1 Diabetes

Introduction: Muslims abstain from eating and drinking from dawn to dusk during Ramadan. We aim to evaluate the fasting experience of people with type 1 diabetes (PwT1D) and identify predictors of successful fasting and attaining glycemic targets during Ramadan. Methods: We included the 149 PwT1D who attempted to fast during Ramadan 2022, were seen in our Endocrine clinics during the month preceding Ramadan, and were using a continuous glucose monitor (CGM). They were categorized, based on their treatment modality, into 3 groups: a) Hybrid closed loop (HCL) pump (n=39); b) Open loop pump (n=12); and c) Multiple daily injections (MDI) (n=98). CGM Reports for Ramadan and the month preceding Ramadan and self-administered surveys about fasting experience were evaluated. Predictors for attaining the “double target” of: a) breaking fast ≤2 days and b) maintaining glucose time in range (TIR) ≥70% during Ramadan were analyzed using uni- and multi-variable logistic regression. Results: The “double target” of a) breaking fast ≤2 days and b) maintaining TIR≥70% during Ramadan was attained by 21.5% of PwT1D. Users of the HCL therapy, compared to the open loop and MDI users, had a significantly lower glycemia risk index (GRI), glucose management indicator (GMI), time below range (TBR), time above range (TAR), and average glucose during Ramadan (all p&amp;lt;0.05). Those with health insurance and better “pre-Ramadan” glycemic control (i.e. lower GRI, TAR, and coefficient of variation and higher TIR) were more likely to attain the “double target” during Ramadan. Users of the HCL pumps were more likely to attain the “double target” compared to the users of MDI + CGM [OR (95% CI): 25.47 (4.72, 137.49)] after adjusting for age, sex, educational level, employment status, insurance status, and diabetes duration. Conclusion: Using HCL pump therapy and having better pre-Ramadan CGM metrics predict attainment of the double target of fasting most of days and having TIR ≥70% during Ramadan among PwT1D. Disclosure M.Al-sofiani: Consultant; Eli Lilly and Company, Speaker's Bureau; Sanofi, Medtronic, Vitalair. S.Alharthi: None. S.Albunyan: Employee; ProMedEx, Medtronic. N.Alzaman: None. D.C.Klonoff: Consultant; EOFlow Co., Ltd., Fractyl Health, Inc., Integrity, Lifecare, Inc., Rockley Photonics, Thirdwayv Inc. A.M.Alguwaihes: Consultant; Eli Lilly and Company, Research Support; AstraZeneca, Novo Nordisk, Speaker's Bureau; Novo Nordisk, Sanofi.

1134-P: Determination of Glucose-Independent Racial Disparity in HbA1c in Youth with Type 1 Diabetes in the Era of Continuous Glucose Monitoring

Introduction: The extent and importance of higher HbA1c levels not due to mean blood glucose (MBG) in non-Hispanic Black (B) versus non-Hispanic White (W) individuals is controversial. We sought to clarify the relationship of HbA1c with metrics of glycemia derived from continuous glucose monitoring (CGM) in a young biracial population. Methods: Glycemic data of 33 B and 85 W, otherwise healthy youth with type 1 diabetes (age 14.7±4.8 years, M/F=51/67, duration of diabetes 5.4±4.7 years) was derived from a factory calibrated CGM and compared with assayed HbA1c. Hemoglobin glycation index (HGI) a metric of MBG difference in HbA1c not due to MBG =assayed HbA1c - Glucose Management Index (GMI). Results: B patients had higher unadjusted levels of HbA1c, MBG, MBGSD, GMI and HGI than W patients. Percent glucose time in range (TIR) and percent sensor use (PSU) were lower for B patients. HbA1c remained higher in B patients (8.6%) versus (7.7%) for W (p&amp;lt;0.0001) after statistical adjustment for MBG, MBGSD, age, gender, insulin delivery method and PSU. MBG and race accounted for 80% of the variation in HbA1c in the model. Results were similar when TIR was substituted for MBG (R2=0.64, p&amp;lt;0.0001). The 95% for HGI=0.47% in W patients, 52% of B patients had HGI ≥0.5%. Percent time below range was similar for both groups. Conclusions: Young B patients have clinically relevant higher HbA1c (~0.9%) at any given level of MBG or TIR than W patients, which may pose an additional risk for diabetes complications. HGI ≥0.5% may be an easy way to identify high risk patients. Disclosure N.J.Christakis: None. D.Felipe: None. R.Gomez: None. S.Chalew: Advisory Panel; Medtronic. Funding National Institutes of Health (1R21DK118643-01A1, U54GM104940)

733-P: Diabetes Remission Outcomes Protocol (DROP)—Early Observation

A 12-week multidisciplinary intensive lifestyle intervention (ILI) was shown to induce diabetes remission (A1C &amp;lt;6.5%, on no medications for ≥3 months), particularly among participants with short diabetes duration. Diabetes remission was also achieved with very low-calorie diet (VLCD) or bariatric surgery. Diabetes Remission Outcomes Protocol (DROP) at Joslin Diabetes Center is an ILI designed to induce diabetes remission in patients with type 2 diabetes who meet 3 criteria: 1- duration of diabetes &amp;lt;5 years, 2- A1C &amp;lt;8%, 3- On up to 2 antihyperglycemic medications, but no insulin. It involves two phases: an intervention phase for 12 weeks and a maintenance phase for 9 months. During intervention phase, participants follow a time-restricted fasting for 16 hours and VLCD (800-1000 Kcal/day). Participants also receive cognitive behavioral support and perform exercises designed to maintain lean muscle mass (LMM). They stop all diabetes medications at the beginning of the program and are monitored by CGM. Reintroduction of medications is suggested if glucose time in range (70-180 mg/dL) (TIR) drops to &amp;lt;70%. During maintenance phase, participants return to 1500-1800 calorie diet with the aim of maintaining weight loss and diabetes remission. We tested feasibility of DROP in a pilot of 5 participants with mean age of 52.8±11.4 years, diabetes duration of 13.2±11.8 months, and A1C of 6.44±0.3% on 2 medications. By the end 12-weeks, average weight loss was 19.9 lbs (8.1%). A1C decreased to 6.14±0.48% (p=0.02) on no medications and TIR was 98%. LMM /total body weight significantly increased by 0.03±0.02 (p=0.03). Patient-reported quality of life measures showed significant improvements in the World Health Organization-5 Well-Being Index (p=0.03), Diabetes Distress Scale-17 (p=0.05) and 36-Item Short Form Survey (p=0.04) submodules. DROP is promising approach to induce diabetes remission and improve patients’ quality of life in selected patients with type 2 diabetes. Larger cohorts should be evaluated for longer duration. Disclosure K.Kibaa: None. A.Khater: None. R.Mccarragher: None. O.Hamdy: Advisory Panel; Abbott Nutrition, Nemaura Medical, L-Nutra Inc., Twin Health, Consultant; Sanofi, Research Support; Novo Nordisk, Eli Lilly and Company, Gilead Sciences, Inc., Stock/Shareholder; Healthimation. S.E.Dhaver: None. C.Johnson: None. J.L.Votta: None. J.I.Shahar: None. C.Mitchell: None. J.M.Beaton: None. T.Salah: None. M.Al-badri: None.

Gegen Qinlian Decoction combined with Metformin for the treatment of patients with Type-2 Diabetes Mellitus: A retrospective observational study.

To investigate Gegen Qinlian Decoction (GQD) combined with metformin for treatment of patients with Type-2 Diabetes Mellitus (T2DM). This retrospective observational study reviewed the clinical data of 89 patients diagnosed with T2DM in the Department of Acupuncture and Massage, Hainan Medical University from January 2021 to June 2022. Patients were non-randomized and divided into two groups based on the treatment received: observation group (n=41, GQD combined with metformin); control group (n=48, metformin only). Fasting blood glucose levels (FBG), traditional Chinese medicine (TCM) syndrome scores, clinical effect, blood glucose time in range and adverse reactions were compared between the two groups. There were no statistically significant differences in age, gender, BMI and duration of T2DM between the two groups (P>0.05). The FBG, 2h glucose, HbA1c levels and TCM syndrome scores of the two groups were significantly lower post-treatment (P<0.001) with a greater decrease in the observation group (P<0.001). The observation group was more clinically efficacious than the control group post-treatment (92.68% vs. 77.08%; P<0.05). Blood glucose time in range and the incidence of adverse reactions were lower in the observation group than the control group (P<0.001 and P<0.05). GQD combined with metformin can significantly reduce FBG, 2h glucose and HbA1c levels, and improve TCM syndrome, with good clinical efficacy, shorter blood glucose time in range and less adverse reactions.

Continuous glucose monitoring-based composite metrics: a review and assessment of performance in recent-onset and long-duration type 1 diabetes.

This study examined correlations between continuous glucose monitoring (CGM)-based composite metrics and standard glucose metrics within CGM data sets from individuals with recent-onset and long-duration type 1 diabetes. First, a literature review and critique of published CGM-based composite metrics was undertaken. Second, composite metric results were calculated for the two CGM data sets and correlations with six standard glucose metrics were examined. Fourteen composite metrics met selection criteria; these metrics focused on overall glycemia (n = 8), glycemic variability (n = 4), and hypoglycemia (n = 2), respectively. Results for the two diabetes cohorts were similar. All eight metrics focusing on overall glycemia strongly correlated with glucose time in range; none strongly correlated with time below range. The eight overall glycemia-focused and two hypoglycemia-focused composite metrics were all sensitive to automated insulin delivery therapeutic intervention. Until a composite metric can adequately capture both achieved target glycemia and hypoglycemia burden, the current two-dimensional CGM assessment approach may offer greatest clinical utility.