1940-P: Association of Glucose Metrics Including Time in Tight Range with Risk of Major Adverse Cardiovascular Events and Severe Hypoglycaemia in Type 2 Diabetes: A Post Hoc Multivariate Analysis of Devote

Introduction and Objective: To investigate associations of derived time-in-range (dTIR), derived time-in-tight-range (dTITR), and derived glucose variability (d%CV) with 3-point major adverse cardiovascular events (MACE) and severe hypoglycaemia in adults with high-risk type 2 diabetes (T2D). Methods: This post hoc analysis included 5,774 participants with 8-point self-monitored plasma glucose profiles at 12 months of observation. Analyses included dTIR (70-180 mg/dL), dTITR (70-140 mg/dL), and d%CV. Incidence of outcome events was analysed using univariate and multivariate logistic regression, investigating interactions between the variables. Cox proportional hazards models assessed consistency of direction and magnitude of associations over time. Results: There were 370 MACE events and 314 severe hypoglycaemic episodes. Mean dTIR, dTITR, and d%CV were 74.6%, 52.1%, and 28.5%. Both dTIR (p=0.002) and dTITR (p=0.02) predicted MACE risk in univariate analysis and dTIR remained significant in multivariate models (p=0.01); higher dTIR (≥70%) was linked to a 27-29% lower MACE risk. For severe hypoglycaemia, dTIR, dTITR, and dCV were significant in univariate analyses (p=0.001), but not in multivariate. The association between dTITR and severe hypoglycaemia was significantly modified by d%CV (p=0.011). Individuals with low d%CV and higher dTITR were associated with a trend toward lower hypoglycaemia risk (p=0.056). For individuals with higher d%CV, lower risk was observed at intermediate dTITR levels and increased risk at lower and higher extremes. Conclusion: dTIR was associated to CV risk. dTITR did not provide prognostic value beyond dTIR and d%CV. For severe hypoglycaemia, dTITR and d%CV were informative through interaction. dTIR appears most suitable for CV risk assessment; dTITR may help in personalising glycaemic targets, when hypoglycaemia risk is interpreted alongside variability. Disclosure L. Lawson-Smith: Employee; Current; Novo Nordisk A/S. R.M. Agesen: Employee; Current; Novo Nordisk A/S. M. Hesselstroem Jensen: Employee; Current; Novo Nordisk. Stock/Shareholder; Current; Novo Nordisk. I. Hirsch: Research Support; Current; MannKind Corporation, Sequel Tech. Consultant; Current; Abbott Diabetes, Roche Diabetes Care, Hagar. N.V. Hartvig: Employee; Current; Novo Nordisk. Stock/Shareholder; Current; Novo Nordisk. U. Pedersen-Bjergaard: Research Support; Current; Novo Nordisk. Speaker's Bureau; Ended; Abbott. Advisory Panel; Ended; Novo Nordisk, Tandem Diabetes Care, Inc. Funding Danish Diabetes and Endocrine Academy (NNF22SA0079901), Novo Nordisk A/S