1931-P: Association between Time in Range and Advanced Cardiovascular–Kidney–Metabolic Syndrome in Older Adults with Type 2 Diabetes: A Cross-Sectional Study

Introduction and Objective: The 2023 Cardiovascular-Kidney-Metabolic (CKM) syndrome framework highlights multisystem pathophysiology; however, optimal glycemic targets for CKM management in older adults with type 2 diabetes remain unclear. This study examined the association between time in range (TIR) and advanced CKM syndrome, to identify appropriate glycemic targets. Methods: In this cross-sectional analysis, 2,497 participants aged ≥60 years with type 2 diabetes were included. Advanced CKM syndrome was defined as stages 3-4 according to the American Heart Association criteria. TIR was defined as the percentage of time with glucose levels between 3.9 and 10.0 mmol/L based on continuous glucose monitoring. Associations between TIR and advanced CKM syndrome were assessed using multivariable logistic regression models and restricted cubic spline analyses. Results: Participants with advanced CKM syndrome exhibited significantly lower TIR levels (P < 0.001). After multivariable adjustment, each 1-standard deviation decrease in TIR was independently associated with a higher likelihood of advanced CKM syndrome (odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.16-1.42), with a C statistic comparable to that of glycated hemoglobin A1c. Restricted cubic spline analysis demonstrated a linear inverse relationship between TIR and advanced CKM, with the estimated OR crossing unity at approximately 70%. Compared with the guideline-recommended TIR threshold of 50%, a higher threshold of 70% significantly improved risk reclassification (net reclassification improvement 0.133, 95% CI 0.060-0.205). Although the highest odds were observed at TIR ≤50%, those with TIR levels (50-70%) remained at elevated odds (OR = 1.40, 95% CI 1.12-1.75). Conclusion: Lower TIR is independently and linearly associated with advanced CKM syndrome in older adults with type 2 diabetes. TIR >70% may represent a more appropriate glycemic target for CKM management in this population. Disclosure J. Ni: None. H. Su: None. J. Cai: None. X. Ma: None. J. Lu: None. J. Zhou: None.