2771-LB: Independent Effects of Noncarbohydrate Macronutrient Intake on Hospital Time in Range in Adults with Diabetes

Introduction and Objective: Hospitalized adults with diabetes often experience variable oral intake, which complicates glycemic management. Carbohydrate intake is a primary determinant of postprandial glycemic outcomes; however, the independent effects of dietary fat and protein on inpatient glycemia are not well defined. This study examined whether protein and fat intake are associated with CGM-derived percent time in range (%TIR, 70-180 mg/dL), independent of carbohydrate intake. Methods: As part of a prospective observational study (study duration: 2-10 days), adults in the hospital with diabetes (type 1 or type 2) reported macronutrient intake (grams/day) by completing the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool and wore a study-provided CGM (Dexcom G7). Those receiving enteral or parenteral nutrition were excluded. Day-level %TIR was calculated from study CGM data, excluding days with <70% completeness, and matched to same-day macronutrient intake. Mixed-effects linear regression with patient-level random intercepts assessed associations between protein and fat intake (grams) and %TIR, adjusting for carbohydrate intake. Results: Forty-eight ASA24 recalls from 27 participants (44% female, 74% Black, mean age 58 years, mean HbA1c 9.0%) were analyzed. In the carbohydrate-adjusted models, higher fat intake was associated with lower %TIR (β=-0.0033 per gram; 95% CI -0.0062, -0.0004; p=0.03), corresponding to a 3.3% lower %TIR per 10g increase of dietary fat intake. Protein showed a similar but non-significant association (β=-0.0018; 95% CI -0.0042, 0.0005; p=0.12). Conclusion: Higher fat intake was independently associated with lower %TIR in this cohort of hospitalized adults with diabetes. These findings suggest dietary fat may influence glycemia during hospitalization and warrant confirmation in larger studies. Disclosure S. Hur: Research Support; Current; Dexcom, Inc. R. Parab: None. S. Usman: None. L. Chadalawada: None. N. Gonzalez: None. G.M. Davis: Research Support; Current; Insulet Corporation, Sequel Med Tech. M.S. Hughes: Consultant; Current; Dexcom, Inc., Sanofi, Sequel Med Tech, LLC. F.J. Pasquel: Research Support; Current; Dexcom, Inc., Insulet Corporation, Ideal Medical Technologies. Research Support; Ended; Novo Nordisk, Tandem Diabetes Care, Inc. Consultant; Ended; Insulet Corporation. J.M. Feeley: Research Support; Current; Dexcom, Inc. Funding Supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378 and TL1TR002382, and Dexcom.