1900-P: Time in Tight Range: Perspectives from an International Survey of Adults with Type 1 Diabetes (T1D)

Introduction and Objective: ADA guidelines recommend that most adults with T1D should ideally spend 70% time in range (TIR) between 70-180 mg/dL based on continuous glucose monitoring (CGM) profiles. Newer recommendations have also included spending 50% in time in tight range between 70-140 mg/dl (TITR). As changing clinical targets may influence the daily burden of T1D self-management, adults with T1D were surveyed to understand their perceived risks and benefits associated with a personal goal of TITR. Methods: Participants were 837 adults with T1D (64% female; 83% Non-Hispanic White; 79% with ≥10 years T1D duration; 71% automated insulin delivery users; 98% CGM users; 75% US-based) recruited from a large US healthcare system and through online flyers in the US and internationally. The survey focused on: perceived TITR benefits and burdens, hypoglycemic awareness (Gold Score), food insecurity (USDA 6-item scale). Fisher’s exact tests and t-tests examined group differences by device uptake. Results: Just over half (56%) agreed TITR would help diabetes management and would be achievable (55%). However, 58% reported that TITR would add stress and burden (50%), increase risk of hypoglycemia (51%); and potentially increase disordered eating (46%). AID users expressed more positive attitudes toward TITR than non-users (p=.004). Specifically, those not using AID were significantly more likely to endorse that TITR would add burden (p=.04) and increase disordered eating risk (p.001) while AID users more often reported that TITR would be achievable (p=.02). Overall, 21% of all respondents reported impaired hypoglycemia awareness and 12% experienced food insecurity. Conclusion: While many adults with T1D report that TITR could offer potential benefits, concerns about potential risks remain common even in a sample with access to CGM and AID. Promoting narrower glycemic targets may increase personal burden and pose challenges related to hypoglycemia unawareness and food insecurity. A trial randomizing people to TIR vs. TITR on glycemic and PRO outcomes is needed. Disclosure M.L. Tanenbaum: Speaker's Bureau; Current; Beta Bionics, Inc. Other - Honoraria; Ended; Sanofi. K. Barnard-Kelly: Research Support; Current; Abbott Diabetes, Dexcom, Inc. S. Hanes: None. E. Wilmot: Advisory Panel; Current; Abbott Diabetes. Speaker's Bureau; Current; Dexcom, Inc., Eli Lilly and Company. Advisory Panel; Current; Insulet Corporation. Consultant; Current; Roche Diabetes Care. Speaker's Bureau; Ended; Sanofi, Novo Nordisk. Advisory Panel; Ended; Medtronic. Speaker's Bureau; Ended; Ypsomed AG. Advisory Panel; Ended; Tandem Diabetes Care, Inc. Speaker's Bureau; Current; Abbott Diabetes. Research Support; Current; Abbott Diabetes. Speaker's Bureau; Current; Insulet Corporation. Research Support; Current; Insulet Corporation. Advisory Panel; Ended; Sanofi. Research Support; Current; Novo Nordisk. Consultant; Ended; Embecta. Research Support; Ended; Embecta. Advisory Panel; Ended; Sinocare. D. Chernavvsky: Employee; Ended; Dexcom, Inc. D. Maahs: Advisory Panel; Current; Abbott Diabetes, Sanofi, Medtronic, biospex, enable biosciences, kriya. D. Kerr: Stock/Shareholder; Current; Glooko, Inc. Research Support; Current; Abbott Diabetes.