375-P: Missed Bolus Doses (MBDs) Are Associated with Reduced Time-in-Range (TIR): The Influence of Hypoglycemic Fear.

Connected insulin pens have potential utility as diagnostic tools to objectively assess MBDs and their impact on glycemic outcomes. This cross-sectional study enrolled 68 people with T1D or insulin-using T2D (A1C ≥ 8%, ≥ 3 insulin boluses/day reported at enrollment). Mean (± SD) age of participants was 48 years (± 12), 44% female, 59% T1D, 51% BMI ≥ 30 and 65% with A1C ≥ 9.0%. Connected pen and blinded CGM data (21 days collected) were used to calculate MBDs (no insulin dose from 2 hrs prior to and 4 hrs after the start of a glucose excursion [defined as > 70 mg/dl rise within 2 hrs, not preceded by a value < 70 mg/dl]). On average, participants had 21.6 MBDs/30 days (range 0-55.8); time-in-range (TIR) was relatively low, 42.6% (± 18.8%) while time-above-range (TAR) was high, 52.8% (± 21.3%). MBD daily frequency was significantly associated with TIR (Spearman's correlation coefficient [rS] = -0.28, p = 0.02) and TAR (rS = 0.26, p = 0.03). Baseline predictors of MBD included A1C (incidence rate ratio, IRR = 1.118, p = 0.003) and BMI (IRR = 0.969, p = 0.008). Due to differences between T1D and T2D populations (age: 42.5 vs. 55.2 yrs, p < 0.001; BMI: 27.7 vs. 34.1, p < 0.001; diabetes duration: 22.7 vs. 16.0 yrs, p = 0.015, respectively), the groups were analyzed separately. For T2D, MBDs were associated with the Worry, Avoidance, and Maintain High subscales of the Hypoglycemic Fear Survey (HFS-W, A, and MH). MBDs were significantly more common among those with lower HFS-W (IRR = 0.940, p = 0.004), but with higher HFS-A (IRR = 1.140, p = 0.004) and higher HFS-MH (IRR = 1.075, p = 0.040). For T1D, none of the HFS subscales were significantly associated with MBDs. Given the differences in behavioral factors associated with MBDs in T1D and T2D, customized therapeutic approaches to reduce MBDs and improve TIR are likely needed. Disclosure: S.S. Edwards: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. X. He: Employee; Self; Eli Lilly and Company. J. Johnson: Employee; Self; Eli Lilly and Company. E. Meadows: Employee; Self; Eli Lilly and Company. Employee; Spouse/Partner; Eli Lilly and Company. Stock/Shareholder; Spouse/Partner; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. W. Wang: None. H. Wolpert: Employee; Self; Eli Lilly and Company. W. Polonsky: Advisory Panel; Self; Intarcia Therapeutics, Roche Diabetes Care. Consultant; Self; Abbott, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation, Novo Nordisk Inc., Onduo, Sanofi US, Xeris Pharmaceuticals, Inc. Funding: Eli Lilly and Company [ABSTRACT FROM AUTHOR]