Abstract Body (Do not enter title and authors here): Background: Time-in-range (TIR), the percentage of time that glucose values are in the range of 70 to 180mg per dL as measured with continuous glucose monitoring (CGM), has become an important metric for assessing glycemic control for clinical care and as an endpoint in cardiometabolic research. For people with diabetes, a TIR >70 % is recommended, which is about 17 hours of a 24-hour day. Diabetes eating and distress are modifiable factors associated with long-term glucose control, such as HbA1c. However, little is known about the relationship between diabetes eating, diabetes distress, and TIR.

Research Hypothesis. A group with the recommended TIR (>70%) will have fewer eating problems or diabetes distress than a group with TIR ≤70%.

Methods. Participants with type 2 diabetes completed sociodemographic surveys, the Diabetes Eating Problem Survey (DEPS), and the Diabetes Distress Scale (DDS). The DDS has 4 subscales—Emotional Burden, Physician distress, Regimen Distress, and Interpersonal Distress. TIR was calculated by a 14-day blinded CGM.

Results. Among 53 participants, 66% were female with a mean (M) age of 62.08±10.26 years. The majority were White (67.9%), followed by Black (17%). About 70% had a TIR over 70%. The mean DEPS score was 31.65 ±10.05, which indicates clinically significant disordered eating behaviors (cut off>20). The mean overall DDS score was 2.0±1.0, indicating a moderate level of diabetes distress: regimen distress was the highest (M:2.3±1.1), followed by emotional burden (M:2.2±1.3). The DEPS score in the TIR>70% group were significantly lower than in the TIR of ≤ 70% group (28.45 vs. 40.36; P=0.004). All DDS scores except physician-related distress were significantly higher in the TIR ≤ 70% group than in the TIR >70% group (p<0.05). Similarly, better TIR was significantly associated with fewer diabetes eating problems (r=-0.48, p<0.05) and lower overall DDS score (r=-0.44, p<0.05).

Conclusions. In our cross-sectional study, diabetes eating problem was significantly associated with TIR—the group with recommended level of TIR showed fewer eating problems. Also, less diabetes distress was significantly associated with better TIR. These findings suggest that interventions targeting eating problems and diabetes distress may help to achieve the recommended TIR. Future research with a prospective study design and large sample size is needed to examine factors associated with TIR and its relationship in type 2 diabetes.