DOI: 10.1177/15209156261474587 ISSN: 1520-9156

Automated Insulin Delivery System Initiation Safely Improves Glycemic Outcomes in Older Adults with Type 1 Diabetes

Carmen Quirós, Montserrat Granados, María J. Picón, Lía Nattero-Chávez, Eva Aguilera-Hurtado, María del Rosario Vallejo-Mora, Pilar Beato-Víbora, Sharona Azriel-Mira, Jesús Moreno-Fernández, Olga Simó-Servat, Roxana Zavala-Arauco, Gonzalo Díaz-Soto, Nuria Alonso-Carril, María A. Martínez-Brocca, Olaia Diaz-Trastoy, Laura Guerrero, Paula Andújar, María Duran-Martínez, Rosa Márquez, María Piedra-León, Elisenda Climent, Ana Chico
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Objective:

To evaluate real-world glycemic outcomes, safety, treatment satisfaction, cognition, and frailty in older adults with type 1 diabetes (T1D) using advanced hybrid closed-loop (aHCL), and to compare them with those of matched older adults treated with multiple daily injections (MDIs).

Research Design and Methods:

Multicenter observational study including 100 adults with T1D from 19 Spanish hospitals who initiated aHCL at ≥65 years and 100 age- and sex-matched MDI users. Glycemic outcomes before aHCL initiation were compared with the final follow-up. Final glycemic outcomes were also compared between the aHCL and MDI groups. Cognitive function and frailty were assessed using the Montreal Cognitive Assessment and FRAIL scales.

Results:

Mean age was 71.2 ± 4.4 years. In aHCL users, time in range (TIR 70–180 mg/dL) increased from 65.3% ± 15.0% before aHCL initiation to 78.6% ± 10.5% at the final follow-up ( P < 0.001), and HbA1c decreased from 7.56% ± 0.97% to 7.01% ± 0.59% (59.1 ± 10.6 mmol/mol to 53.1 ± 6.4 mmol/mol) ( P < 0.001). At the final follow-up, aHCL users had a higher TIR than matched MDI users (78.6% ± 10.5% vs. 63.0% ± 18.1%; P < 0.001) and lower HbA1c (7.01% ± 0.59% vs. 7.65% ± 0.98%; 53.1 ± 6.4 mmol/mol to 59.9 ± 10.7 mmol/mol; P < 0.001). Severe hypoglycemia decreased from 28.0 to 1.6 events per 100 patient-years after aHCL initiation. A total of 60% of aHCL users had mild-to-moderate cognitive impairment, yet the final TIR was similar across cognitive strata within the aHCL group.

Conclusions:

In older adults with T1D, real-world aHCL initiation was associated with improved glycemic outcomes and better glycemic outcomes than in matched MDI users in a cohort with substantial cognitive vulnerability. These findings support the effectiveness of aHCL therapy in routine geriatric diabetes care.

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