Automated Insulin Delivery Could Be Used for Older Adults With Type 1 Diabetes

Investigators found automated insulin delivery (AID) systems are safe and effective to use for older adults with type 1 diabetes (T1D), according to results of a study (NCT04016662) published in NEJM Evidence. The findings challenge the common assumption that older adults might struggle to use more advanced medical devices.^1,2

Disparities also exist in diabetes technology, including higher age, male sex, and racial and migration background. | Image Credit: CottonCandyClouds

“It’s a big change for people to use technology to manage their diabetes when many of them have used multiple daily injections for 30 years or more,” Naomi Chaytor, one of the principal investigators on the study and chair of the WSU Elson S. Floyd College of Medicine Department of Community and Behavioral Health, said in a news release.¹ “There’s a stereotype that technology is harder for older adults, but they did quite well.”

AID is considered the preferred treatment option for those who can use it, with real-world findings showing that data from AID devices show similar average results for time in range between countries. However, disparities also exist in diabetes technology, including higher age, male sex, and racial and migration background, according to an article in Diabetes Care.³

Clinical trials of AID technologies that have lower burdens have not included older adults in sufficient numbers, according to the clinical trial information. Therefore, evaluations of efficacy and quality of life were often observed for younger age groups. In the study, investigators used a multicenter, randomized, crossover trial that consists of 3 12-week periods. Patients in the study had a T1D diagnosis, were 65 years or older, and were willing to use an AID. There were 3 arms, consisting of a hybrid closed loop, using a continuous glucose monitoring (CGM) device and insulin pump, predictive low-glucose insulin suspension, using an insulin pump with basal-IQ technology, and CGM, sensor-augmented pump.⁴

The primary outcome included CGM measured time of less than 70 mg/dL at weeks 5 to 12 for each intervention crossover. Secondary outcomes included CGM measured time of less than 54 mg/dL, hypoglycemia, glucose control, and hemoglobin A_1c. Other outcomes included patient-reported questionnaires on hypoglycemia fear, hypoglycemia confidence, diabetes distress scale, technology acceptance, and system usability.⁴

There were 78 individuals included that used each device for 12 weeks. The findings showed that the sensor-augmented pump, hybrid closed-loop, and predictive low-glucose suspend periods had percentages of time with glucose less than 70 mg/dl of 2.57%, 1.58%, and 1.67%, respectively. The mean difference of the hybrid closed-loop system and predictive low-glucose suspend system compared with the sensor-augmented pump was –1.05 percentage points and –0.93 percentage points, respectively. Time in range for the hybrid close-loop increased by 8.9 percentage points compared with the sensor-augmented pump and increased by 0.2 points for glycated hemoglobin level.²

The questionnaires showed that individuals were equally willing to use AIDs and found them as easy to use as nonautomated devices. Further, investigators found that those with mild cognitive impairments also used the devices just as effectively.¹

“Onboarding took more time and effort in this population than it would in younger populations, so it’s important for providers to understand that it may take some upfront work to get people really comfortable with the technology,” Chaytor said in the news release.¹ “Providers should plan for that but not be discouraged.”

REFERENCES

1. New tech for managing type 1 diabetes is effective for older adults. News release. Washington State University. March 11, 2025. Accessed March 14, 2025. https://www.eurekalert.org/news-releases/1076543

2. Kudva YC, Henderson RJ, Kanapka LG, et al. Automated Insulin Delivery in Older Adults with Type 1 Diabetes. NEJM Evid. 2025;4(1):EVIDoa2400200. doi:10.1056/EVIDoa2400200

3. Limbert C, Kowalski AJ, Danne TPA. Automated Insulin Delivery: A Milestone on the Road to Insulin Independence in Type 1 Diabetes. Diabetes Care. 2024;47(6):918-920. doi:10.2337/dci24-0007

4. Automated Insulin Delivery in Elderly With Type 1 Diabetes (AIDE T1D) (AIDE T1D). ClinicalTrials.gov identification: NCT04016662. January 1, 2025. Accessed March 14, 2025. https://clinicaltrials.gov/study/NCT04016662