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

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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Journal
Diabetes Technology & Therapeutics
Published
2026-08-03
DOI
https://doi.org/10.1177/15209156261474587
Primary Topic
Diabetes Management and Research
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article

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

Carmen Quirós, Eva Aguilera, Maria Asunción Martínez‐Brocca, Paula Andújar et al.
Diabetes Technology & Therapeutics
Diabetes Management and Research
article

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

Carmen Quirós, Eva Aguilera, Maria Asunción Martínez‐Brocca, Paula Andújar, Marı́a Durán-Martinez, Ana Chico, Olaia Díaz-Trastoy, Jesús Moreno-Fernández, Gonzalo Díaz-Soto, Laura Viviana Leal Guerrero, Pilar Isabel Beato-Víbora, María del Rosario Vallejo‐Mora, Montserrat Granados, Lía Nattero-Chávez, María José Picón, Elisenda Climent, Sharona Azriel-Mira, Olga Simó-Servat, Nuria Alonso-Carril, María Piedra-León, Roxana Zavala-Arauco, Rosa Márquez
article en

Abstract

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.

Diabetes Technology & Therapeutics
Universitat Autònoma de Barcelona (ES), Instituto de Salud Carlos III (ES), Hospital de Sant Pau (ES), Hospital Universitario Virgen Macarena (ES), Complejo Hospitalario Universitario de Santiago (ES), Hospital Universitario de Gran Canaria Doctor Negrín (ES), Marqués de Valdecilla University Hospital (ES), Hospital Universitario de Getafe (ES), Hospital Regional Universitario de Málaga (ES), Instituto de Investigación Marqués de Valdecilla (ES), Hospital Clínic de Barcelona (ES), Hospital General Universitario de Ciudad Real (ES), Vall d'Hebron Hospital Universitari (ES), Hospital Juan Ramón Jiménez (ES), Mútua Terrassa (ES), Hospital Del Mar (ES), Centro de Implantología Cirugía Oral y Maxilofacial (ES), Instituto de Investigación Sanitaria de Santiago (ES), Hospital Universitari Joan XXIII de Tarragona (ES), Hospital Universitari Germans Trias i Pujol (ES), Hospital Clínico Universitario Virgen de la Victoria (ES), Hospital Clínico Universitario de Valladolid (ES), Hospital Universitario Infanta Sofía (ES), Hospital Universitario Ramón y Cajal (ES)
Good health and well-being
Openalex Percentile: Top 9%
Diabetes Management and Research
DOISourceOpenAlex
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