Washington State University-led research has found that older adults with type 1 diabetes can safely use automated insulin delivery systems, revolutionizing diabetes management for this demographic.
New research from Washington State University and five other institutions demonstrates that automated insulin delivery (AID) systems are both safe and effective for older adults with type 1 diabetes. This counters the common belief that older adults might struggle with advanced medical technology.
In an AID system, a sensor attached to the arm or belly continuously monitors blood sugar levels and communicates data to a wearable insulin pump. The pump then automatically adjusts insulin delivery without the need for manual input or injections. Some models offer wireless connectivity to smartphones, providing users with real-time blood sugar data.
“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, a professor and chair of the WSU Elson S. Floyd College of Medicine Department of Community and Behavioral Health and one of the study’s principal investigators, said in a news release. “There’s a stereotype that technology is harder for older adults, but they did quite well.”
The study, published in NEJM Evidence, addresses a significant knowledge gap by showing who can benefit from this technology. Automated insulin delivery has become the preferred method for managing type 1 diabetes, improving glucose control and reducing the burden of managing this lifelong condition for both children and adults.
This research marks the largest clinical trial involving older adults with type 1 diabetes, a group often underrepresented in such studies. With a focus on factors relevant to older adults, such as the usability of technology and the prevention of hypoglycemia, the study highlights significant benefits. Hypoglycemia poses a particular risk for older adults due to its association with cognitive decline and complications like falls.
The trial assessed two AID systems — the hybrid closed-loop system and the predictive low glucose suspend system — against a non-automated sensor-augmented pump system. Across 12 weeks, 78 participants aged 65 and older used each device, with regular monitoring.
The results showed that the automated systems significantly reduced the time participants spent with dangerously low blood sugar levels compared to the non-automated system. The hybrid closed-loop system was especially effective, maintaining blood sugar in the target range 74% of the time, compared to 67% for the predictive system and 66% for the sensor-augmented pump.
While automated systems required more initial technical support to train participants, questionnaires indicated that participants were willing to adopt the new technology and found it just as user-friendly as the non-automated devices. Remarkably, those with mild cognitive impairment used the devices as effectively as those without.
“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 added. “Providers should plan for that but not be discouraged.”
Since the trial concluded, predictive low glucose suspend systems have been discontinued in the United States in favor of more sophisticated hybrid closed-loop systems, aligning with the study’s findings.
The multicenter study included collaborators and enrollment sites at the Mayo Clinic in Minnesota, the University of Pennsylvania Perelman School of Medicine, the State University of New York Upstate Medical University, and AdventHealth Translational Research Institute. The Jaeb Center for Health Research in Florida served as the clinical trial coordinating center.
Source: Washington State University