SPOKANE, Wash.—Automated insulin delivery systems are safe and effective in older adults with type 1 diabetes, countering assumptions that they would struggle to use the technology, according to new research from the Washington State University Elson S. Floyd College of Medicine in collaboration with other research centers.
The study, published in NEJM Evidence, closes a knowledge gap about who can benefit from the breakthrough technology for diabetes management. Now the preferred treatment option for type 1 diabetes, automated insulin delivery (AID) improves glucose control and reduces the burden of managing a lifelong condition for both children and adults.
This study is the largest trial to enroll older adults with type 1 diabetes, a group underrepresented in clinical trials for AID devices. The trial focused on uniquely relevant factors for older adults, such as technology usability and preventing hypoglycemia, a particular concern in older adults since it raises the risk of cognitive decline and complications such as falls.
“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,” said Professor Naomi Chaytor, PhD, ABPP, one of the principal investigators on the study and chair of the Department of Community and Behavioral Health. “There’s a stereotype that technology is harder for older adults, but they did quite well.”
In an AID system, a continuous glucose monitor communicates data to an automated insulin pump, enabling adjustments in insulin dosing based on actual or predicted glucose levels without intervention from the wearer.
The study tested the efficacy of two AID systems, a hybrid closed loop system and a predictive low glucose suspend system, compared to a non-automated sensor-augmented pump system. In a randomized crossover trial, 78 participants aged 65 and older used each device for 12 weeks with regular monitoring.
Results showed that the two automated insulin delivery systems significantly reduced the time participants spent with dangerously low blood sugar compared to a non-automated system. The hybrid closed loop system proved most effective at keeping blood sugar in the target range, with a mean time in range of 74% compared to 67% for the predictive low glucose system and 66% for the sensor-augmented pump.
Participants also experienced fewer adverse events while using the automated systems, with 1-2% experiencing an episode of severe hypoglycemia compared to 4% for the sensor-augmented pump.
“We were surprised at the high level of glycemic control participants were able to achieve with the automated systems,” Chaytor said. “Overall, many providers recommend older adults with type 1 diabetes, especially those with mild cognitive impairment, have higher glycemic targets than middle aged or young adults out of concerns about hypoglycemia, but this study shows that they can achieve the same level of glycemic control as younger adults, and just as safely.”
Automated systems did require more technical support initially to train participants to use the devices. Participants’ technology acceptance and usability scores were the same for all three devices, however, showing a willingness to embrace new technologies. Participants with mild cognitive impairment were also able to use the devices just 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 said. “Providers should plan for that but not be discouraged.”
Chaytor notes that since the trial concluded, predictive low glucose suspend systems have been discontinued in the U.S. in favor of more sophisticated hybrid closed loop systems, a move which their results support.
The multicenter study involved 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.
This research was supported by funding from the National Institute of Diabetes and Digestive and Kidney Diseases (award number R01 DK122603), with trial supplies provided by Dexcom and Tandem Diabetes Care.
Media Contact
Stephanie Engle, WSU Elson S. Floyd College of Medicine Communications and Marketing, 509-368-6937, stephanie.engle@wsu.edu