A collaborative study involving Washington State University researchers found that automated insulin delivery (AID) systems, known for their safety, are also effective for older adults with type 1 diabetes. This challenges previous assumptions about technology adoption in this age group, providing reassurance about the use of AID systems.
The research team discovered that despite the long-term use of traditional insulin injection methods, older adults adapted well to newer technological solutions for diabetes management.
According to Dr. Naomi Chaytor, study co-investigator and Department Chair of Community and Behavioral Health at WSU's Elson S. Floyd College of Medicine, many people believe seniors struggle with new technology. However, their research demonstrates otherwise, showing that even after decades of manual injections, older patients successfully transitioned to automated systems, instilling optimism about technology adoption in seniors.
The findings, published in NEJM Evidence, address a significant gap in understanding which patient populations can benefit from these advanced diabetes management technologies. AID systems have become the preferred treatment approach for type 1 diabetes across various age groups because they improve glucose control and reduce the management burden of this chronic condition, offering hope for the future of diabetes management.
This clinical trial stands out as the largest to specifically focus on older adults with type 1 diabetes, a demographic historically underrepresented in AID device studies. Researchers paid particular attention to factors that were especially relevant to seniors, including technology usability and hypoglycemia prevention. This is critical since low blood sugar in older adults increases the risks of cognitive decline and falls.
Researchers compared three systems: a hybrid closed loop system, a predictive low glucose suspend system, and a non-automated sensor-augmented pump. Using a randomized crossover design, 78 participants aged 65 and above used each system for 12-week periods with regular monitoring.
The data showed that both automated systems significantly minimized dangerous low blood sugar episodes compared to the non-automated option. The hybrid closed-loop system performed best at maintaining target blood sugar levels, achieving a mean time-in-range of 74% versus 67% for the predictive low glucose system and 66% for the sensor-augmented pump.
While participants initially required more technical support to learn the automated systems, survey responses indicated they found the devices equally acceptable and usable as the non-automated alternative. Importantly, participants with mild cognitive impairment demonstrated the same level of effective use as those without such impairment.
Chaytor observed that getting participants comfortable with the technology took more time than it might with younger users. She advised that healthcare providers should anticipate this additional onboarding effort but shouldn't let it discourage them from recommending these systems.
Chaytor mentioned that since the study's completion, predictive low glucose suspend systems have been phased out in the United States in favor of more advanced hybrid closed-loop systems. This shift is supported by their research findings, which showed that the hybrid closed-loop system performed best at maintaining target blood sugar levels. This suggests that the more advanced systems are not only effective but also preferred by older adults, which is a significant finding for diabetes management in this age group.
The multi-institutional study involved research teams from the Mayo Clinic in Minnesota, the University of Pennsylvania Perelman School of Medicine, the State University of New York Upstate Medical University, and the AdventHealth Translational Research Institute. The Jaeb Center for Health Research in Florida coordinated the clinical trial.
