Automated insulin delivery systems safe and effective for use by older adults with type 1 diabetes: Study
New research from Washington State University in collaboration with five other institutions suggests that automated insulin delivery (AID) systems are safe and effective for use by older adults with type 1 diabetes. The findings counter common assumptions that older adults would struggle to use the more advanced technology employed in the medical devices.
In an AID system, a sensor attached to the arm or belly continuously monitors blood sugar levels and communicates that data to a wearable insulin pump, which then automatically adjusts insulin dosing without the wearer having to input instructions or inject the insulin themselves. Some models connect wirelessly to smartphones, providing the wearer with detailed and real-time data about their blood sugar control.
“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, 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. “There’s a stereotype that technology is harder for older adults, but they did quite well.”
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 improves glucose control and reduces the burden of managing a lifelong condition for both children and adults.
This study is the largest clinical trial to enroll older adults with type 1 diabetes, a group underrepresented in previous 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.
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 systems significantly reduced the time participants spent with dangerously low blood sugar compared to the 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.
Automated systems did require more technical support initially to train participants to use the devices. Questionnaires completed during the trial, however, showed that participants were equally willing to embrace the automated devices and found them as easy to use as the non-automated device. 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.
Reference:
Yogish C. Kudva, Robert J. Henderson, Automated Insulin Delivery in Older Adults with Type 1 Diabetes, NEJM Evidence, DOI: 10.1056/EVIDoa2400200.
