Closed-loop system improves CGM metrics for older adults with type 1 diabetes
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Older adults with type 1 diabetes had more time in range and less time below range with closed-loop insulin pump therapy compared with a sensor-augmented pump, according to a presenter.
“Closed-loop therapy safely improved all CGM outcomes compared with sensor-augmented pump therapy among older adults with long-duration type 1 diabetes,” Sybil A. McAuley, MBBS, PhD, FRACP, senior research fellow at the University of Melbourne in Australia and an endocrinologist at St. Vincent’s Hospital in Melbourne, told Healio. “Even with a strong trial comparator of sensor-augmented pump therapy, the glycemic benefits of closed loop, notably increased time in range and less time below range, were clinically and statistically significant, and were sustained for the duration of the trial.”
McAuley and colleagues conducted a two-stage randomized crossover trial with 30 adults aged 60 years and older with type 1 diabetes for at least 10 years who previously used an insulin pump (mean age, 68 years; 63% women). After collecting baseline measures, participants were provided a MiniMed 670G insulin pump (Medtronic) and took part in multidisciplinary education that included diabetes education, carbohydrate counting and insulin dosing advice. Participants were then randomly assigned to 4 months of closed-loop therapy in which the device was used in auto mode or sensor-augmented therapy in which the same device was in manual mode. Participants crossed over to the opposite therapy after 4 months. Data on HbA1c, functional ability, frailty, cognition and psychosocial well-being were collected at baseline and the end of each 4-month period.
At baseline, one-third of participants had impaired awareness of hypoglycemia. The entire study cohort was cognitively healthy, and no participants met the criteria for frailty.
The study cohort spent 6.2% more time in range between 70 mg/dL and 180 mg/dL during the closed-loop stage compared with the sensor-augmented pump stage (95% CI, 4.4-8; P < .001).
Closed-loop therapy was also associated with 5.4% less time above range of 180 mg/dL (95% CI, –7.3 to –3.5; P < .001) and 0.5% less time below range of 70 mg/dL (95% CI, –1.1 to –0.3; P < .001) compared with a sensor-augmented pump therapy. All the CGM metrics were achieved with no change in overall insulin-delivered dose.
“Closed-loop delivery had its greatest benefit overnight,” McAuley said during a presentation. “There was 10% more time in range overnight, with a median of 87% during closed loop. Of particular clinical importance is less time below hypoglycemic thresholds of both 54 mg/dL and 70 mg/dL overnight with closed-loop than with sensor-augmented pump.”
No differences were seen in frailty, psychosocial well-being and cognitive function with closed-loop vs. sensor-augmented pump. There were three severe hypoglycemic events during the closed-loop stage vs. two in the sensor-augmented pump stage, but none required hospitalization.
“Older age is not a barrier to closed-loop therapy and closed-loop has important clinical benefits,” McAuley told Healio. “However, further research is needed to examine the effects and safety of closed-loop among people with frailty or major cognitive impairment.”
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McAuley SA, et al. 212-OR. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).
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