Artificial pancreas improves glycemic control for older adults with type 1 diabetes
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Use of a hybrid closed-loop insulin-delivery system was associated with better glycemic control cor older adults with type 1 diabetes, according to a brief report published in Diabetes Technology & Therapeutics.
“In this cohort of older adults in a tertiary clinic, initiation of hybrid closed-loop system resulted in an improvement of glycemic targets, such as time in range and time spent in hypoglycemia,” Elena Toschi, MD, staff physician and director of the young adult program at Joslin Diabetes Clinic, and assistant professor of medicine at Harvard Medical School, told Healio. “Further, the study highlighted that cognitive and physical barriers may prevent the initiation of the hybrid closed-loop system.”
Researchers analyzed data from 46 adults aged 65 years or older with type 1 diabetes who were prescribed the Control-IQ hybrid closed-loop system (Tandem) in 2020. Clinical information and continuous glucose monitoring data were obtained from electronic medical records. Data points included the clinic visit immediately before starting the closed-loop control system and subsequent 3-month follow-up visits.
Of the study cohort, 37 participants started the closed-loop control system, whereas nine never initiated use. Of those nine, two reported having trouble with dexterity and vision, four declined to switch to closed-loop control due to challenges encountered in starting the system, and no reason was documented for three adults. Of the 37 who started the system, 36 previously used an insulin pump and 35 had previously used CGM.
“Clinicians should assess barriers that older people encounter, such as physical and cognitive declines that may impair the ability to learn and master a new device,” Toschi said. “Further, clinicians should have an informative discussion with each patient about potential challenges and benefits of starting these new systems.”
Time in range for closed-loop system users increased from 62% before initiation to 76% with the new system (P < .001), time in hypoglycemia decreased from 2% to 1% (P = .03), and time spent in hyperglycemia decreased from 30% to 20% (P < .001). There were no changes in time spent in severe hypoglycemia or severe hyperglycemia.
Coefficient of variation improved from 35% before closed-loop initiation to 27% after initiation (P = .001), and glucose management indicator decreased from 7% to 6.8% (P = .002). HbA1c was missing for most participants due to COVID-19 restrictions for in-person visits.
“Our study timeline overlapped the COVID-19 lockdown, and so the data on laboratory HbA1c after starting closed-loop control are not available,” the researchers wrote. “The lockdown and the limited access to in-person visits may have affected patients’ and clinicians’ decision to prescribe or change to a new diabetes-related device. However, it is important to note that even with limited in-person contact, most of the older adults who were prescribed closed-loop control were able to use it successfully.”
Toschi said future research should focus on identifying barriers with starting a hybrid closed-loop system with older adults and assessing interventions to overcome those barriers.
“Furthermore, research is needed to understand how best clinicians can leverage caregivers to support people with diabetes to use these systems that have the potential to improve glycemic control,” Toschi said.
For more information:
Elena Toschi, MD, can be reached at elena.toschi@joslin.harvard.edu.
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