NEW research has confirmed that automated insulin delivery (AID) systems are both safe and effective for older adults with Type 1 diabetes. The findings challenge assumptions that older individuals might struggle with the advanced technology required to operate these devices.
AID systems use a sensor attached to the arm or abdomen to continuously monitor blood sugar levels, sending data to a wearable insulin pump that automatically adjusts insulin delivery. Some systems can connect wirelessly to smartphones, providing real-time updates on glucose control.
“It’s a big change for people to use technology to manage their diabetes when many of them have relied on multiple daily injections for 30 years or more,” the research team said. “There’s a stereotype that technology is harder for older adults, but they did quite well.”
The study addresses a key knowledge gap regarding who can benefit from AID technology. While automated insulin delivery is now the preferred treatment for Type 1 diabetes, older adults have been underrepresented in previous clinical trials.
This study, the largest of its kind involving older adults, examined factors particularly relevant to this age group, such as ease of use and the prevention of hypoglycaemia. Low blood sugar is a critical concern for older adults as it increases the risk of cognitive decline and falls.
The trial enrolled 78 participants aged 65 and older, testing two AID systems—a hybrid closed-loop system and a predictive low glucose suspend system—against a non-automated sensor-augmented pump system. Over a 12-week period, results showed that the AID systems significantly reduced time spent in dangerous low blood sugar levels. The hybrid closed-loop system proved most effective, maintaining blood sugar within the target range for an average of 74% of the time, compared to 67% for the predictive system and 66% for the non-automated pump.
Training participants to use the AID devices initially required more technical support, but questionnaires completed during the study indicated that older adults adapted well. Even those with mild cognitive impairment managed the devices as effectively as those without.
“Onboarding took more time and effort in this population than in younger individuals, so providers should plan for that but not be discouraged,” the authors noted.
Since the trial concluded, predictive low glucose suspend systems have been discontinued in the USA in favour of more advanced hybrid closed-loop models, a decision supported by the study’s findings.
Reference
Kudva YC et al. Automated insulin delivery in older adults with Type 1 diabetes. NEJM Evid 2025;4(1).
