A RANDOMISED crossover trial has demonstrated that automated insulin delivery systems significantly reduce hypoglycaemia risk in older adults with type 1 diabetes compared to standard sensor-augmented pump therapy.
Older adults with type 1 diabetes face heightened risks of severe hypoglycaemia, which can lead to falls, cognitive impairment, and hospitalisation. While automated insulin delivery (AID) systems, including hybrid closed-loop (HCL) and predictive low-glucose suspend (PLGS) technologies, have shown promise in younger populations, their efficacy and safety in adults aged 65 and older remained understudied. This trial aimed to evaluate three insulin delivery methods—HCL, PLGS, and sensor-augmented pump (SAP)—to determine their impact on hypoglycaemia prevention and glucose management in this vulnerable age group.
The multicentre trial enrolled 82 participants aged 65–86 (45% female) with a mean baseline HbA1c of 7.2% and 2.49% time spent in hypoglycaemia (<70 mg/dl). Each participant completed three 12-week periods using HCL, PLGS, and SAP in randomised order. Compared to SAP, HCL reduced time in hypoglycaemia by 1.05 percentage points (95% CI: −1.48 to −0.73; p<0.001), while PLGS achieved a 0.93-point reduction (95% CI: −1.27 to −0.66; p<0.001). Time in the target glucose range (70–180 mg/dl) improved by 8.9 percentage points with HCL versus SAP (95% CI: 7.4–10.4). HbA1c decreased by 0.2 percentage points (95% CI: −0.3 to −0.1). Severe hypoglycaemia occurred in ≤4% of participants, with two cases of diabetic ketoacidosis hospitalisation. Both automated systems demonstrated comparable safety profiles, with no significant differences in adverse events between interventions.
These findings support the integration of AID systems into clinical care for older adults with type 1 diabetes to mitigate hypoglycaemia risks while maintaining glucose control. For clinicians, prioritising HCL or PLGS over SAP could enhance patient safety and quality of life in this population. Future research should focus on long-term outcomes, usability assessments for older users, and cost-effectiveness analyses to guide healthcare policies. Additionally, tailored training programmes may help optimise adoption and adherence among older patients, ensuring the benefits of automation are fully realised.
Katrina Thornber, EMJ
Reference
Kudva YC et al. Automated insulin delivery in older adults with type 1 diabetes. NEJM evidence. 2025;4(1):EVIDoa2400200.
