Age not a barrier to diabetes technology, new study finds
Closed-loop insulin-delivery could be the key to treating older adults with long-duration type 1 diabetes according to a study that assessed the clinical benefits of the treatment in comparison to sensor-augmented pump therapy.
Led by Dr Sybil McAuley from St Vincent’s Hospital and the University of Melbourne and published in Diabetes Care, it is the first randomised, closed-loop clinical trial exclusively involving people aged over 60 with type 1 diabetes.
Closed-loop therapy, also known as an artificial pancreas, is a technology that provides automated insulin dosing to replace lost pancreatic beta-cell function. The therapy was shown to achieve better glucose control among the study participants compared with sensor-augmented pump therapy, which delivers standard manual insulin doses.
“Older age is not a barrier to closed-loop therapy and closed-loop has important clinical benefits, although longer-term effects will need further study,” Dr McAuley said.
While previous studies have demonstrated the benefits of closed-loop therapy among children and younger adults with type 1 diabetes, there has been limited research into its effects on older adults.
The findings provide a much-needed insight into therapy options for older adults, given people in this higher age bracket are more at risk of developing life-threatening severe hypoglycaemia compared to younger people with type 1 diabetes – they also face additional clinical challenges in maintaining healthy glucose levels including medical comorbidities, cognitive impairment, reduced dexterity and frailty.
While these results propose a promising option for older adults with diabetes, Dr McAuley said she would not necessarily advise all patient to switch to closed loop therapy if they’ve had long-term success with traditional insulin pumps or injection therapy or if they have particular medical conditions that could affect their safe use of the technology.
“As a clinician I support providing options... so patients can choose what works for them. The more I can discuss the options and individual circumstances, hopefully, that supports each person with diabetes to make a decision about what technology they would like to use or what equipment they wish to wear to manage their diabetes,” Dr McAuley said. Our research aims to embrace technology to reduce the burden of living with type 1 diabetes.”
The technology used in the study was a first generation closed loop system MiniMed 670G, which still involves multiple fingerpicks a day to regulate the sensor. Future closed-loop systems under development, with more advanced sensor technology and algorithms, will have increased automation. This will make the technology even more accessible to people who may have physical or cognitive issues that limit them interacting with the system.
The year-long trial involved 30 participants (19 women and 11 men with an average age of 67 years), who had on average diabetes for almost 40 years.