The Impact of a Recently Approved Automated Insulin Delivery System on Glycemic, Sleep, and Psychosocial Outcomes in Older Adults With Type 1 Diabetes: A Pilot Study

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Main idea: Use of this automated insulin delivery system in older adults improved glycemic control with high scores in ease of use, trust, and usability. Participants reported an improvement in diabetes distress with automated insulin delivery use. There were no significant changes in sleep.

Abstract

Background: Older adults with type 1 diabetes (≥65 years) are often under-represented in clinical trials of automated insulin delivery systems. We sought to test the efficacy of a recently FDA-approved automated insulin delivery system in this population.

Methods: Participants with type 1 diabetes used sensor-augmented pump (SAP) therapy for four weeks and then used an automated insulin delivery system (Control-IQ) for four weeks. In addition to glucose control variables, patient-reported outcomes (PRO) were assessed with questionnaires and sleep parameters were assessed by actigraphy.

Results: Fifteen older adults (mean age 68.7 ± 3.3, Hemoglobin A1c(HbA1c)e A1c(HbA1c) of 7.0 ± 0.8) completed the pilot trial. Glycemic outcomes improved during automated insulin delivery compared to SAP. During automated insulin delivery use, mean glucose was 146.0 mg/dL; mean percent time in range (TIR, 70-180 mg/dL) was 79.6%; median time below 70 mg/dL was 1.1%. The automated insulin delivery system was in use 92.6% ± 7.0% of the time. Compared to SAP, while participants were on automated insulin delivery the TIR increased significantly (+10%, P = .002) accompanied by a reduction in both time above 180 mg/dL (-6.9%, P = .005) and below 70 mg/dl. Diabetes-related distress decreased significantly while using automated insulin delivery, but sleep parameters remained unchanged.

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