Automated Insulin Delivery System Initiation Safely Improves Glycemic Outcomes in Older Adults with Type 1 Diabetes
Authors' conclusion
In older adults with T1D, real-world aHCL initiation was associated with improved glycemic outcomes and better glycemic outcomes than in matched MDI users in a cohort with substantial cognitive vulnerability.
Study context
- Population
- Older adults with T1D who initiated advanced hybrid closed-loop (aHCL) at ≥65 years, 19 Spanish hospitals; mean age 71.2 ± 4.4 yearsmatched
- Participants
- 100 vs 100
- Exposure
- aHCL vs matched MDI; and before vs after aHCL initiation
- aHCLn = 100
- MDIn = 100reference
- Outcome
- TIR 70-180 mg/dL, aHCL users before initiation vs final follow-up
- Follow-up
- Final
Methodological detailsreal-world, age- and sex-matched MDI comparison group
- Real-world
- Age- and sex-matched MDI comparison group
Main finding
As reported in the abstract
P < 0.001
Observational data: associations, not effects.
Further findings
TIR, aHCL vs matched MDI · final follow-up
P < 0.001
HbA1c, aHCL vs matched MDI · final follow-up
P < 0.001
| Outcome | P value |
|---|---|
| HbA1c, aHCL users before initiation vs final follow-up | P < 0.001 |
- HbA1c, aHCL users before initiation vs final follow-up: aHCL (before initiation) mean 7.56% (SD 0.97%)
- HbA1c, aHCL users before initiation vs final follow-up: aHCL (final follow-up) mean 7.01% (SD 0.59%)
- HbA1c, aHCL users before initiation vs final follow-up: 59.1 ± 10.6 mmol/mol to 53.1 ± 6.4 mmol/mol
- HbA1c, aHCL vs matched MDI: 53.1 ± 6.4 mmol/mol to 59.9 ± 10.7 mmol/mol
Cognition in aHCL users
- aHCL users with mild-to-moderate cognitive impairment
- 60%
- Final TIR similar across cognitive strata within aHCL
Safety
Events per 100 patient-years
| Outcome | aHCL (before initiation) | aHCL (after initiation) |
|---|---|---|
| Severe hypoglycaemia, aHCL users | 28.0 | 1.6 |
Original publication
Automated Insulin Delivery System Initiation Safely Improves Glycemic Outcomes in Older Adults with Type 1 Diabetes. Diabetes Technol Ther. Published 3 August 2026. doi:10.
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