Closed-loop therapy 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 McAulay from St Vincent’s Hospital and the University of Melbourne and published in Diabetes Care, it is the first randomised, crossover clinical trial exclusively involving people over 60 with long-duration (10 plus years) type 1 diabetes.
Closed-loop insulin delivery is a technology that provides therapeutic nerve stimulation only when necessary. The therapy was shown to have better glucose control among the study participants compared with sensor-augmented pump therapy, which measures glucose levels every few minutes.
“Of clinical relevance, participants’ cognitive and functional status did not deteriorate during the trial with the more intensive closed-loop therapy intervention, 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 sufferers, given people in this higher age bracket are more at risk of developing 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 a patient to switch to closed loop therapy if they’ve had long-term success with multiple daily injection therapy or if they have particular medical conditions that could affect their safe use of the technology.
“As a clinician I support having many 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.
“All this is to use 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.
The year-long trial involved 30 participants (19 women and 11 men with an average age of 67), all with type 1 diabetes for almost 40 years.
