Type 1 diabetes

Older T1D patients give thumbs up to closed-loop therapy

Older Australians with type 1 diabetes are mainly positive about their experiences of closed-loop therapy, with the glycaemic benefits outweighing any issues with the technology, interviews with participants in an Australian trial suggest.

However, cost remains a key concern outside trial settings and some patients complained of usability issues such as disruptive overnight alarms and sensor inaccuracy, researchers say.

The findings are based on interviews with 21 patients aged 60 and older with type 1 diabetes in a trial comparing first-generation closed-loop therapy (MiniMed 670G) versus sensor-augmented pump therapy.

Overall, the participants had high hopes for the technology, particularly that less effort would be required in blood glucose testing, checking readings and carbohydrate input.

Unfortunately, these expectations were not always met in reality, the researchers wrote in Diabetic Medicine (link here).

“The expectation of being able to ‘go along and forget’ about having diabetes did not occur during the day, leading to disappointment,” they wrote.

Many participants also went into the trial believing the system would act just like a healthy pancreas, only to realise that some effort would still be required to manage their diabetes.

But while this was disappointing, most also acknowledged the considerably reduced effort compared to manual insulin delivery, according to the researchers.

This was especially the case when it came to exercise, which suddenly required less planning with the assistance of a closed-loop device.

In the interviews, participants also praised the closed-loop system’s ability to achieve tighter glucose control.

This qualitative experience reflected the trial’s CGM outcomes, where time in range improved by six percentage points overall, and by 10 percentage points overnight, the researchers reported.

Significant quality of life benefits were identified in the context of these improved glucose levels, including improved sleep and reduced fear of hypoglycaemia and diabetes-related psychological burden.

“Although computerphobia was not measured in the present study, the use and trust of the technology by these older adults grew to be positive; whereas information overload has been considered a potential challenge to closed-loop therapy use in older age,” the researchers noted.

“Alarms were mentioned to be annoying and intrusive, especially night-time alarms; however, the benefit of alerting to prevent hypoglycaemia events appeared to outweigh the burden.”

On the other hand, cost was an ongoing headache, even amidst the Commonwealth’s expanded eligibility criteria for subsidised CGM products to all people with type 1 diabetes.

“Participants interviewed in the present study reported prior experiences sacrificing in other areas of their lives to afford CGM, insulin pumps, and health insurance,” the researchers wrote.

The authors concluded: “System usability including customisable alarms in next-generation closed-loop systems should continue to be addressed, alongside possible cost barriers, given potential benefits of closed-loop therapy for glycaemia, mental health, and sleep quality among older adults.”

They stressed the group was relatively unique, as all participants, except for one, were functionally independent and able to manage their diabetes without caregiver assistance.

While the study was believed to be the first to examine the lived experience of older closed-loop users, its findings were comparable to those in younger patients, according to the researchers.

This provided an important message: that older age itself was not necessarily a barrier to using closed-loop therapy, they wrote.

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