Keywords
Insulin pump
Hybrid closed loop systems
Elderly
Hypoglycemia
Time in range
How to Cite
Abstract
Background: As the general population ages, the prevalence of chronic non-communicable diseases such as diabetes mellitus (DM) increases. With the improvement in treatments for diabetes, it has been possible to reduce the rate of complications related to the disease and prolong the life expectancy of these patients; therefore, we will increasingly have more elderly patients living with diabetes. Older adults are a heterogeneous group of patients, with wide differences in comorbidities, physical and cognitive abilities. Furthermore, they have certain characteristics that make them more vulnerable to experiencing episodes of hypoglycemia, which significantly increase their risk of morbidity and mortality for a long period of time.
Purpose: To summarize the evidence in the literature about the safety and effectiveness of the use of continuous glucose monitoring and insulin pumps in the elderly population with diabetes, in terms of glycemic control and risk of hypoglycemia. To identify the gaps in knowledge that exist about the use of this technology in the elderly population.
Methodology: To carry out the literature search, databases such as PubMed, GoogleScholar and Trip were used, using keywords such as “elderly”, “older adults”, “aged”, “continuous glucose monitoring”, “insulin pump”, “hypoglycemia”, “glucose control”. Articles identified as relevant were included in this narrative review.
Results: Continuous glucose monitoring and insulin pumps are safe and effective tools in the treatment of DM in older adults; They allow adequate metabolic control and reduce the risk of hypoglycemia, especially closed-loop systems. These benefits appear to also extend to quality of life.
Conclusions: Insulin pumps are effective and safe in the elderly, especially last generation devices. More studies are needed to evaluate whether the benefits in metabolic control and reduced risk of hypoglycemia extend to populations with a high disease burden; as well as cost-effectiveness studies to evaluate whether this treatment can be implemented widely and massively.
References
Bellary S, Kyrou I, Brown JE, Bailey CJ. Type 2 diabetes mellitus in older adults: clinical considerations and management. Nat Rev Endocrinol. 2021;17(9):534-48. https://doi.org/10.1038/s41574-021-00512-2
International Diabetes Federation. IDF Diabetes Atlas 2021. International Diabetes Federation; 2021. https://diabetesatlas.org/atlas/tenth-edition/
Sircar M, Bhatia A, Munshi M. Review of hypoglycemia in the older adult: clinical implications and management. Can J Diabetes. 2016;40(1):66-72. https://doi.org/10.1016/j.jcjd.2015.10.004
Battelino T, Danne T, Bergenstal RM, Amiel SA, Beck R, Biester T, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019;42(8):1593-603. https://doi.org/10.2337/dci19-0028
Boughton CK, Hartnell S, Thabit H, Mubita WM, Draxlbauer K, Poettler T, et al. Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study. Lancet Healthy Longev. 2022;3(3):e135-42. https://doi.org/10.1016/s2666-7568(22)00005-8
Matejko B, Cyganek K, Katra B, Galicka-Latala D, Grzanka M, Malecki MT, et al. Insulin pump therapy is equally effective and safe in elderly and young type 1 diabetes patients. Rev Diabet Stud. 2011;8(2):254-8. https://doi.org/10.1900/rds.2011.8.254
Morros-González E, Gómez AM, Henao Carrillo DC, Ursida V, Serrano S, Rondón Sepúlveda MA, et al. Efficacy and safety of sensor augmented insulin pump therapy with low-glucose suspend feature in older adults: a retrospective study in Bogota, Colombia. Diabetes Metab Syndr. 2021;15(3):649-53. https://doi.org/10.1016/j.dsx.2021.02.029
McAuley SA, Trawley S, Vogrin S, Ward GM, Fourlanos S, Grills CA, et al. Closed-loop insulin delivery versus sensor-augmented pump therapy in older adults with type 1 diabetes (ORACL): a randomized, crossover trial. Diabetes Care. 2022;45(2):381-90. https://doi.org/10.2337/dc21-1667
Continuous Glucose Monitoring: Optimizing Diabetes Care: Executive Summary | Clinical Diabetes | American Diabetes Association [Internet]. Disponible en: https://diabetesjournals.org/clinical/article/40/4/394/147332/Continuous-Glucose-Monitoring-Optimizing-Diabetes
American Diabetes Association Professional Practice Committee. 7. Diabetes Technology: Standards of Medical Care in Diabetes-2022. Diabetes Care. 2022;45(supl. 1):S97-112. https://doi.org/10.2337/dc22-s007
Toschi E, Munshi MN. Benefits and challenges of diabetes technology use in older adults. Endocrinol Metab Clin North Am. 2020;49(1):57-67. https://doi.org/10.1016/j.ecl.2019.10.001
Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C, DIAMOND Study Group. Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND trial. J Diabetes Sci Technol. 2017;11(6):1138-46. https://doi.org/10.1177/1932296817704445
Pratley RE, Kanapka LG, Rickels MR, Ahmann A, Aleppo G, Beck R, et al. Effect of continuous glucose monitoring on hypoglycemia in older adults with type 1 diabetes: a randomized clinical trial. JAMA. 2020;323(23):2397-406. https://doi.org/10.1001/jama.2020.6928
Bao S, Bailey R, Calhoun P, Beck RW. Effectiveness of continuous glucose monitoring in older adults with type 2 diabetes treated with basal insulin. Diabetes Technol Ther. 2022;24(5):299-306. https://doi.org/10.1089/dia.2021.0494
Miller KM, Kanapka LG, Rickels MR, Ahmann AJ, Aleppo G, Ang L, et al. Benefit of continuous glucose monitoring in reducing hypoglycemia is sustained through 12 months of use among older adults with type 1 diabetes. Diabetes Technol Ther. 2022;24(6):424-34. https://doi.org/10.1089/dia.2021.0503
Leite SAO, Silva MP, Lavalle ACR, Bertogy MCV, Bastos M, Kuklik SCV, et al. Use of continuous glucose monitoring in insulin-treated older adults with type 2 diabetes. Diabetol Metab Syndr. 2023;15(1):240. https://doi.org/10.1186/s13098-023-01225-4
Ahn J, Yang Y, Park G. Advancing elderly diabetes care: exploring the usability and acceptance of continuous glucose monitoring (CGM). Geriatr Nurs. 2024;59:15-25. https://doi.org/10.1016/j.gerinurse.2024.06.041
Been RA, van Beek AP, Gans ROB, van Dijk PR. The elderly lag behind in the use of intermittent scanning continuous glucose monitoring. J Diabetes Sci Technol. 2023;17(1):262-3. https://doi.org/10.1177/19322968221126691
Berget C, Messer LH, Forlenza GP. A clinical overview of insulin pump therapy for the management of diabetes: past, present, and future of intensive therapy. Diabetes Spectr. 2019;32(3):194-204. https://doi.org/10.2337/ds18-0091
Da Silva JD, Lepore G, Battelino T, Arrieta A, Castañeda J, Grossman B, et al. Real-world performance of the MiniMedTM 780G system: first report of outcomes from 4120 users. Diabetes Technol Ther. 2022;24(2):113-9. https://doi.org/10.1089/dia.2021.0203
Grassi B, Gómez AM, Calliari LE, Franco D, Raggio M, Riera F, et al. Real-world performance of the MiniMed 780G advanced hybrid closed loop system in Latin America: Substantial improvement in glycaemic control with each technology iteration of the MiniMed automated insulin delivery system. Diabetes Obes Metab. 2023;25(6):1688-97. https://doi.org/10.1111/dom.15023
Choudhary P, Arrieta A, van den Heuvel T, Castañeda J, Smaniotto V, Cohen O. Celebrating the data from 100,000 real-world users of the MiniMedTM 780G system in Europe, Middle East, and Africa collected over 3 years: from data to clinical evidence. Diabetes Technol Ther. 2024;26(S3):32-7. https://doi.org/10.1089/dia.2023.0433
Borda MG, Patino-Hernandez D, Morros-González E, Pérez-Zepeda MU, Chavarro-Carvajal D, Cano-Gutiérrez C, et al. Sensor augmented insulin pump therapy in older adults: impact on self-rated health and glycemic control. J Am Med Dir Assoc. 2017;18(6):545-7. https://doi.org/10.1016/j.jamda.2017.02.019
Kudva YC, Henderson RJ, Kanapka LG, Weinstock RS, Rickels MR, Pratley RE, et al. Automated insulin delivery in older adults with type 1 diabetes. NEJM Evid. 2025;4(1):EVIDoa2400200. https://doi.org/10.1056/evidoa2400200
Pintaudi B, Gironi I, Meneghini E, Conti M, Guidoni C, Di Vieste G, et al. Advanced hybrid closed loop system use in elderly with type 1 diabetes: effectiveness and safety in a prospective, observational, 1-year follow-up real-world study. Diabetes Obes Metab. 2023;25(7):2034-7. https://doi.org/10.1111/dom.15055
Gómez Medina AM, Parra Prieto DA, Henao Carrillo DC, Gómez CM, Muñoz Velandia OM, Caicedo S, et al. Characteristics associated with elevated time below range in elderly patients with type 1 diabetes using an automated insulin delivery system. J Diabetes Sci Technol. 2024;19322968241232659. https://doi.org/10.1177/19322968241232659
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