Research Information System
ENDO2025, California, United States Of America, 12 - 15 July 2025, vol.9, pp.548, (Full Text)
Diabetes and Vascular Disease OR20-06
Efficacy and Safety of Hybrid Closed-Loop System Compared With Sensor-Augmented Pump Therapy Among Older Adults With Long-Duration Type 1 Diabetes: A Systematic Review and Meta-Analysis
Piyush Ratan, MD1 , Sena Kodalak, MD2 , Luisa Saldarriaga, MD3 , Alberto Daniel Andrade, MD4 , Rodrigo Nunes Lamounier, MD, PhD5 , and Talita Trevisan, MD6 1 Patna Medical College and Hospital, Patna, India; 2 Hacettepe University Hospital, Ankara, Turkey; 3 Universidad CES, Medellin, Colombia; 4 Loyola University Medical Center, Maywood, IL, USA; 5 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 6 Talita Trevisan Endocrinologia e Diabetes, Itajai, Brazil Disclosure: P. Ratan: None. S. Kodalak: None. L. Saldarriaga: None. A.D. Andrade: None. R. Nunes Lamounier: None. T. Trevisan: None.
Introduction: People with type 1 diabetes (T1D) are living longer; however, elderly individuals remain underrepresented in clinical trials. The evidence supporting the use of hybrid closed-loop systems (HCLS) in this population is still limited. We conducted a systematic review and metaanalysis to evaluate the safety and efficacy of HCLS compared to sensor-augmented pump (SAP) therapy in older adults with T1D. Methods: A systematic search of PubMed, Embase, Web of Science, Cochrane Library, and clinicaltrials.gov identified randomized crossover trials comparing HCLS and SAP in individuals aged 60 years or older with T1D. Mean differences (MD) with 95% confidence intervals (CIs) were calculated using a randomeffects model. Higgins’ I² statistic assessed heterogeneity, and statistical analyses were performed using Review Manager 5.4.1. Results: Three studies involving a total of 149 participants were included, contributing 292 observations from both HCLS and SAP treatment periods. The median duration of diabetes was 38 years, and the mean time in range (TIR; 70-180 mg/dL) at baseline was 68.4±14.4%. Approximately 90% of participants had previously used insulin pumps. During the HCLS period, TIR increased by 7.9% (95% CI: 6.14 to 9.66; p < 0.001), while time above range (TAR; >180 mg/dL) decreased by 7.14% (95% CI: 6.09 to 8.20; p < 0.001) compared to SAP. TIR was extended by an average of 118 minutes with HCLS, while TAR was reduced by 107 minutes. No significant difference in time below range (TBR; <70 mg/dL) was found between groups (MD -0.59%; 95% CI: -1.20 to 0.01; p = 0.06). Glycated hemoglobin levels decreased by 0.2% (95% CI: 0.13 to 0.27; p < 0.001) with HCLS, and glucose variability, as measured by the coefficient of variation, significantly decreased by 1.96% (95% CI: 1.39 to 2.53; p < 0.001). Conclusion: Hybrid closed-loop systems in older adults with longduration T1D improved glycemic control without increasing the risk of hypoglycemia when compared to SAP therapy. Further research is warranted to address the unique challenges faced by this population.
Presentation: Sunday, July 13, 2025