Automated insulin delivery in older adults with type 1 diabetes: evidence, limitations, and clinical perspectives.
9 affiliations
- 1Department of Clinical and Experimental Medicine, Endocrinology Section, Garibaldi-Nesima Hospital, University of Catania, Catania, 95122, CT, Italy.
- 2Department of Medicine, Unit of Geriatrics, Azienda Ospedaliera "Annunziata - Mariano Santo - S. Barbara", Cosenza, 87100, CS, Italy.
- 3Department of Clinical and Experimental Medicine, Endocrinology Section, Garibaldi-Nesima Hospital, University of Catania, Catania, 95122, CT, Italy. [email protected].
- 4Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
- 5Unit of Metabolic and Endocrine Disease, "Centro Catanese di Medicina e Chirurgia" Clinic, Catania, Italy.
- 6Department of Medicine and Surgery, University Kore of Enna, Enna, Italy.
- 7Unit of Diabetology, Metabolic and Endocrine Diseases, "Cannizzaro" Emergency Hospital, Catania, Italy.
- 8Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi- Nesima Hospital, University of Catania, Catania, 95122, CT, Italy.
- 9Endocrine Unit, Garibaldi-Nesima Hospital, Catania, 95122, CT, Italy.
Abstract
Objective: Automated insulin delivery (AID) systems have significantly improved the management of type 1 diabetes (T1D), leading to better glycemic control and reduced hypoglycemia. However, older adults (≥ 65 years) remain underrepresented in clinical trials, and evidence specific to this population is limited.
Design and patients: This narrative review synthesizes current evidence on the efficacy, safety, and usability of AID systems in older adults (≥ 65 years) with T1D. A comprehensive literature search of MEDLINE/PubMed was conducted using the PICO framework to identify relevant RCTs, observational studies, and systematic reviews, supplemented by literature studies on cognitive, functional, and psychosocial factors impacting technology adoption.
Results: While data from randomized trials and meta-analyses in the general population consistently demonstrate improvements in time in range (TIR, 70–180 mg/dL) and reductions in hypoglycemia, evidence in older adults is still emerging. Frail individuals and those with multiple comorbidities are often underrepresented or excluded from current studies. Nevertheless, the available evidence suggests that many of these benefits are also maintained in older populations, particularly regarding hypoglycemia reduction. At the same time, factors such as cognitive impairment, functional limitations, caregiver dependence, and reduced digital literacy may affect the adoption and effective use of these technologies.
Conclusions: AID systems appear effective and generally safe in selected older adults, with benefits in glycemic control and hypoglycemia reduction. However, given the marked heterogeneity of this population, further studies are needed to better define their role and applicability in routine clinical practice.
Graphical Abstract: This image explains the use of automated insulin delivery (AID) systems for older adults with type 1 diabetes. It highlights that this population is diverse, with some being active and others confused. The system requires setup and starting to create a closed loop between a pump and sensors. The clinical workflow involves patient screening, education, and starting AID, with training described as easy and understood by patients. Implementation challenges include cognitive impairment, vision and hearing loss, functional limitations, and digital literacy. Key outcomes include reduced hypoglycemia, increased time in range for blood glucose, reduced distress, and an adaptive life supported by AI technology.
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BibTeX
@article{galeano2026automated,
title = {{Automated insulin delivery in older adults with type 1 diabetes: evidence, limitations, and clinical perspectives.}},
author = {Francesco Galeano and Agnese Rita Catena Mobilia and Filippo Luca Fimognari and Vittorio Oteri and Rossella Cannarella and Giuseppe Papa and Rosario Le Moli and Tommaso Piticchio and Antonino Di Pino and Maurizio Di Marco and Sabrina Scilletta and Francesco Frasca and Andrea Tumminia},
journal = {Endocrine},
year = {2026},
month = oct,
doi = {10.1007/s12020-026-04816-z},
url = {https://europepmc.org/article/MED/42955196},
note = {CC BY},
}
RIS
TY - JOUR
TI - Automated insulin delivery in older adults with type 1 diabetes: evidence, limitations, and clinical perspectives.
AU - Francesco Galeano
AU - Agnese Rita Catena Mobilia
AU - Filippo Luca Fimognari
AU - Vittorio Oteri
AU - Rossella Cannarella
AU - Giuseppe Papa
AU - Rosario Le Moli
AU - Tommaso Piticchio
AU - Antonino Di Pino
AU - Maurizio Di Marco
AU - Sabrina Scilletta
AU - Francesco Frasca
AU - Andrea Tumminia
PY - 2026
DA - 2026/10/29
JO - Endocrine
DO - 10.1007/s12020-026-04816-z
UR - https://europepmc.org/article/MED/42955196
AB - Objective: Automated insulin delivery (AID) systems have significantly improved the management of type 1 diabetes (T1D), leading to better glycemic control and reduced hypoglycemia. However, older adults (≥ 65 years) remain underrepresented in clinical trials, and evidence specific to this population is limited. Design and patients: This narrative review synthesizes current evidence on the efficacy, safety, and usability of AID systems in older adults (≥ 65 years) with T1D. A comprehensive literature search of MEDLINE/PubMed was conducted using the PICO framework to identify relevant RCTs, observational studies, and systematic reviews, supplemented by literature studies on cognitive, functional, and psychosocial factors impacting technology adoption. Results: While data from randomized trials and meta-analyses in the general population consistently demonstrate improvements in time in range (TIR, 70–180 mg/dL) and reductions in hypoglycemia, evidence in older adults is still emerging. Frail individuals and those with multiple comorbidities are often underrepresented or excluded from current studies. Nevertheless, the available evidence suggests that many of these benefits are also maintained in older populations, particularly regarding hypoglycemia reduction. At the same time, factors such as cognitive impairment, functional limitations, caregiver dependence, and reduced digital literacy may affect the adoption and effective use of these technologies. Conclusions: AID systems appear effective and generally safe in selected older adults, with benefits in glycemic control and hypoglycemia reduction. However, given the marked heterogeneity of this population, further studies are needed to better define their role and applicability in routine clinical practice. Graphical Abstract: This image explains the use of automated insulin delivery (AID) systems for older adults with type 1 diabetes. It highlights that this population is diverse, with some being active and others confused. The system requires setup and starting to create a closed loop between a pump and sensors. The clinical workflow involves patient screening, education, and starting AID, with training described as easy and understood by patients. Implementation challenges include cognitive impairment, vision and hearing loss, functional limitations, and digital literacy. Key outcomes include reduced hypoglycemia, increased time in range for blood glucose, reduced distress, and an adaptive life supported by AI technology.
SN - 1355-008X
SN - 1559-0100
ER -