The impact of hybrid closed loop systems on glycemic control in elderly patients with type 1 Diabetes Mellitus: a review
DOI:
https://doi.org/10.34119/bjhrv7n4-488Keywords:
type 1 Diabetes, elderly, insulin pump, hypoglycemiaAbstract
Diabetes mellitus is a condition that has become increasingly common in people aged 65 and over (2). It is well known that elderly people with diabetes face significant challenges in therapeutic management, such as cognitive impairment and polypharmacy, and disease management is made more complex in these patients by the variability of the conditions and comorbidities presented (5). In this context, this review aims to assess how the development of the hybrid closed-loop system can contribute to optimizing the treatment of the elderly with type 1 Diabetes Mellitus (DM1). To this end, this narrative review was carried out using studies in the Pubmed database and considering the latest recommendations published in Diabetes Care. Thus, a reduction in the frequency of hypoglycemia and better glycemic stability were observed with these new insulin infusion systems (7) (19), which allows us to conclude that the growing prevalence of DM1 among the elderly requires an adapted approach and the use of advanced technologies to ensure effective glycemic control and a better quality of life.
References
LAITEERAPONG N, HUANG ES. Diabetes in older adults. Diabetes in America. 3rd ed. Cowie CC, Casagrande SS, Menke A, et al., Eds. Bethesda, MD, National Institute of Diabetes and Digestive and Kidney Diseases (US), 2018. PMID: 33651542
AMERICAN DIABETES ASSOCIATION PROFESSIONAL PRACTICE COMMITTEE. 13. Older adults: Standards of care in diabetes-2024. Diabetes care, v. 47, n. Suppl 1, p. S244–S257, 2024.
SELVIN, E.; CORESH, J.; BRANCATI, F. L. The burden and treatment of diabetes in elderly individuals in the u.s. Diabetes care, v. 29, n. 11, p. 2415–2419, 2006.
BANDEEN-ROCHE, K. et al. Frailty in older adults: A nationally representative profile in the United States. The journals of gerontology. Series A, Biological sciences and medical sciences, v. 70, n. 11, p. 1427–1434, 2015.
KALYANI, R. R. et al. Hyperglycemia and incidence of frailty and lower extremity mobility limitations in older women. Journal of the American Geriatrics Society, v. 60, n. 9, p. 1701–1707, 2012.
LEE, A. K. et al. Abstract P048: Risk factors for severe hypoglycemia differ in black and white older adults with diabetes: The atherosclerosis risk in communities (ARIC) study. Circulation, v. 135, n. suppl_1, 2017.
MCAULEY, S. A. 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, v. 45, n. 2, p. 381–390, 2022.
BOUGHTON, C. K. 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. The Lancet. Healthy longevity, v. 3, n. 3, p. e135–e142, 2022.
LESLIE, R. D. et al. Adult-onset type 1 diabetes: Current understanding and challenges. Diabetes care, v. 44, n. 11, p. 2449–2456, 2021.
YANG, K. et al. Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study. BMJ (Clinical research ed.), v. 385, p. e078432, 2024.
GREGORY, G. A. et al. Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: a modelling study. The lancet. Diabetes & endocrinology, v. 10, n. 10, p. 741–760, 2022.
SEAQUIST, E. R. et al. Hypoglycemia and diabetes: A report of a workgroup of the American Diabetes Association and The Endocrine Society. Diabetes care, v. 36, n. 5, p. 1384–1395, 2013.
INTERNATIONAL HYPOGLYCAEMIA STUDY GROUP. Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: A joint position statement of the American diabetes association and the European association for the study of diabetes. Diabetes care, v. 40, n. 1, p. 155–157, 2017.
HEPBURN, D. A. et al. Symptoms of acute insulin-induced hypoglycemia in humans with and without IDDM: Factor-analysis approach. Diabetes care, v. 14, n. 11, p. 949–957, 1991.
SUE KIRKMAN, M. et al. Diabetes in older adults: A consensus report. Journal of the American Geriatrics Society, v. 60, n. 12, p. 2342–2356, 2012.
KHUNTI, K. et al. Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin‐treated type 1 and type 2 diabetes: the global HAT study. Diabetes, obesity & metabolism, v. 18, n. 9, p. 907–915, 2016.
CRYER, P. E. Severe hypoglycemia predicts mortality in diabetes. Diabetes care, v. 35, n. 9, p. 1814–1816, 2012.
Assessing cognitive impairment in older patients. Disponível em: <https://www.nia.nih.gov/health/assessing-cognitive-impairment-older-patients>. Acesso em: 13 aug. 2024.
GUBITOSI-KLUG, R. A. et al. Continuous glucose monitoring in adults with type 1 diabetes with 35 years duration from the DCCT/EDIC study. Diabetes care, v. 45, n. 3, p. 659–665, 2022.
FORLENZA, G. P. et al. Real-world evidence supporting tandem control-IQ hybrid closed-loop success in the medicare and medicaid type 1 and type 2 diabetes populations. Diabetes technology & therapeutics, v. 24, n. 11, p. 814–823, 2022.
YOO, J. H. et al. Effect of structured individualized education on continuous glucose monitoring use in poorly controlled patients with type 1 diabetes: A randomized controlled trial. Diabetes research and clinical practice, v. 184, n. 109209, p. 109209, 2022.
WHEELER, B. J. et al. Insulin pump–associated adverse events in children and adolescents—A prospective study. Diabetes technology & therapeutics, v. 16, n. 9, p. 558–562, 2014.
GUINN, T. S.; BAILEY, G. J.; MECKLENBURG, R. S. Factors related to discontinuation of continuous subcutaneous insulin-infusion therapy. Diabetes care, v. 11, n. 1, p. 46–51, 1988.
KORDONOURI, O. et al. Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy: CFP counting in type 1 diabetes. Pediatric diabetes, v. 13, n. 7, p. 540–544, 2012.
WONG, J. C. et al. Insulin pump use and glycemic control in adolescents with type 1 diabetes: Predictors of change in method of insulin delivery across two years: Depression and pump discontinuation. Pediatric diabetes, v. 16, n. 8, p. 592–599, 2015.
