MiniMed 780G system performance in older users with type 1 diabetes: Real-world evidence and the case for stricter glycaemic targets.

Abstract

Aims: Large-scale studies on the effectiveness of automated insulin delivery (AID) systems in older people with type 1 diabetes are still limited. A multinational, retrospective, real-world study was conducted to examine the performance of the MiniMed™ 780G advanced hybrid closed-loop system in users with type 1 diabetes aged ≥56 years compared with those aged 16-55 years.

Materials and methods: Data from 35 366 MiniMed™ 780G system users aged 16-55 years and 7415 users aged ≥56 years were included. The main outcome was time in range 70-180 mg/dL (TIR); other continuous glucose monitoring (CGM) metrics were also assessed.

Results: Across all users, mean TIR was 77.1% for users aged ≥56 years and 73.1% for those aged 16-55 years (Δ4.0, 95% confidence interval [CI]: 3.8-4.2, p <0.0001). In users employing the optimal system settings (i.e., Glucose Target: 100 mg/dL; active insulin time: 2 h), mean TIR was 81.9% in older and 79.7% in younger users (Δ2.2, 95% CI: 1.5-2.9, p <0.0001). Across all users, mean time below range <70 mg/dL (TBR₇₀) was 1.5% in older and 2.1% in younger users. In older users, TIR and TBR₇₀ remained consistent over 12 months.

Conclusions: This real-world analysis demonstrated that older MiniMed™ 780G system users with type 1 diabetes can achieve a TIR >70% without increasing hypoglycaemia risk. Users employing optimal settings showed the best outcomes. The system performed as well as or better than in younger users. These findings support the case that more stringent TIR targets can be achieved safely.