Contemporary automated insulin delivery systems in older adults with type 1 diabetes: A systematic review and meta-analysis.

Abstract

Older adults with type 1 diabetes are clinically heterogeneous, with variable cognition, dexterity, comorbidity burden, caregiver support, and prior technology experience. Evidence on automated insulin delivery systems (AIDs) in this population remains limited and largely observational. We performed a systematic review and meta-analysis of contemporary AIDs in adults aged ≥60 years with type 1 diabetes. We searched PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov through February 2026. Nine studies (7 observational studies and 2 randomized crossover trials; 8,765 participants) were included. We pooled outcomes during AID use using single-arm random-effects meta-analyses. When baseline data were available, we performed change-from-baseline analyses. With AIDs, pooled mean time in range (TIR) was 77.95% (95% CI 75.31-80.59), HbA1c was 6.95% (52 mmol/mol) (95% CI 6.67-7.24), and time below range (TBR) < 70 mg/dL was 1.35% (95% CI 1.12-1.57). From baseline, AID use was associated with higher TIR, lower hyperglycemia, lower HbA1c (MD - 0.36%; 95% CI - 0.63 to - 0.09), and lower diabetes distress, without increased hypoglycemia. Findings were consistent in direction with broader AID literature. Older age alone should not preclude individualized AID use.