1858-P: Glycemic Outcomes in Older Adults Using the Twiist Automated Insulin Delivery (AID) System: Real-World Experience

Introduction and Objective: Older adults with diabetes often have comorbidities, variable insulin sensitivity, and increased hypoglycemia risk, prompting more relaxed glycemic goals that prioritize hypoglycemia reduction. Although AID systems have proven beneficial in trials, real-world evidence for this population remains scarce. The objective of this study is to evaluate real-world glycemic outcomes among older adults (>65 years) using the twiist AID system which offers a wide correction range of 87-180 mg/dL. Methods: This analysis included data from 57 twiist users aged >65 years, encompassing 2,958 user-days. Time on device ranged from 2-161 days (median 38 days, IQR 17-94 days). Glycemic metrics were assessed according to international consensus targets including time in range (TIR) 70-180 mg/dL, time >180 mg/dL, time > 250mg/dL, time 54 -<70mg/dL, time <54mg/dL, and time in tight range (TiTR 70-140mg/dL). Daytime and overnight periods were analyzed separately to capture variability in glycemic control. Results: Mean overall TIR (70-180 mg/dL) was 80.4%, with overnight TIR 88.2%. Time >180-250mg/dL was 14.0%, time >250mg/dL was 3.2%, time 54-<70mg/dL was 2.2%, and time <54mg/dL 0.3%. TiTR was 57.9% overall and reached 70.0% overnight. Mean glucose was 138 +/- 22.7 mg/dl and GMI was 6.6%. Conclusion: In this real-world analysis, older adults using twiist demonstrated excellent TIR and minimal time above range, particularly during overnight periods, without an increased risk of hypoglycemia. twiist users exceeded current glycemic targets (50-70% TIR) for older adults safely, including achieving high TiTR, indicating both favorable safety profile and the potential to achieve tight glycemic control. Additional research is warranted to assess further benefits, such as reductions in hospitalization, infection, and other complications among older individuals using twiist. Disclosure J. Mitri: Employee; Current; Sequel. N. Ehrhardt: Advisory Panel; Current; Novo Nordisk. Research Support; Current; Novo Nordisk. Advisory Panel; Ended; Bayer AG. Advisory Panel; Current; Medtronic. Research Support; Current; Boehringer Ingelheim International GmbH. J. Jacoby: None. K. Snow: Employee; Current; Sequel Medtech.