1040-OR: Hybrid Closed-Loop Increases Time in Tight Range while Reducing Hypoglycemia in Older Adults with Type 1 Diabetes: Pooled Analysis from Three Randomized Controlled Trials

Introduction and Objective: Hypoglycemia and its sequelae have traditionally limited glycemic management among older adults with type 1 diabetes (T1D). Hybrid closed loop (HCL) therapy improves overall glycemia while lowering hypoglycemia risk. Increasing time in tight range (TITR; 70 - 140 mg/dL) is correlated with reduced microvascular complications; however, the relationship between TITR and hypoglycemia among older adults using HCL is unknown. Methods: Three randomized controlled trials (RCTs; ORACL, DAN06, and AIDE-T1D) allocated older adults (aged ≥ 60 years) with T1D to HCL or sensor-augmented pump (SAP) for between 12 - 16 weeks. Participant-level data were pooled to analyze glycemic outcomes and the relationships between TITR and other glycemic outcomes during HCL versus SAP therapy. Results: Among 149 adults (mean ±SD age 69 ±5y, T1D duration 40 ±16y, 48% females), use of HCL compared to SAP significantly increased TITR and time in range (70 - 180 mg/dL), while improving both hypoglycemic and hyperglycemic outcomes (Fig. 1A). Increased TITR was not associated with increased level 2 hypoglycemia (Fig. 1B). TITR correlated with other glycemic outcomes (Fig.1C). Conclusion: Among older adults with T1D, HCL decreases hypoglycemia and increases TITR compared to SAP. Older adults can safely achieve tight glycemic management with HCL use. Disclosure A. Bilal: None. L. Kanapka: None. C.K. Boughton: Consultant; Current; CamDiab Ltd. Research Support; Current; Abbott Diabetes, Dexcom, Inc., Ypsomed AG. S.A. McAuley: Speaker's Bureau; Ended; AstraZeneca. S.R. Rizvi: None. N. Chaytor: None. R. Henderson: None. R. Hovorka: Board Member; Current; CamDiab Ltd. Consultant; Current; Abbott Diabetes. Research Support; Current; Abbott Diabetes, Dexcom, Inc., Ypsomed AG, Novo Nordisk Foundation. Other - Speaker bureau; Ended; Novo Nordisk, Eli Lilly and Company. J.L. Jo Kamimoto: None. Y. Kudva: Advisory Panel; Current; Tandem Diabetes Care, Inc., Vertex Pharmaceuticals Incorporated, Novo Nordisk. Research Support; Current; Insulet Corporation. M. El Muayed: Research Support; Current; Lilly. D. O’Neal: None. M.R. Rickels: Consultant; Ended; Novo Nordisk. Consultant; Current; Vertex Pharmaceuticals Incorporated. Other - Invited speaker; Ended; Bayer AG. Consultant; Current; Sernova, Corp., Sanofi. Research Support; Current; Dompé, vTv Therapeutics, Hua Medicine. Research Support; Ended; Tandem Diabetes Care, Inc. S.L. Trawley: Research Support; Current; Dexcom, Inc. A. Casu: Research Support; Current; Enable Biosciences. R. Pratley: Consultant; Current; Lilly USA LLC. Research Support; Current; National Institutes of Health, Novo Nordisk. Speaker's Bureau; Current; Novo Nordisk. Other - Consulting: Thru 12/31/2023 payment directed to Dr. Pratley's employer; as of 1/1/2024 payment directed to Dr. Pratley personally.; Current; Novo Nordisk. Consultant; Current; Pfizer Inc., Recordati Rare Diseases Inc., Regeneron Pharmaceuticals Inc., Response Pharmaceuticals, Rona Therapeutics Ltd. Research Support; Current; Sanofi. Consultant; Current; Scholar Rock Inc. Other - Consulting: Thru 12/31/2023 payment directed to Dr. Pratley's employer; as of 1/1/2024 payment directed to Dr. Pratley personally.; Current; Sun Pharmaceutical Industries Ltd. Consultant; Current; Third Rock Ventures, Verdiva Bio Dev Limited. Research Support; Current; AstraZeneca AB, Boehringer Ingelheim International GmbH, Abbott Laboratories. Consultant; Current; Abbott Laboratories, AbbVie Inc. Other - Consulting; stock options; Current; Altanine, Inc. Consultant; Current; Amgen Inc., AstraZeneca Pharmaceuticals LP. 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Other - Consulting: Thru 12/31/2023 payment directed to Dr. Pratley's employer; as of 1/1/2024 payment directed to Dr. Pratley personally.; Ended; Gasherbrum Bio Inc., Genprex. Consultant; Current; Hanmi Pharm. Co., Ltd. Other - Consulting: Thru 12/31/2023 payment directed to Dr. Pratley's employer; as of 1/1/2024 payment directed to Dr. Pratley personally.; Ended; Intas Pharmaceuticals Ltd. Research Support; Current; Lexicon Pharmaceuticals, Inc. Consultant; Current; Lexicon Pharmaceuticals, Inc. Speaker's Bureau; Current; Lilly USA LLC.