Automated insulin delivery in older adults with type 1 diabetes: evidence, limitations, and clinical perspectives

Objective Automated insulin delivery (AID) systems have significantly improved the management of type 1 diabetes (T1D), leading to better glycemic control and reduced hypoglycemia. However, older adults (≥ 65 years) remain underrepresented in clinical trials, and evidence specific to this population is limited. Design and patients This narrative review synthesizes current evidence on the efficacy, safety, and usability of AID systems in older adults (≥ 65 years) with T1D. A comprehensive literature search of MEDLINE/PubMed was conducted using the PICO framework to identify relevant RCTs, observational studies, and systematic reviews, supplemented by literature studies on cognitive, functional, and psychosocial factors impacting technology adoption. Results While data from randomized trials and meta-analyses in the general population consistently demonstrate improvements in time in range (TIR, 70–180 mg/dL) and reductions in hypoglycemia, evidence in older adults is still emerging. Frail individuals and those with multiple comorbidities are often underrepresented or excluded from current studies. Nevertheless, the available evidence suggests that many of these benefits are also maintained in older populations, particularly regarding hypoglycemia reduction. At the same time, factors such as cognitive impairment, functional limitations, caregiver dependence, and reduced digital literacy may affect the adoption and effective use of these technologies. Conclusions AID systems appear effective and generally safe in selected older adults, with benefits in glycemic control and hypoglycemia reduction. However, given the marked heterogeneity of this population, further studies are needed to better define their role and applicability in routine clinical practice.