COLUMBIA UNIVERSITY New York, New York, United States
Disclosure(s):
Neha Mulpuri, MD: No financial relationships to disclose
As clinical care of T1D has improved, increasing numbers of individuals are aging with T1D, but reports of outcomes in this population are limited. Here we describe the characteristics and clinical outcomes of a cohort of patients with T1D aged 65 years and over managed by a multidisciplinary diabetes care team at a single center between 2020-2024. 131 patients were identified by electronic medical record search for inclusion in the analysis, and data was extracted by chart review. Average age of the cohort was 72.4 years. Average age at T1D diagnosis was 40.4 years, and average duration of disease was 32.7 years. A minority (14%) were diagnosed with T1D in childhood. Average most recent A1c was 7.3%. C-peptide levels were available for 58 patients; 29 of 58 patients had c-peptide < 0.2 ng/ml. The average BMI was 25.4 kg/m2. Six patients were treated with a GLP-1 receptor agonist for weight loss. Regarding diabetes technology, 52% were using an insulin pump vs 48% multiple daily injections (MDI). Of those using an insulin pump, 75% were using Tandem t:slim with Control IQ, 17.6% Omnipod 5, 5.9% Medtronic, and 1.5% Animus Ping. Continuous glucose monitor (CGM) use was near universal (92%); 85% of CGM users were using Dexcom, and the remainder were using Abbott Libre or Medtronic Guardian. Most recent 14-day period of CGM data was reviewed at the time of data extraction, demonstrating average time in range (TIR) 63% (median 69%), average time below range 7% (median 1%), with average sensor time active of 86% (median 93%). Regarding diabetes complications, 16% of the cohort had a history of DKA, 17% a history of severe hypoglycemia, 34% retinopathy, 22% neuropathy, 11.5% nephropathy, and 24% cardiovascular disease. Only 3% of the cohort had a chart diagnosis of dementia or cognitive impairment; 9% of had a mental health diagnosis such as depression or anxiety. Compared to MDI, insulin pump use was associated with lower average A1c (6.8% vs 7.8%, p< 0.01) and higher average TIR (73% vs 50%, p< 0.01). There was no significant difference in the prevalence of microvascular disease, cardiovascular disease, DKA, or hypoglycemia requiring hospitalization between insulin pump vs MDI users. Pump users had a longer mean disease duration compared with MDI users (31.04 vs 38 years, p=0.021), though there was no difference in age between the groups. Mean duration of disease was significantly longer in patients with retinopathy compared to those without (42.8 vs 28.6 years, p< 0.01). There was no significant association between duration of disease and presence of nephropathy or neuropathy or between duration of disease and TIR. Our data demonstrates that as patients with T1D age, they can continue successful implementation of diabetes technology with benefit for glycemic control. Older patients with T1D should be encouraged to utilize diabetes technology, particularly with the support of a dedicated multidisciplinary care team.
*Unless otherwise noted, all abstracts presented at ENDO must not be released to the press or the public until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.*
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