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Researchers from the University of Melbourne, St Vincent鈥檚 Hospital Melbourne and Royal Melbourne Hospital have undertaken the first randomised clinical trial examining effects of 鈥榗losed-loop鈥� automated insulin delivery for older individuals with type 1 diabetes. Findings from the Older Adult Closed-Loop (ORACL) trial revealed that closed-loop therapy achieved better glucose management than sensor-augmented (open loop) pump therapy, and that 鈥渙lder age is not a barrier to closed-loop therapy.鈥�  

Pump systems can involve communication between CGMs (continuous glucose monitors) and insulin pumps which continuously deliver insulin at variable doses. In open-loop systems (sensor-augmented pumps) this communication is not automated and the insulin doses delivered are manually determined.

In closed-loop systems (also known as an 鈥榓rtificial pancreas鈥�), CGMs and insulin pumps 鈥榯alk鈥� to each other to automate insulin delivery. Such systems are considered 鈥榗losed-loop鈥� since they do not always require user input (such as pressing buttons); instead, the sensor can direct how much insulin the pump delivers.

Findings from the four-month intervention in the ORACL trial, led by Dr Sybil McAuley, revealed that 鈥渃losed-loop insulin delivery provided significantly better glucose control than sensor-augmented pump therapy鈥� and 鈥渘o serious adverse events occurred during the closed-loop stage.鈥�

The closed-loop therapy resulted in important clinical benefits, such as reducing hyperglycaemia and hypoglycaemia (high and low blood glucose levels) and increasing the time glucose levels remained within the recommended range.

These outcomes were 鈥�achieved with no overall change in insulin dose delivered, though with greater within-day variability in dosing during closed-loop than sensor-augmented pump.鈥� Notably, the benefits of closed-loop therapy were greatest overnight, with a 鈥渇ourfold reduction in the time overnight spent below all hypoglycemia thresholds.鈥� Such results are consistent with trials involving younger individuals.

Additionally, 鈥減articipants were positive about using closed-loop therapy before starting, and remained positive about the impact of closed-loop delivery on living with diabetes at the end of the closed-loop stage.鈥�

These findings are certainly promising; however, closed-loop technology is still being developed. Further research is needed to examine the long-term effects of closed-loop use among older adults.

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The full findings of this study can be accessed .

Key Messages

• Closed-loop therapy enables glucose monitors and insulin pumps to 鈥榗ommunicate鈥� and automate insulin delivery, whereas open-loop therapy (sensor-augmented therapy) requires human input for insulin dosing.
• Closed-loop therapy can safely improve all CGM (continuous glucose monitoring) outcomes beyond the levels seen with sensor-augmented pump therapy. With closed-loop therapy, glucose levels spent a higher proportion of time within the recommended range. 
• During clinical research, closed-loop therapy was found to be an effective and safe treatment option for older adults with long-duration type 1 diabetes.
• Further research on the effects of long-term closed-loop therapy among different cohorts is needed.