{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T17:56:36Z","timestamp":1792000596801,"version":"4.4.0"},"reference-count":42,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82501081"],"award-info":[{"award-number":["82501081"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the efficacy and safety of advancing to higher levels of diabetes technology in older adults with type 1 diabetes (T1D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Web of Science, PubMed, Cochrane Library, and SCOPUS were searched. Inclusion criteria were randomised controlled trials (RCTs); aged \u226560\u2009years with T1D. Interventions were pre\u2010specified into two domain comparisons: (1) Higher\u2010level insulin delivery (defined as automated insulin delivery, AID) versus lower\u2010level insulin delivery (comprising sensor\u2010augmented pumps and predictive low\u2010glucose suspend); and (2) Higher\u2010level glucose monitoring (defined as continuous glucose monitoring, CGM) versus lower\u2010level glucose monitoring (self\u2010monitoring of blood glucose). Co\u2010primary efficacy outcomes were time\u2010below\u2010range of &lt;3.9\u2009mmol\/L(TBR3.9) and time\u2010in\u2010range of 3.9\u201310.0\u2009mmol\/L (TIR). Safety outcomes were episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia (SH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five RCTs (comprising six comparisons) with 482 participants were included. Three trials enrolled participants aged \u226560\u2009years, and two trials enrolled those aged \u226565\u2009years. Three crossover trials contributed to the AID comparison, and two parallel to the CGM comparison. The mean age was 69.2\u2009years, with a mean T1D duration of 36.1\u2009years. In the pooled analysis, higher\u2010level technologies significantly increased TIR (MD\u2009=\u2009+7.90%, 95% CI: 7.09 to 8.72,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001) and reduced TBR3.9 (MD\u2009=\u2009\u20130.62%, 95% CI: \u22121.02 to \u22120.22,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Benefits were also observed for TBR &lt;3.0\u2009mmol\/L, time\u2010above\u2010range &gt;10.0 and &gt;13.9\u2009mmol\/L, HbA1c, and glycemic variability (all\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.05). Critically, SH risk was markedly lower with higher\u2010level technologies (Peto OR\u2009=\u20090.16, 95% CI: 0.06 to 0.41,\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001; number\u2010needed\u2010to\u2010treat\u2009=\u200920), without a significant increase in DKA risk (Peto OR\u2009=\u20093.72, 95% CI: 0.75 to 18.49,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.11).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Advancing to higher\u2010level technologies for glucose monitoring and insulin delivery significantly and safely improve glycemic control in older adults with T1D. Physiological age alone should not be a primary barrier to prescribing these technologies, particularly for carefully selected older adults.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70355","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:30:41Z","timestamp":1765603841000},"page":"1750-1763","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of stepwise diabetes technology advances in older adults with type 1 diabetes: A systematic review and meta\u2010analysis of randomised trials"],"prefix":"10.1111","volume":"28","author":[{"given":"Mengyun","family":"Lei","sequence":"first","affiliation":[{"name":"Department of Endocrinology Zhongnan Hospital of Wuhan University  Wuhan 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