{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T04:38:49Z","timestamp":1792471129980,"version":"4.5.0"},"reference-count":37,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100020192","name":"Medtronic Europe","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020192","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":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence on psychological, cognitive and functional outcomes of advanced diabetes technologies in older adults with long\u2010standing type 1 diabetes (T1D) remains limited. We evaluated whether initiation of advanced hybrid closed\u2010loop (AHCL) therapy was associated with changes in fear of hypoglycaemia, diabetes distress, psychological well\u2010being, cognition, frailty\u2010related measures and mobility\u2010related function in adults aged \u2265\u200965\u2009years with T1D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prespecified, exploratory secondary analysis was conducted within a single\u2010centre, open\u2010label, randomised, controlled, parallel\u2010group trial including adults aged \u2265\u200965\u2009years with long\u2010standing T1D. Participants were randomly assigned (1:1) to initiate AHCL therapy using the MiniMed 780G system or to continue standard diabetes treatment. The secondary outcomes included WHO\u20105, the 17\u2010item Diabetes Distress Scale (DDS), Hypoglycemia Fear Survey\u2010II (HFS\u2010II), Montreal Cognitive Assessment, Digit Symbol Substitution Test, Fried frailty phenotype and performance\u2010based functional measures. No formal sample\u2010size calculation was performed for these secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010one participants were randomised and 29 completed 12\u2009months of follow\u2010up and were included in the treatment\u2010effect analyses. In the baseline\u2010adjusted primary analysis, AHCL therapy was associated with a lower HFS\u2010II score than standard treatment (adjusted mean difference \u221218.9; 95% CI: \u221232.4 to \u22125.4; nominal\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), although this finding did not remain statistically significant after Holm correction (adjusted\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.104) or in an exploratory model additionally adjusted for sex (difference \u221213.6; 95% CI: \u221232.2 to 5.0;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.145). Diabetes distress, psychological well\u2010being, global cognition and processing speed did not differ between groups. In sex\u2010adjusted sensitivity analyses, the between\u2010group differences remained statistically significant for 6\u2010min walk distance (92.6\u2009m; 95% CI: 36.8 to 148.3;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) and Timed Up and Go performance (\u22122.27\u2009s; 95% CI: \u22124.28 to \u22120.27;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.028), but not for gait speed (0.27\u2009m\/s; 95% CI: \u22120.05 to 0.59;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.099). At 12\u2009months, 12 of 14 AHCL participants were robust and 2 were pre\u2010frail; in the control group, 11 of 15 were robust and 4 were pre\u2010frail. No participant was classified as frail at follow\u2010up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this small, selected cohort, AHCL therapy was associated with a nominally lower fear\u2010of\u2010hypoglycaemia score and better performance on selected mobility\u2010related tests over 12\u2009months. The fear\u2010of\u2010hypoglycaemia finding did not remain statistically significant after correction for multiple comparisons or additional adjustment for sex. Six\u2010minute walk distance and Timed Up and Go remained statistically significant in the exploratory sex\u2010adjusted sensitivity analyses, whereas the gait\u2010speed difference did not. No measurable between\u2010group deterioration in global cognition or processing speed was observed. These exploratory findings require confirmation in larger studies with balanced representation by sex and direct measurement of physical activity. These findings also support a person\u2010centred clinical message: older age alone should not be regarded as a barrier to AHCL when treatment is introduced with individualised education and appropriate ongoing support.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71170","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T03:28:24Z","timestamp":1785468504000},"page":"9473-9482","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Glycaemia: Fear of Hypoglycaemia, Cognition and Functional Mobility After Advanced Hybrid Closed\u2010Loop Therapy in Older Adults With Type 1 Diabetes: A Prespecified Secondary Analysis of a Randomised, Single\u2010Centre Study"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0897-9394","authenticated-orcid":false,"given":"Katarzyna","family":"Cyranka","sequence":"first","affiliation":[{"name":"Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"Unit of Psychodiabetology, Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"University Hospital in Krakow  Krakow Poland"},{"name":"Department of Psychiatry Jagiellonian University Medical College  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6938-352X","authenticated-orcid":false,"given":"Bart\u0142omiej","family":"Matejko","sequence":"additional","affiliation":[{"name":"Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"Unit of Psychodiabetology, Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"University Hospital in Krakow  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamila","family":"Susu\u0142","sequence":"additional","affiliation":[{"name":"Unit of Psychodiabetology, Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"University Hospital in Krakow  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Sudu\u0142","sequence":"additional","affiliation":[{"name":"Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"Unit of Psychodiabetology, Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"University Hospital in Krakow  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Wawszczyk","sequence":"additional","affiliation":[{"name":"Institute of Psychology Humanitas University  Sosnowiec Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1289-5633","authenticated-orcid":false,"given":"Tali","family":"Cukierman\u2010Yaffe","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center; Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Herczeg Institute on Aging Tel Aviv University  Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej T.","family":"Malecki","sequence":"additional","affiliation":[{"name":"Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"University Hospital in Krakow  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Klupa","sequence":"additional","affiliation":[{"name":"Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"Unit of Psychodiabetology, Department of Metabolic Diseases Jagiellonian University Medical College  Krakow Poland"},{"name":"University Hospital in Krakow  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc26-S013"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/db11-1625"},{"issue":"11","key":"e_1_2_9_4_1","first-page":"236","article-title":"An International Position Statement on the Management of Frailty in Diabetes Mellitus: Summary of Recommendations","volume":"41","author":"Sinclair A. 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