{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T09:32:21Z","timestamp":1788168741311,"version":"build-2803163510"},"reference-count":22,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology &amp; Therapeutics"],"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To evaluate real-world glycemic outcomes, safety, treatment satisfaction, cognition, and frailty in older adults with type 1 diabetes (T1D) using advanced hybrid closed-loop (aHCL), and to compare them with those of matched older adults treated with multiple daily injections (MDIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Design and Methods:<\/jats:title>\n                    <jats:p>Multicenter observational study including 100 adults with T1D from 19 Spanish hospitals who initiated aHCL at \u226565 years and 100 age- and sex-matched MDI users. Glycemic outcomes before aHCL initiation were compared with the final follow-up. Final glycemic outcomes were also compared between the aHCL and MDI groups. Cognitive function and frailty were assessed using the Montreal Cognitive Assessment and FRAIL scales.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Mean age was 71.2 \u00b1 4.4 years. In aHCL users, time in range (TIR 70\u2013180 mg\/dL) increased from 65.3% \u00b1 15.0% before aHCL initiation to 78.6% \u00b1 10.5% at the final follow-up (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), and HbA1c decreased from 7.56% \u00b1 0.97% to 7.01% \u00b1 0.59% (59.1 \u00b1 10.6 mmol\/mol to 53.1 \u00b1 6.4 mmol\/mol) (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). At the final follow-up, aHCL users had a higher TIR than matched MDI users (78.6% \u00b1 10.5% vs. 63.0% \u00b1 18.1%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and lower HbA1c (7.01% \u00b1 0.59% vs. 7.65% \u00b1 0.98%; 53.1 \u00b1 6.4 mmol\/mol to 59.9 \u00b1 10.7 mmol\/mol;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). Severe hypoglycemia decreased from 28.0 to 1.6 events per 100 patient-years after aHCL initiation. A total of 60% of aHCL users had mild-to-moderate cognitive impairment, yet the final TIR was similar across cognitive strata within the aHCL group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In older adults with T1D, real-world aHCL initiation was associated with improved glycemic outcomes and better glycemic outcomes than in matched MDI users in a cohort with substantial cognitive vulnerability. These findings support the effectiveness of aHCL therapy in routine geriatric diabetes care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15209156261474587","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T06:23:06Z","timestamp":1785824586000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Automated Insulin Delivery System Initiation Safely Improves Glycemic Outcomes in Older Adults with Type 1 Diabetes"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0423-6446","authenticated-orcid":false,"given":"Carmen","family":"Quir\u00f3s","sequence":"first","affiliation":[{"name":"Hospital Universitari M\u00fatua de Terrassa, Terrassa, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Montserrat","family":"Granados","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednic Barcelona, Barcelona, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda J.","family":"Pic\u00f3n","sequence":"additional","affiliation":[{"name":"Hospital Universitario Virgen de la Victoria, M\u00e1laga, CIBERObn, Instituto de Salud Carlos III, Madrid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L\u00eda","family":"Nattero-Ch\u00e1vez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Ram\u00f3n y Cajal. CIBERDEM, Madrid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Aguilera-Hurtado","sequence":"additional","affiliation":[{"name":"Hospital Universitario Germans Trias i Pujol, Barcelona, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda del Rosario","family":"Vallejo-Mora","sequence":"additional","affiliation":[{"name":"Hospital Regional Universitario de M\u00e1laga. M\u00e1laga, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Beato-V\u00edbora","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Badajoz, Badajoz, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharona","family":"Azriel-Mira","sequence":"additional","affiliation":[{"name":"Hospital Infanta Sof\u00eda, Madrid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Moreno-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Hospital General Universitario de Ciudad Real, Ciudad Real, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Sim\u00f3-Servat","sequence":"additional","affiliation":[{"name":"Hospital Universitari Vall d\u2019Hebron, Barcelona, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Zavala-Arauco","sequence":"additional","affiliation":[{"name":"Hospital Universitari Joan XXIII, Tarragona. Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9743-9412","authenticated-orcid":false,"given":"Gonzalo","family":"D\u00edaz-Soto","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednico Universitario de Valladolid, Valladolid, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Alonso-Carril","sequence":"additional","affiliation":[{"name":"Hospital Universitari M\u00fatua de Terrassa, Terrassa, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda A.","family":"Mart\u00ednez-Brocca","sequence":"additional","affiliation":[{"name":"Hospital Universitario Virgen Macarena, Sevilla, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaia","family":"Diaz-Trastoy","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, A Coruna, Spain."},{"name":"Laboratorio de Endocrinolog\u00eda Molecular, Instituto de Investigaci\u00f3n Sanitaria Santiago de Compostela (IDIS), Hospital Cl\u00ednico Universitario de Santiago (CHUS\/SERGAS), Santiago de Compostela, A Coruna, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3655-2751","authenticated-orcid":false,"given":"Laura","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Hospital Doctor Negr\u00edn, Las Palmas de Gran Canaria, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"And\u00fajar","sequence":"additional","affiliation":[{"name":"Complejo Hospitalario Universitario de Santiago de Compostela, A Coru\u00f1a, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Duran-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Hospital Universitario de Getafe, Getafe, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"M\u00e1rquez","sequence":"additional","affiliation":[{"name":"Hospital Universitario Juan Ram\u00f3n Jim\u00e9nez, Huelva, Spain."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda","family":"Piedra-Le\u00f3n","sequence":"additional","affiliation":[{"name":"Servicio de Endocrinolog\u00eda y Nutrici\u00f3n. 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