1259-P: Using Simplification Strategies for Older Adults with Type 1 Diabetes

Abstract

Objective: Simplification of insulin regimen algorithms for older adults with type 2 diabetes have been established and recommended as the standard of care. However, simplification of insulin regimens in older adults with type 1 diabetes (T1D) has not been described. Methods: Community-living older adults ≥65 years with T1D were randomized to assess the impact of technology use, combined with geriatric specific interventions to reduce the risk of hypoglycemia (Clinicaltrials.gov NCT03078491) . We developed simplification strategies as part of a geriatric intervention program. Glycemic parameters and quality of life measures were evaluated at baseline and 6-months after enrollment. Results: Thirty-four out of forty-one older adults (83%) with T1D (age 71±4 years, T1D duration 41±16 years, 36% with cognitive dysfunction, 22% living alone) in the subpopulation from the intervention arm were considered appropriate for simplification. We identified four procedures for simplification.1) Liberalization of goals for A1C and/or pump and CGM targets were recommended for 16/34 (47%) participants;2) Fixed-dose boluses for routinely eaten meals, especially at breakfast and lunch, were recommended for 24/34 (71%) participants;3) Avoiding multiple correction doses was recommended for to 25/34 (74%) participants; and4) Proactive adjustment to boluses, rather than constantly reacting to hyper- and hypoglycemia was recommended to 13/34 (38%) . The change in glycemic metrics from baseline to 6-months post-enrollment showed a decreased percent of hypoglycemia (6% vs. 2%; p<0.0001) and decreased glycemic variability (coefficient of variation (%)) (41% vs. 35%, p=0.0001) . A1c and time-in-range remained stable (7.5% vs. 7.6%: 56% vs. 57%, respectively) . Conclusions: In this study, simplification procedures for insulin regimens in older adults with T1D were developed. Simplification of regimens did not contribute to worsening of glycemic parameters. Prospective studies are needed to confirm our findings. Disclosure M.Munshi: Consultant; Sanofi. C.Slyne: None. R.Hurlbert: None. E.Toschi: Consultant; Medtronic. Funding This research was supported by an NIH DP3 Grant (1DP3DK112214-01) and an NIH P30 Grant (P30DK036836) . Continuous glucose monitoring materials were partially suppliedby Dexcom.