| Sumario: | Objective: Evidence on advanced hybrid closed-loop (AHCL) systems in older adults with type 1 diabetes (T1D) remains limited. This study compared the effectiveness and safety of the MiniMed 780G system between adults aged ≥60 years and younger adults. Methods: We conducted a cross-sectional study in patients with T1D using the MiniMed 780G system. Eligible participants were aged ≥40 years and had used the device for at least four weeks before study entry. Clinical variables, body composition, grip strength, and glycemic outcomes were compared according to age group (<60 vs. ≥60 years). Results: A total of 118 patients were included, 45% of whom were aged ≥60 years. In this group, 79% were independent for basic activities of daily living and 60% used SmartGuard at optimal settings. Glycemic management was similar in both age groups, including time in range (76.58±8.59 vs. 76.73±9.58; p=0.535), time in tight range (52.0±10.02 vs. 52.75±10.73; p=0.694), and time below range <70 mg/dL (1.39±1.33 vs. 1.81±1.39; p=0.100). In adjusted ANCOVA models, age group was not significantly associated with either TIR or TITR. Optimal SmartGuard settings, grip strength, fat mass, and phase angle were more strongly associated with glycemic profile than age. Conclusions: MiniMed 780G use was safe and effective in older adults with T1D, achieving glycemic outcomes comparable to younger adults. Optimal SmartGuard settings are associated with a better metabolic profile and should be considered regardless of age. Additionally, grip strength and body composition should be included in the clinical assessment of patients with T1D using AHCL systems. Plain Language Summary: Older adults with type 1 diabetes may benefit from automated insulin delivery systems, but research in this age group is still limited. This study examined whether the MiniMed 780G system works as safely and effectively in adults aged 60 years and older as it does in younger adults. We studied 118 adults with type 1 diabetes who had been using the MiniMed 780G for at least 4 weeks. We compared glucose control between younger and older adults and also looked at body composition, hand grip strength, and use of the system's recommended settings. Nearly half of the participants were aged 60 years or older. Overall, older adults had glucose results similar to those of younger adults. They spent a similar amount of time within the recommended glucose range and did not have more low blood sugar episodes. The study also found that some factors were more closely linked to glucose control than age, especially use of the system at recommended settings, hand grip strength, and body composition. These results suggest that the MiniMed 780G can be a safe and effective option for older adults with type 1 diabetes. They also suggest that using the system correctly may be especially important for achieving the best glucose results. Measures such as hand grip strength and body composition may also help improve patient assessment and care.
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