# Missed opportunities for risk reduction: type 1 diabetes management in older adults in DPV and T1DX-QI registries

## TL;DR

This study compares diabetes management in older adults with type 1 diabetes in the U.S. and Germany/Austria, finding missed opportunities in guideline-recommended treatments and technology use.

## Contribution

The study highlights disparities in treatment adherence and technology adoption among older adults with T1D across two international registries.

## Key findings

- Higher prevalence of cardiovascular and kidney disease was observed in Germany/Austria compared to the U.S.
- Use of diabetes technologies like insulin pumps and automated delivery systems was significantly higher in the U.S.
- Less than half of older adults received recommended lipid-lowering therapies or used diabetes technologies.

## Abstract

To examine prescription of guideline-recommended therapies and achievement of treatment targets across the span of older adulthood in type 1 diabetes (T1D) in the United States and Germany/Austria.

Cross-sectional data of adults aged ≥60 years with T1D for ≥1 year seen in 2022 in the T1D Exchange Quality Improvement Collaborative (T1DX-QI) and the Diabetes Prospective Follow-up (DPV) registry. Descriptive statistics and within-registry comparisons across age groups using analysis of variance and chi-squared tests were used to analyze the data.

Thirty-six hundred adults aged ≥60 years, median age 67.5 [interquartile range (IQR) 63.4, 72.8] in T1DX-QI (n = 1549) and 68.9 (IQR 63.6, 75.7) in DPV (n = 2051) were included. The prevalence of atherosclerotic cardiovascular disease (ASCVD) (34.6% vs 16.8%) and chronic kidney disease (28.5% vs 11.8%) was higher in the DPV than the T1DX-QI. Lipid-lowering therapy for secondary prevention (52.9% vs 38%) and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use (55.3% vs 44.8%) were higher in the DPV. Continuous glucose monitoring use was similar (50.3% vs 47.9%), insulin pump use was >2 × higher (40.7% vs 17%), and automated insulin delivery use was >3 × higher (20.4% vs 6.4%) in the T1DX-QI as compared to the DPV.

Despite a high prevalence of ASCVD and risks of hypoglycemia, guideline-recommended treatments including lipid-lowering therapy for secondary prevention and diabetes technologies were used in approximately half or fewer of older adults with T1D. Additional attention to prescribing and practices to support clinicians and older adults in the use of diabetes technologies is urgently needed.