As care for type 1 diabetes (T1D) advances, the number of adults with T1D living into older adulthood (ages ≥65 years) continues to grow. The population of older adults with T1D is highly heterogeneous, and over the life span, various factors may change over time while others may not, necessitating an individualized approach to management. A key care consideration for people with T1D is the ongoing need for exogenous insulin replacement intensive self-monitoring for effective management. At the same time, growing older may bring changes such as increased risk of misdiagnosis of T1D as type 2 diabetes, greater vulnerability to hypoglycemia, accumulating comorbidities and complications, declining independence due to geriatric syndromes, and a growing need for support in using diabetes technologies and navigating complex care transitions. Given the unique clinical and management needs of this population, we sought to present key care challenges in this population and suggest strategies to optimize quality of care in older adults with T1D, including 1) integrating geriatric screenings, age-friendly care frameworks, and regular reassessments into routine T1D management; 2) developing tailored care approaches for cognitive impairment; 3) establishing support systems for diabetes technology use in primary and long-term care settings; and 4) ensuring insurance coverage and access to diabetes technologies and therapies. Forward-thinking strategies to optimize care include individualized glycemic goal setting, the development and adoption of care models that support continuity of diabetes technology use, and individualized management strategies that consider of the goals and capabilities of the person living with T1D and care partners.

OBJECTIVE:Intraindividual cognitive variability (IICV) is a promising measure for early identification of dementia risk. Fewer studies have assessed IICV using high-frequency digital cognitive assessment or in populations with medical conditions. We aimed to characterize associations between IICV for reaction time and accuracy with plasma biomarkers of neurodegeneration (phosphorylated tau 181, phosphorylated tau 217, β-amyloid 42/40 ratio, glial fibrillary acidic protein, and neurofilament light chain) in individuals with Type 1 diabetes. METHOD:We analyzed data from 114 participants from the Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes study who provided blood samples (M = 48.9 years, range = 19-84). Cognition was assessed digitally at baseline and three times daily for 15 days via ecological momentary assessment. Hierarchical linear regression models examined associations between biomarkers and IICV, adjusting for demographics, glycemic variability, mean cognition, and nephropathy. Multiple testing correction used Benjamini-Hochberg. RESULTS:IICVs for reaction time at baseline and across repeated assessments were correlated and associated with β-amyloid 42/40, glial fibrillary acidic protein, neurofilament light chain, and phosphorylated tau 217 (small to moderate effect size, p < .05), but associations did not remain significant after adjustment. Exploratory analyses indicated interactions with age and sex. IICV for accuracy was not associated with any biomarker. CONCLUSIONS:Although associations between IICV and plasma biomarkers were not robust after full adjustment, exploratory analyses suggested potential interactions with age and sex. The sample was predominantly non-Hispanic White, limiting the generalizability of our findings. These findings support continued investigation of digital IICV as a dynamic marker of early cognitive vulnerability. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The prevalence of diabetes is rising among older adults. While most diabetes cases in older adults are type 2 diabetes mellitus (T2D), advances in type 1 diabetes mellitus (T1D) management and rising rates of adult-onset T1D have translated into a growing number of individuals with T1D living into older adulthood. This narrative review integrates existing evidence on management of T1D in older adults with expert opinions to provide practical guidance for generalists increasingly encountering the unique challenges and complexities of this growing population. The profound heterogeneity in clinical presentation, pathobiology, and disease progression across the older adult population can make it challenging to differentiate older adults with T1D from those with insulin treated T2D, particularly in adult-onset cases. However, timely diagnosis is critical to minimize exposure to hyperglycemia and reduce the risk for complications, as individuals with T1D rely entirely on exogenous insulin and require intensive self-management to prevent acute complications like hypoglycemia and ketoacidosis. Self-management of T1D in older adults presents unique challenges, including a high risk of hypoglycemia that must be mitigated in the setting of a lifelong requirement for insulin and evolving mismatches between intensive self-management demands and an older person’s capacity for self-care. The growing number of older adults with T1D underscores a lack of access to specialized care and limited training and resources for evidence-based management in primary care and post-acute/long-term care settings, as well as the dearth of high-quality clinical evidence specific to this population to inform care. Research to support changes across healthcare systems and at the policy level, in combination with education and multi-specialty collaboration, will ensure that healthcare providers and health systems are equipped and prepared to better meet the needs of the growing population of older adults with T1D.

Objective: to assess the association between attention-deficit/hyperactivity disorder (ADHD), type 1 diabetes mellitus (T1D), and cardiovascular comorbidities in adults. Methods: The Adult Self-Report Scale V1.1 (ASRS) for ADHD symptoms was electronically sent to 2069 adults with T1D. Cardiometabolic conditions, laboratory measurements, and PHQ-2/PHQ-9 depression scores were obtained from the electronic medical record. Results: In total, 292 (14.1%) individuals responded and 279 consented to medical records extraction. The average age was 47.4 years (SD: ±18.9), 64.2% were women, 95.7% were non-Hispanic white, and the mean HbA1c level was 7.7% (±1.5%). Of 273 completing ASRS, 87 med ADHD criteria (ASRS positive, 31.9%), and 42 (15.4%) had an ADHD diagnosis or medication. Women had higher scores than men. ADHD symptoms decreased with age, but remained significantly higher than the general population levels. HbA1c levels were positively associated with the ASRS scores (Spearman’s r = 0.28, p < 0.0001). ASRS positive individuals had worse glycemic control (HbA1c ≥ 8.0%, adjusted OR 2.3, 95%CI: 1.3–4.1, p < 0.0001) and higher PHQ-9 scores (10 ± 7.3 vs. 6.1 ± 6, χ2(1) = 9.2, p = 0.002) than the ASRS negative group. No associations were found between ASRS scores and cardiometabolic diseases, or other laboratory or clinical measurements. Conclusions: Many adults with T1D exhibit undiagnosed ADHD symptoms, which correlate with poorer glycemic control and depression. Further research with larger samples is needed to investigate ADHD prevalence and impacts in this group.

Published Version: This article has been peer-reviewed and published in Alzheimer’s & Dementia. Please cite the published version:Fonseca LM, Beeri MS, Hawks ZW, Jung L, Cleveland M, Delgado N, Bulger J, Grinspoon E, Janess K, Sliwinski MJ, Weinstock RS, Chhatwal JP, Kivisäkk P, Germine LT, Chaytor NS. ATN blood biomarkers are related to digital cognitive assessment in type 1 diabetes. Alzheimers Dement (Amst). 2024 Oct 23;16(4):e70029. doi: 10.1002/dad2.70029. PMID: 39445343; PMCID: PMC11497176.https://doi.org/10.1002/dad2.70029INTRODUCTION, Associations between Amyloid-Tau-Neurodegeneration (ATN) plasma biomarkers and cognition have not been characterized in adults with type 1 diabetes (T1D).METHODS, Using data from participants in the Glycemic Variability and Fluctuations in Cognitive Status in Adults with T1D study (N=114), associations between phosphorylated tau (pTau)181, pTau217, β-amyloid 42/40 ratio, glial fibrillary acidic protein (GFAP), and neurofilament light (NfL) and cognition measured by self-administered digital tests were investigated with adjustments for age, sex, education, comorbidities (e.g. kidney disease), and glycemic indices. RESULTS, Higher concentrations of pTau181 and GFAP were associated with slower responses on working memory tasks (pTau181: β=0.261 p=0.007; GFAP: β=0.175, p=0.036), and higher β-amyloid 42/40 ratio was associated with better vocabulary (β=0.260, p=0.009). Except for GFAP, these associations remained significant after adjustments. DISCUSION, Digital cognitive performance was associated with several ATN plasma biomarkers in T1D adults. Prospective studies are needed to understand the utility of these biomarkers in T1D.

Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations.

Ziel Temporäre Basalrate (TBR) und verzögerter Bolus (EB) sind Insulinpumpenfunktionen, die die individuelle Insulintherapieanpassung ermöglichen. Diese Studie untersuchte retrospektiv glykämische Ergebnisse, die nach Häufigkeit der TBR/EB-Anwendung bei einer großen Kohorte von Patienten mit T1D stratifiziert wurden, die das Omnipod Insulin-Managementsystem (Insulet Corp., MA, USA) mit integriertem BZ-Messgerät (Abbott Diabetes Care Inc., CA, USA) und einem Datenmanagementsystem (Glooko, CA, USA) verwendeten.

Ziel Beurteilung glykämischer Ergebnisse, stratifiziert nach Bolusfrequenz bei Erwachsenen mit T1D, die mit dem Omnipod® Insulin-Managementsystem (Insulet Corp., USA) mit einem integrierten Blutzuckermessgerät (BGM) (Abbott Diabetes Care Inc., USA) und/oder einem CGM- und Datenmanagementsystem (Glooko, USA) behandelt wurden.

BACKGROUND Higher serum urate levels are associated with an increased risk of diabetic kidney disease. Lowering of the serum urate level with allopurinol may slow the decrease in the glomerular filtration rate (GFR) in persons with type 1 diabetes and early-to-moderate diabetic kidney disease. METHODS In a double-blind trial, we randomly assigned participants with type 1 diabetes, a serum urate level of at least 4.5 mg per deciliter, an estimated GFR of 40.0 to 99.9 ml per minute per 1.73 m(2) of body-surface area, and evidence of diabetic kidney disease to receive allopurinol or placebo. The primary outcome was the baseline-adjusted GFR, as measured with iohexol, after 3 years plus a 2-month washout period. Secondary outcomes included the decrease in the iohexol-based GFR per year and the urinary albumin excretion rate after washout. Safety was also assessed. RESULTS A total of 267 patients were assigned to receive allopurinol and 263 to receive placebo. The mean age was 51.1 years, the mean duration of diabetes 34.6 years, and the mean glycated hemoglobin level 8.2%. The mean baseline iohexol-based GFR was 68.7 ml per minute per 1.73 m(2) in the allopurinol group and 67.3 ml per minute per 1.73 m(2) in the placebo group. During the intervention period, the mean serum urate level decreased from 6.1 to 3.9 mg per deciliter with allopurinol and remained at 6.1 mg per deciliter with placebo. After washout, the between-group difference in the mean iohexol-based GFR was 0.001 ml per minute per 1.73 m(2) (95% confidence interval [CI], -1.9 to 1.9; P= 0.99). The mean decrease in the iohexolbased GFR was -3.0 ml per minute per 1.73 m(2) per year with allopurinol and -2.5 ml per minute per 1.73 m(2) per year with placebo (between-group difference, -0.6 ml per minute per 1.73 m(2) per year; 95% CI, -1.5 to 0.4). The mean urinary albumin excretion rate after washout was 40% (95% CI, 0 to 80) higher with allopurinol than with placebo. The frequency of serious adverse events was similar in the two groups. CONCLUSIONS We found no evidence of clinically meaningful benefits of serum urate reduction with allopurinol on kidney outcomes among patients with type 1 diabetes and early-to-moderate diabetic kidney disease.

Aims To compare the outcomes of partners who participated in a telephone couples behavioural intervention to improve glycaemic control in persons with Type 2 diabetes with those of untreated partners of participants in an individual intervention or education; to explore 'ripple effects', i.e. positive behaviour changes seen in untreated partners. Methods The Diabetes Support Project was a three-arm randomized telephone intervention trial comparing outcomes of couples calls (CC), individual calls (IC) and diabetes education calls (DE). Couples included one partner with Type 2 diabetes and HbA(1c) >= 58 mmol/mol (7.5%). All arms received self-management education (two calls). CC and IC arms participated in 10 additional behaviour change calls. CC included partners, emphasizing partner communication, collaboration and support. Blinded assessments were performed at 4, 8 and 12 months. Partner outcomes were psychosocial (diabetes distress, relationship satisfaction, depressive symptoms), medical (BMI, blood pressure) and behavioural (fat intake, activity). Results Partners' (N = 268) mean age was 55.8 years, 64.6% were female and 29.9% were from minority ethnic groups. CC (vs. IC and DE) partners had greater reductions in diabetes distress, greater increases in marital satisfaction (4 and 8 months), and some improvements in diastolic BP. There were no consistent differences among arms in other outcomes. There was no evidence of a dietary or activity behaviour ripple effect on untreated partners, i.e. comparing partners in the IC and DE arms. Conclusions A collaborative couples intervention resulted in significant improvements in partner diabetes distress and relationship satisfaction. There were no consistent effects on behavioural or medical partner outcomes, and no evidence of diet or activity behaviour ripple effects, suggesting that partners should be targeted directly to achieve these changes. (Clinical Trial Registry No: NCT01017523)

AimsTo compare the once‐weekly glucagon‐like peptide‐1 (GLP‐1) receptor dulaglutide with the dipeptidyl peptidase‐4 (DPP‐4) inhibitor sitagliptin after 104 weeks of treatment.MethodsThis AWARD‐5 study was a multicentre, double‐blind trial that randomized participants to dulaglutide (1.5 or 0.75 mg) or sitagliptin 100 mg for 104 weeks or placebo (reported separately) for 26 weeks. Change in glycated haemoglobin (HbA1c) concentration from baseline was the primary efficacy measure. A total of 1098 participants with HbA1c concentrations ≥7.0% (≥53.0 mmol/mol) and ≤9.5% (≤80.3 mmol/mol) were randomized, and 657 (59.8%) completed the study. We report results for dulaglutide and sitagliptin at the final endpoint.ResultsChanges in HbA1c at 104 weeks were (least squares mean ± standard error) −0.99 ± 0.06% (−10.82 ± 0.66 mmol/mol), −0.71 ± 0.07% (−7.76 ± 0.77 mmol/mol) and −0.32 ± 0.06% (−3.50 ± 0.66 mmol/mol) for dulaglutide 1.5 mg, dulaglutide 0.75 mg and sitagliptin, respectively (p < 0.001, both dulaglutide doses vs sitagliptin). Weight loss was greater with dulaglutide 1.5 mg (p < 0.001) and similar with 0.75 mg versus sitagliptin (2.88 ± 0.25, 2.39 ± 0.26 and 1.75 ± 0.25 kg, respectively). Gastrointestinal adverse events were more common with dulaglutide 1.5 and 0.75 mg versus sitagliptin (nausea 17 and 15% vs 7%, diarrhoea 16 and 12% vs 6%, vomiting 14 and 8% vs 4% respectively). Pancreatic, thyroid, cardiovascular and hypersensitivity safety were similar across groups.ConclusionsDulaglutide doses provided superior glycaemic control and dulaglutide 1.5 mg resulted in greater weight reduction versus sitagliptin at 104 weeks, with acceptable safety.