Automated Insulin Delivery Effects During Driving Among Older Adults with Type 1 Diabetes in a Randomized Trial

Dysglycemia among drivers with type 1 diabetes (T1D) is associated with impaired driving performance, and glucose levels "above 5 to drive" are often recommended for insulin-treated drivers. Evidence for diabetes treatments that support euglycemia while driving is minimal, particularly for older drivers. In this randomized, crossover trial involving adults aged ≥60 years with T1D, we used continuous glucose monitoring (CGM) during driving to compare the first-generation closed-loop automated insulin delivery (AID) versus a sensor-augmented pump therapy. There were 1894 trips undertaken by 8 drivers (median age 68 years [IQR: 64-70]). During AID versus sensor-augmented pump, time in range >5.0-10.0 mmol/L was greater (100% [0-100] vs. 81% [0-100]; P = 0.033) and fewer trips had any CGM >16.7 mmol/L (3.5% vs. 6.4%; P = 0.006). Three percent of all trips included CGM <3.9 mmol/L, with no between-stage difference (3.0% vs. 3.5%; P = 0.52). System alerts occurred in 10% of all trips, with no between-stage difference (9% vs. 11%; P = 0.078). First-generation AID reduces hyperglycemic driving among older drivers with T1D, without increasing hypoglycemia. Developing dedicated "driving-mode" settings could prioritize safety while minimizing distraction. Trial Registration: ACTRN12619000515190.