The Impact of Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older

Polonsky, William H.; Hessler, Danielle

doi:10.1177/1932296816643542

Cited by 52 publications

(48 citation statements)

References 14 publications

(18 reference statements)

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“…The 18 studies included in this review consist of 5 qualitative studies [40][41][42][43][44], 5 experimental studies [31][32][33][34][35], 3 observational studies [28][29][30], 4 cross-sectional studies [36][37][38][39] and 1 mixed methods [45]. Five of the studies were smaller samples drawn from parent clinical trials [29,32,38,40,41].…”

Section: Resultsmentioning

confidence: 99%

“…The total number of participants who were included in the 18 studies review were 3320 and the mean age was 42 years although one study [36] specifically recruited people over the age of 65 years. Female participants represented 53% of the sample.…”

Section: Data Abstraction and Analysismentioning

confidence: 99%

“…Polansky et al [36] surveyed two groups of participants of 65 years of age and above with T1DM to determine differential characteristics between users of realtime CGM and non-users ('hopefuls'). CGM 'hopefuls' reported a higher incidence of 1 moderate hypoglycemic episode in the preceding 6 months (90% vs. 78%, P =.04, 1 hypoglycemic related emergency room visit during the preceding 6 months, (18.7% vs. 6.7%, P =.002), 1 hypoglycemic event requiring assistance by another during the preceding 6 months (80% vs. 57.6%, P =.0009).…”

Section: Engaging Older Adults With Cgmmentioning

confidence: 99%

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Human Factors and Data Logging Processes With the Use of Advanced Technology for Adults With Type 1 Diabetes: Systematic Integrative Review (Preprint)

Waite¹,

Martin²,

Franklin³

et al. 2017

Preprint

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Background: People with T1DM are confronted with self-management tasks and strategies to reduce risks of long-term complications against the risk of hypoglycemic events. The potential of advanced and evolving technology to address these issues involves consideration of psychological and behavioral constructs alongside the usability of devices. Access and uptake of advanced technology is further influenced by economic factors and health care provider capacity to support such interventions. Previous reviews have focused upon either clinical outcomes or descriptively scoped the literature and sometimes synthesize studies on adults with children and young people where human factors are different. Objective:The objective of this review was to describe the relationship between human factors and adherence with technology for data logging processes in adults with T1DM and to explore the factors which influence this association. Methods: A systematic literature review.Results: 18 studies were included in the review following a literature search using the PRISMA guidelines and the quality appraisal process. Six constructs emerged from the data analysis:. The relationship between adherence to data logging and measurable outcomes; Satisfaction with the transition to advanced technology for self-management; Use of advanced technology and time spent on diabetes related activities; Strategies to mediate the complexities of diabetes and the use of advanced technology; Cognition in the wild and Meanings, views and perspectives from the users of technology.There was evidence of increased treatment satisfaction on transition to advanced technology (insulin pump and CGM), the most significant contributing factor was when BG levels were consistently < 7.00mmol/l (P =.009). However, participants spent considerable time on their diabetes self-care. There was evidence that 1 logging of data was positively correlated with increasing age with the use of an app that provided meaningful feedback (regression coefficient = 55.8 recordings/ year; P = 0.009). Furthermore, there were benefits of CGM for older people in mediating complexities and their fears of hypoglycemia with reported significant differences in well-being (P= .009).Qualitative studies within the review aimed to explore the use and uptake of technology within the context of everyday lives. There were 'frustrations' with CGM, CSII, calibration of devices and alarms. In addition, the implications of 'body image' and the way in which 'significant' others impacted on the behavior and attitude of the individual towards technology use. There were wide variations in the normal use of and interaction with technology across a continuum of sociocultural contexts. This has implications for the way in which future technologies are designed. Conclusions:Many of the quantitative studies in the review were limited by small sample sizes. This may make it difficult to generalize findings to other contexts. This is further limited by a sample that was predominantly Caucasian, well-contr...

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Section: Resultsmentioning

confidence: 99%

Section: Data Abstraction and Analysismentioning

confidence: 99%

Section: Engaging Older Adults With Cgmmentioning

confidence: 99%

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Human Factors and Data Logging Processes With the Use of Advanced Technology for Adults With Type 1 Diabetes: Systematic Integrative Review (Preprint)

Waite¹,

Martin²,

Franklin³

et al. 2017

Preprint

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“…38) This strategy is also expected to lower glycemic variability and reduce postoperative complications such as SSI and POAF. Moreover, a real-time CGM system, recently noted for its ability to further reduce glycemic variability and improve outcomes, 39) might be effective for glycemic control during SQII. There are several limitations to this study.…”

Section: Discussionmentioning

confidence: 99%

Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

Sato

Hosojima

Ishikawa

et al. 2017

ATCS

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Purpose: This purpose of this prospective study was to use a continuous glucose monitoring (CGM) system to evaluate the suitability of our institution's glucose management protocol after cardiovascular surgery and to clarify the impact of glycemic variability on postoperative complications. Methods: In all, 76 patients who underwent elective cardiovascular surgery and were monitored perioperatively using a CGM system were evaluated. Postoperative glucose management consisted of continuous intravenous insulin infusion (CIII) in the intensive care unit, and subcutaneous insulin injections (SQII) after oral food intake started. CIII and subcutaneous injections were initiated when blood glucose level exceeded 150 mg/dL. CGM data were used to analyze perioperative glycemic variability and association with postoperative complications. Results: Target glucose levels (71-180 mg/dL) were achieved during 97.1 ± 5.5% and 86.4 ± 19.0% of the continuous insulin infusion and subcutaneous injection periods, respectively. Major postoperative complications were surgical site infections, found in 6.6% of total patients, and atrial fibrillation, found in 44% of patients with off-pump coronary artery bypass grafting. High glycemic variability during SQII was associated with increased risk for both complications. Conclusion: Data analysis revealed that our glucose management protocol during CIII was adequate. However, the management protocol during SQII required improvement.

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“…30 A recent survey of older adults using CGM reported better glycemic control with reduced hypoglycemia compared with those not using CGM. 31 The ability to monitor real-time glucose data and receive alerts regarding hypoglycemic events can aid in the management of T1D in older adults for the patients as well as their caregivers. Thus, CGM is effective and valuable for older adults as well as younger patients.…”

Section: Cgm Use In Older Adultsmentioning

confidence: 99%

Practical Considerations on the Use of Continuous Glucose Monitoring in Pediatrics and Older Adults and Nonadjunctive Use

Forlenza

Argento²,

Laffel

2017

Diabetes Technology & Therapeutics

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Clinical use of continuous glucose monitoring (CGM) devices has grown over the past 15 years from a niche concept to becoming standard of care for patients with type 1 diabetes (T1D). With the December 2016 Food and Drug Administration approval for diabetes treatment decisions directly from CGM values (nonadjunctive use) without finger-stick confirmation, the uptake and scope of CGM use will likely further expand. With this expansion, it is important to consider the role and impact of CGM technology in specific settings and high-risk populations, such as the young and the elderly. In pediatric patients, CGM concerns include limited body surface area, difficulty keeping sensors adhered, and the role of nonadjunctive use in the school setting. In older adults, Medicare did not, until very recently, cover CGM devices and as such, their use had been limited by lack of reimbursement. As CGM use will likely expand in clinical practice given the nonadjunctive indication, guidelines and recommendations for clinical practice are warranted. In this article, we discuss recent research on CGM use in the special populations of children and older adults and provide initial guidelines for nonadjunctive use in clinical practice.Keywords: Continuous glucose monitoring, Nonadjunctive use, Type 1 diabetes. CGM IntroductionC ontinuous glucose monitoring (CGM) devices have grown over the past 15 years from a niche concept to the standard of care for patients with type 1 diabetes (T1D). While traditional blood glucose monitoring (BGM) allowed for multiple, episodic snapshots of glycemia at various points in time, CGM data provide patients, caregivers, and medical providers with a 24-h ''glycemic video'' showing where glucose is, where it has been, and a prediction of where it may be going. In addition, many CGM systems now allow for digital remote monitoring, through which caregivers are able to view a patient's CGM tracing on their own smartphone and receive alerts based on individualized thresholds and trend parameters, a feature particularly useful in the pediatric population. 1Over the past 5 years, there has been substantial improvement in CGM performance leading to greater uptake and use in a broader spectrum of patients.2 Studies on earlygeneration CGM systems showed usage rates of about 5%-20% of patients with rates below 10% in the pediatric, adolescent, and young adult populations. 3,4 More recent data from the T1D exchange (T1DX) have shown growth in CGM use from 17% to 25% of patients, with particularly large increases in use among preschool-aged and early school-aged children.5 CGM barriers include dislike of on-body devices, cost, and insurance coverage. With the Food and Drug Administration (FDA) approval in December 2016 for management decisions that include insulin dosing from CGM values (nonadjunctive dosing), the scope and use of CGM will likely expand further as the benefit increases relative to burden.7 As CGM use expands, especially regarding nonadjunctive use, it is important to consider the role and im...

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The Impact of Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older

Cited by 52 publications

References 14 publications

Human Factors and Data Logging Processes With the Use of Advanced Technology for Adults With Type 1 Diabetes: Systematic Integrative Review (Preprint)

Human Factors and Data Logging Processes With the Use of Advanced Technology for Adults With Type 1 Diabetes: Systematic Integrative Review (Preprint)

Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery

Practical Considerations on the Use of Continuous Glucose Monitoring in Pediatrics and Older Adults and Nonadjunctive Use

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