Use of Continuous Glucose Monitoring in Older Adults: A Review of Benefits, Challenges and Future Directions

Abstract

Many new technologies have been developed over the past decade, and these have substantially changed the way diabetes is managed. Continuous glucose monitoring is now the standard of care for many people living with diabetes, and among its numerous benefits, it has been shown to improve glycaemic outcomes and enhance quality of life. Older adults carry a high burden of diabetes and have a high risk of hypo-glycaemia and hypo-glycaemic unawareness, and continuous glucose monitoring can help to improve glycaemic management in this vulnerable population. Unfortunately, only a few trials have evaluated the effectiveness of continuous glucose monitoring in older adults. Certainly, the implementation of continuous glucose monitoring in older adults can come with many challenges, including logistical, educational and reimbursement barriers. This article will discuss the benefits of continuous glucose monitoring in older adults with diabetes, the clinical studies that support its use and the barriers to its optimal implementation in this population.

Continuous glucose monitoring in older adults with diabetes: Data from the diabetes prospective follow‐up (DPV) registry

“…Further, recommendations for implementation of CGM in older adults remain largely undefined, which might negatively affect HCPs confidence to implement diabetes technology in this population. 9 Individuals using CSII might be more prone to technology or might be treated in a diabetes centre that has more experience in utilizing diabetes technologies in older adults. Previous publications have emphasized on the importance of human factors engineering and research on actual everyday use of diabetes technologies in different groups of users (e.g.…”

“…5,6 Older adults carry a high burden of diabetes: increased risk of hypoglycaemia and hypoglycaemia unawareness can have detrimental effects in this vulnerable population 7,8 pointing towards potential benefits of CGM use. 9,10 Reducing the risk of hypoglycaemia is a major treatment goal for older adults with diabetes. 11 A small number of clinical studies specifically in older populations have pointed out that CGM may reduce hypoglycaemia in people with type 1 12,13 and type 2 diabetes, 14 and can lead to greater reductions in HbA1c compared with a non-CGM control group.…”

“…15 A recent review on benefits and challenges of CGM in older adults concludes that while CGM use has shown positive effects on diabetes-related and patient-reported outcomes in several trials, its use in older adults is still largely based upon anecdotal and extrapolated data due to a small number of clinical trials including or focusing on this population. 9 Determinants of sensor use in older adults have not yet been studied and despite the evidence suggesting improvements in glycaemic control and patient satisfaction, CGM use in older adults has been neglected in guidelines and recommendations in the past, particularly in type 2 diabetes. 9 More recently, the attention on diabetes technology use in older adults has increased and recommendations on CGM use have been published by several professional diabetes organizations.…”

“…9 Determinants of sensor use in older adults have not yet been studied and despite the evidence suggesting improvements in glycaemic control and patient satisfaction, CGM use in older adults has been neglected in guidelines and recommendations in the past, particularly in type 2 diabetes. 9 More recently, the attention on diabetes technology use in older adults has increased and recommendations on CGM use have been published by several professional diabetes organizations. The American Diabetes Association (ADA) just recently published guidelines that recommend CGM use for older adults with type 1 diabetes to detect and reduce hypoglycaemia, and for those with cognitive and/or physical impairments whose diabetes self-management is performed by a caregiver.…”

Continuous Glucose Monitors; a replacement for standard Blood Glucose Monitor

“…However, some people quit using CGM due to difficulties such as painful insertions, wearing several devices on small bodies, obtrusive alarms, data gaps, skin and adhesive issues, and trouble analyzing the volume of data produced by CGM [4] . It has been demonstrated that those with diabetes who use CGM experience improved glycemic results and quality of life [5] , but the lifespan of the biosensors is short, making them expensive. Patients and medical practitioners may struggle to interpret CGM data, and routine maintenance may be required, making it difficult for many patients to use CGMs.…”