Use of Telecommunication and Diabetes-Related Technologies in Older Adults With Type 1 Diabetes During a Time of Sudden Isolation: Mixed Methods Study

Abstract

Background The COVID-19 lockdown imposed a sudden change in lifestyle with self-isolation and a rapid shift to the use of technology to maintain clinical care and social connections. Objective In this mixed methods study, we explored the impact of isolation during the lockdown on the use of technology in older adults with type 1 diabetes (T1D). Methods Older adults (aged ≥65 years) with T1D using continuous glucose monitoring (CGM) participated in semistructured interviews during the COVID-19 lockdown. A multidisciplinary team coded the interviews. In addition, CGM metrics from a subgroup of participants were collected before and during the lockdown. Results We evaluated 34 participants (mean age 71, SD 5 years). Three themes related to technology use emerged from the thematic analysis regarding the impact of isolation on (1) insulin pump and CGM use to manage diabetes, including timely access to supplies, and changing Medicare eligibility regulations; (2) technology use for social interaction; and (3) telehealth use to maintain medical care. The CGM data from a subgroup (19/34, 56%; mean age 74, SD 5 years) showed an increase in time in range (mean 57%, SD 17% vs mean 63%, SD 15%; P=.001), a decrease in hyperglycemia (>180 mg/dL; mean 41%, SD 19% vs mean 35%, SD 17%; P<.001), and no change in hypoglycemia (<70 mg/dL; median 0.7%, IQR 0%-2% vs median 1.1%, IQR 0%-4%; P=.40) during the lockdown compared to before the lockdown. Conclusions These findings show that our cohort of older adults successfully used technology during isolation. Participants provided the positive and negative perceptions of technology use. Clinicians can benefit from our findings by identifying barriers to technology use during times of isolation and developing strategies to overcome these barriers.

Patient experiences of continuous glucose monitoring and sensor‐augmented insulin pump therapy for diabetes: A systematic review of qualitative studies

“…I think you need the resources allocated from the get go (HCP6, high uptake)-Say somebody comes in thinking about a pump, we have developed a resource, it is an information sheet about pump therapy, so some of the pros and cons and then the options that are available in Ireland right now with the websites for the companies." 39 (22,39,42,55,65,69,75) Abbreviations: CGM, continuous glucose monitoring; NHS, National Health Service; RT-CGM, real-time continuous glucose monitoring.…”

“…(23,28,34,41,46,48,52,55,56,58,60,65,69,71) one thing to hear 'avoid being low it could kill you,' which had not been my experience with the first 40-50 years of management, but seeing it happen and nipping it in the bud, I could see a downward trend or a fast downward trend, I could catch it before it became an issue, and the same on the high ends. Yeah it was definitely good to avoid the extremes.…”