Introduction and Objective: CGM uptake remains limited in insulin-using older population in spite of data showing its effectiveness in improving glycemic control and lowering hypoglycemia risk. Whether remote education with strategies to overcome age-related barriers can improve adoption of CGM in older population is not known.Methods: In this prospective 6-month intervention study, we enrolled older adults (≥65 years) with insulin-treated diabetes, either CGM naïve or if CGM users, not meeting glycemic goals (time-in-range (TIR; 70-180) <40%) and/or having excessive hypoglycemia (<70 mg/dL) >4%)]. The intervention included remote education pertaining to CGM use, combined with geriatrics principles (i.e. adjusting glycemic goals based on health status, simplifications of insulin regimens based on CGM pattern). The two co-primary effectiveness outcomes were the change TIR and individualized TIR and hypoglycemia duration at 6-months. The co-primary implementation outcomes were the change in adoption of CGM and sustained CGM use at 6 months.Results: We enrolled 109 older adults (mean age 71±5 years, mean duration 27±13 years, 63% CGM naïve, 33% with type 1 diabetes), of which 79% completed the 6-month intervention. The TIR at 6 months improved in the overall cohort [+11% (CI 3.9-23%); p<0.001)] with similar improvement in individualized TIR. There was no change in hypoglycemia duration in the overall cohort, however the change in hypoglycemia duration was significant for the subgroup with >1% hypoglycemia at baseline (-1.12% [(95% CI -4.23, -0.8%); (p<0.001)]. Both implementation outcomes improved at 6 months: among participants who were CGM-naïve at baseline and completed follow-up CGM uptake was 100%. Median CGM wear for the full cohort was 94% at 6 months. The median change in HbA1c was −0.30% (95% CI −0.60, −0.10; Wilcoxon p<0.001).Conclusion: Remote education combined with strategies to overcome age-related barriers can result in successful onboarding and sustained use of CGM in older adults with improvement in glycemic control.
E. Toschi: Consultant; Current; Vertex Pharmaceuticals Incorporated. Advisory Panel; Current; Vertex Pharmaceuticals Incorporated. A. Adam: None. C. Slyne: None. M. Savory: None. J. Bulger: None. H. Brabant: None. N. Krakoff: None. B. Matthews: None. A. Bradshaw: None. R. Weinstock: Research Support; Current; Amgen Inc., Eli Lilly and Company, JDRF, Diasome, DEKA Research and Development, Tandem Diabetes Care, Inc. Research Support; Ended; Kowa Research Institute, Inc. Research Support; Current; National Institutes of Health. Research Support; Ended; Insulet Corporation. Research Support; Current; T1D Exchange. M. Munshi: Advisory Panel; Current; Abbott Diabetes. Research Support; Ended; Dexcom, Inc.
This work is supported by a grant from The Leona M. and Harry B. Helmsley Charitable Trust.
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