350-P: The Importance of Professional CGM Use in Clinical Care of Older Adults with Type 2 Diabetes on Insulin

Abstract

Background: In recent years, professional continuous glucose monitoring (CGM) has become a beneficial tool in pattern management in older adults with type 2 diabetes (T2D) on insulin, however the need for use of professional CGM in this population had not been shown. Methods: We evaluated electronic health record (EHR) data of a tertiary diabetes center to identify the use of professional CGM in patients over the age of 65 years with T2D using insulin. Professional CGM data from this cohort were analyzed when a minimum of 70% of data was available (≥10 days). Results: A total of 2,481 patients over the age of 65 years with type 2 diabetes using insulin were seen at the Joslin Diabetes Center from January 2017-March 2020. Average age of the total cohort was 72±7 yrs, A1c was 8.2±1.5% and diabetes duration was 21±10 years. Professional CGM was used in 169 older adults with T2D using insulin (7% of the total patients seen). CGM data from 139/169 was sufficient for analysis. The average age of this cohort (139 patients) was 77±8 yrs, A1c 8.0±1.5%, duration of diabetes 21±12 yrs. The mean duration of hypoglycemia was 80±92 min/day <70 mg/dL and 32±51 min/day ≤54 mg/dL. A total of 86% of the cohort had ≥1 episode of hypoglycemia. The measure of high glycemic variability (CV >36%) was seen in 59 (42%) of the cohort, with a high A1c (8.2±1.2%). When comparing those people with and without hypoglycemia on CGM, there was no difference in age, A1c, or duration of diabetes. Conclusion: In the real world, a small percentage of older adults with T2D on insulin therapy received professional CGM. Our data shows a high burden of hypoglycemia in this population, despite suboptimal A1c. Broader use of professional CGM would be beneficial in recognizing hypoglycemia in this vulnerable population. Disclosure C. Slyne: None. E. Toschi: Consultant; Self; Medtronic. A. Michals: None. A. Atakov-castillo: None. K. Sifre: None. R. Dewar: None. D. J. Davis: None. M. Munshi: Consultant; Self; Sanofi. Funding National Institutes of Health (1DP3DK112214-01)