Continuous glucose monitoring in older people with diabetes receiving home care—a feasibility study

Larsen, Annette Bævre; Hermann, Monica; Graue, Marit

doi:10.1186/s40814-020-00754-3

Cited by 6 publications

(3 citation statements)

References 16 publications

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“…On the other hand, a recent study showed that CGM data from 7 days compared with 14 days did not show significant differences in glucose management indicators [ 38 ]. The results from the published feasibility study [ 39 ] showed that a five-day period was sufficient to produce relevant data. Moreover, the five-day study period allowed for conducting the CGM measures primarily on weekdays.…”

Section: Discussionmentioning

confidence: 99%

High number of hypoglycaemic episodes identified by CGM among home-dwelling older people with diabetes: an observational study in Norway

Fløde,

Hermann,

Haugstvedt

et al. 2023

BMC Endocr Disord

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Background A scoping review from 2021 identified a lack of studies on the incidence, prevention and management of hypoglycaemia in home-dwelling older people with diabetes. The aim of this study was to investigate the frequency and duration of hypoglycaemic episodes measured by continuous glucose monitoring (CGM) in older people with diabetes who received home care and who were treated with glucose-lowering medications, and to compare the frequency and duration of hypoglycaemic episodes between subgroups of the study population according to demographic and clinical variables. Methods This was an observational study investigating the occurrence of hypoglycaemia in people with diabetes aged ≥ 65 years. Data were collected using blinded continuous glucose monitoring (CGM, iPro2) for 5 consecutive days. Frequency and duration of hypoglycaemic episodes were assessed using a sensor glucose cut-off value of 3.9 mmol/L. A blood sample for measurement of HbA1c and creatinine-based eGFR (CKD-EPI) was obtained during the monitoring period. Demographic and clinical data were collected from electronic patient records. Results Fifty-six individuals were enrolled (median age 82 years and 52% were men). Of the 36 participants who were treated with insulin, 33% had at least one hypoglycaemic episode during the five-day period. Among 18 participants who neither used insulin nor sulfonylurea, but other glucose-lowering medications, 44% had at least one hypoglycaemicepisode. Of those with hypoglycaemic episodes, 86% lived alone. The median duration of the hypoglycaemia was 1 h and 25 min, ranging from 15 min to 8 h and 50 min. Conclusion This study identified an unacceptably high number of unknown hypoglycaemic episodes among older home-dwelling people with diabetes receiving home care, even among those not using insulin or sulfonylurea. The study provides essential knowledge that can serve as a foundation to improve the treatment and care for this vulnerable patient group. The routines for glucose monitoring and other prevention tasks need to be considered more comprehensively, also, among those treated with glucose-lowering medications other than insulin.

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Section: Discussionmentioning

confidence: 99%

High number of hypoglycaemic episodes identified by CGM among home-dwelling older people with diabetes: an observational study in Norway

Fløde,

Hermann,

Haugstvedt

et al. 2023

BMC Endocr Disord

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“…Telehealth applications enable reduction of the information gap between medical experts and patients. Since it can be applied to diverse fields and specialties, its usefulness has been reported for both diagnosing and monitoring various medical conditions [5–12] . Telehealth is also widely used for monitoring various cardiac diseases [13–16] and, regarding patients with CIED, has been used for remote monitoring [17] .…”

Section: Discussionmentioning

confidence: 99%

“…Since it can be applied to diverse fields and specialties, its usefulness has been reported for both Hwang and Kim Medicine (2022) 101:23 Medicine diagnosing and monitoring various medical conditions. [5][6][7][8][9][10][11][12] Telehealth is also widely used for monitoring various cardiac diseases [13][14][15][16] and, regarding patients with CIED, has been used for remote monitoring. [17] The extent of RM of CIEDs goes beyond monitoring the device parameters and providing information on patients' condition.…”

Section: Discussionmentioning

confidence: 99%

The first survey on patient needs for remote monitoring of cardiac implantable electronic device in South Korea

Hwang

Kim

2022

Medicine

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Background/Aims: Studies showed that remote device monitoring reduced unnecessary outpatient visits and increased patient satisfaction. As there was no local research on remote monitoring (RM) in Korea, there was a lack of evidence for policy or insurance standards due to the lack of domestic data despite high demand by domestic arrhythmia experts. To establish the basis for patient satisfaction, economic efficiency, and safety of wireless monitoring, a survey-based study was planned. Methods: This was a single-university hospital survey. The satisfaction index was evaluated using a questionnaire to investigate patient satisfaction in outpatient clinics, economic efficiency (measured as home-to-clinic time, waiting time, and actual clinic time), and demand for RM in patients with implantable cardiac devices. The questionnaire was adopted and modified from the Survey on Telehealth Patient Experience by Bas-Villalobos, 2006 (modified Korean version 2.0 by You Mi Hwang, 2020). Results: Surveys were answered by 171 patients. The mean age of these patients was 71.2 ± 12.4 years. Based on the survey, home to clinic time was usually less than one h, mean waiting time in the hospital until clinic time ranged 42.6 ± 24.5 minutes, and mean clinic time ranged 3.1 ± 1.7 minutes. Based on the survey, patients favored RM over hospital visits with cardiac implantable electronic device follow-up mainly because of long travel times from home to clinic. Conclusion: Based on the survey results, there is a clear need for RM in patients who have cardiac implantable electronic devices.

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Ageing well with diabetes: the role of technology

Maltese,

McAuley,

Trawley

et al. 2024

Diabetologia

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Over the past two decades there has been a substantial rise in the adoption of diabetes therapeutic technology among children, adolescents and younger adults with type 1 diabetes, and its use is now also advocated for older individuals. Older people with diabetes are more prone to experience hypoglycaemia because of numerous predisposing factors and are at higher risk of hypoglycaemic events requiring third-party assistance as well as other adverse sequelae. Hypoglycaemia may also have long-term consequences, including cognitive impairment, frailty and disability. Diabetes in older people is often characterised by marked glucose variability related to age-associated changes such as variable appetite and levels of physical activity, comorbidities and polypharmacotherapy. Preventing hypoglycaemia and mitigating glucose excursions may have considerable positive impacts on physical and cognitive function and general well-being and may even prevent or improve frailty. Technology for older people includes continuous glucose monitoring systems, insulin pumps, automated insulin delivery systems and smart insulin pens. Clinical trials and real-world studies have shown that older people with diabetes benefit from technology in terms of glucose management, reductions in hypoglycaemic events, emergency department attendance and hospital admissions, and improvement in quality of life. However, ageing may bring physical impairments and other challenges that hinder the use of technology. Healthcare professionals should identify older adults with diabetes who may benefit from therapeutic technology and then adopt an individualised approach to education and follow-up for individuals and their caregivers. Future research should explore the impact of diabetes technology on outcomes relevant to older people with diabetes. Graphical Abstract

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Continuous glucose monitoring in older people with diabetes receiving home care—a feasibility study

Cited by 6 publications

References 16 publications

High number of hypoglycaemic episodes identified by CGM among home-dwelling older people with diabetes: an observational study in Norway

High number of hypoglycaemic episodes identified by CGM among home-dwelling older people with diabetes: an observational study in Norway

The first survey on patient needs for remote monitoring of cardiac implantable electronic device in South Korea

Ageing well with diabetes: the role of technology

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