Personal Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older

Argento, Nicholas B.; Nakamura, Katherine

doi:10.4158/ep14017.or

Cited by 16 publications

(11 citation statements)

References 12 publications

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“…Of note, we showed that patients who used CGMS (N = 4) had better glycaemic control, compared with those who did not, which was consistent with prior data from observational and randomized trial in patients aged >60 (65) years [15][16][17].…”

Section: Discussionsupporting

confidence: 88%

Efficacy and safety of long-term insulin pump treatment in patients with type 1 diabetes aged over 50 years

et al. 2020

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Continuous subcutaneous insulin infusion (CSII) therapy using insulin pumps has become widely used in the treatment of type 1 diabetes mellitus (T1DM). This retrospective study aimed to assess the efficacy and safety of long-term insulin pump treatment in patients with T1DM aged ≥50 years. The study included patients aged ≥50 years, who had a diagnosis of T1DM based on clinical criteria and/or presence of autoantibodies characteristic of autoimmune diabetes, and had received ≥5 years of recent and uninterrupted treatment with a personal insulin pump. We analyzed records on HbA1c levels across the entire observation period. The cohort comprised 17 patients, of whom 6 (35%) were men and 11 (65%) were women. The mean duration of observation was 6.6 years, during which patients had a mean of 8.4 HbA1c measurements. Mean HbA1c level over the entire observation period was 6.7% (range, 5.3-7.4%). Overall, 11 patients (65%) had mean HbA1c levels at the ADA-recommended target of <7% and 5 patients (29%) had mean HbA1c <6.5%. Mean HbA1c level was significantly lower at the end of the observation period than at the start (6.52% versus 6.91%; difference, -0.39%; p < 0.01), indicating an improvement in glycaemic control over time. On average, patients experienced one level 1 hypoglycaemia episode every 2.4 days. This retrospective analysis of at least 5 years of follow-up of selected patients with T1DM aged ≥50 years at the start of observation, showed that CSII is a safe and effective treatment option in this age group.

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Section: Discussionsupporting

confidence: 88%

Efficacy and safety of long-term insulin pump treatment in patients with type 1 diabetes aged over 50 years

et al. 2020

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“…The potential value of RT-CGM in older adults is becoming more widely recognized, 10 especially given the growing understanding that reduced hypoglycemic awareness is a major contributor to the problems of severe hypoglycemia in this patient population. 6 Indeed, from the RT-CGM current users group, we informally surveyed a small number of their physicians (n = 26) and found that the vast majority agreed that RT-CGM had helped their patient to achieve better control of their diabetes (96.2%) and had led to an improvement in their patient’s QOL (100%), while all agreed that Medicare should provide RT-CGM coverage in “appropriately needy patients over 65.” Future studies will need to document these observations in a more prospective manner.…”

Section: Discussionmentioning

confidence: 99%

“… 8 Indeed, among seniors with diabetes, recent studies have documented that hospitalizations for hypoglycemia exceed those for hyperglycemia and are linked to elevated mortality risk. 9 Early evidence suggests that RT-CGM use in this population may reduce the frequency of severe hypoglycemic episodes and improve overall glycemic control, 10 but—quite unfortunately—when many patients with T1D switch to Medicare at age 65, RT-CGM is no longer a covered benefit. This means that those individuals at the highest risk for hypoglycemia lose the security of having a device that can alert them to incipient and/or actual hypoglycemia.…”

mentioning

confidence: 99%

The Impact of Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older

Polonsky

Hessler

2016

J Diabetes Sci Technol

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Background:Older adults with type 1 diabetes (T1D) or insulin-using type 2 diabetes (iT2D) are at high risk for severe hypoglycemic episodes. Real-time continuous glucose monitoring (RT-CGM) in this population may reduce this risk, but when patients switch to Medicare at age 65, RT-CGM is no longer a covered benefit. We developed a survey to examine health and quality of life (QOL) benefits of RT-CGM in seniors (age ≥ 65).Methods:Two groups of seniors with T1D or iT2D—current RT-CGM users (n = 210) and RT-CGM “hopefuls” (patients who wanted but could not obtain RT-CGM due to lack of insurance coverage; n = 75)—completed an online survey. The survey examined history of hypoglycemic experiences as well as current quality of life (QOL), including generic and diabetes-specific measures.Results:Current users reported fewer moderate (P < .01) and fewer severe hypoglycemic episodes (P < .01) over the past 6 months than “hopefuls” and greater reductions over time in hypoglycemic events requiring the assistance of another, ER visits, and paramedic visits to the home (in all cases, P < .01). Regarding QOL, current users reported significantly better well-being (P < .001), less hypoglycemic fear (P < .05), and less diabetes distress (P < .05) than “hopefuls.”Conclusions:These data suggest that RT-CGM use in seniors is associated with reductions in episodes of severe hypoglycemia and improved QOL, suggesting that restrictive access to RT-CGM in the Medicare age population may have deleterious health, economic, and QOL consequences.

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“…Here, CGM users were shown to have a reduction in severe hypoglycemic episodes from 52 (recorded in the five years before CGM initiation) to 12 after starting CGM. Overall, the proportion of patients with any severe hypoglycemia fell from 79% to 31% after initiation of CGM (7). However, we are conscious of the major limitations of these studies which are non-randomized, unblinded, and without any specific treatment protocols involving glucose-lowering drugs.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Detection of asymptomatic drug-induced hypoglycemia using continuous glucose monitoring in older people – Systematic review

Mattishent

Loke

2018

Journal of Diabetes and its Complications

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Personal Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older

Cited by 16 publications

References 12 publications

Efficacy and safety of long-term insulin pump treatment in patients with type 1 diabetes aged over 50 years

Efficacy and safety of long-term insulin pump treatment in patients with type 1 diabetes aged over 50 years

The Impact of Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older

Detection of asymptomatic drug-induced hypoglycemia using continuous glucose monitoring in older people – Systematic review

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