Continuous glucose monitoring (CGM) systems may be more difficult for older adults to use due to a number of factors, according to a new study published in the journal Applied Clinical Informatics.
CGM systems involve wearing a sensor on or under the skin that detects glucose levels, with many sensors needing to be replaced every 14 days. This sensor connects to a transmitter that sends your glucose readings to a compatible device, such as a smartphone or an insulin pump. Continuous glucose monitoring has been shown to help with blood glucose control in both older and younger people with type 1 diabetes, and has recently become increasingly popular among young people with type 1. Using a CGM system has also been shown to help reduce hospitalizations in people with type 1 or type 2 diabetes.
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For the latest study, researchers were interested in exploring the feasibility of older adults with diabetes using a variety of health-related devices — a CGM system, a physical activity monitor, electronic medication bottles (which help people manage their medications), or a smartphone that offers prompts about medications, behaviors, or symptoms. First, a small pilot group of 10 participants ages 50 to 85 with diabetes was recruited to try out these devices. In the area of CGM, they were asked to review graphs of their glucose values and asked about the experience of using a CGM system. Second, a larger group of 70 participants used each of these devices for two weeks and provided feedback about their experiences to researchers. The second group had an average age of 60 and was 59% female, and 23% of the group indicated that they never checked their blood glucose level on a regular basis before participating in the study.
Difficulties encountered by older CGM users
In the initial pilot group of 10 participants, some participants experienced difficulty with getting CGM sensors to stick effectively to their skin. Participants also often needed help interpreting graphs of their glucose trends that the CGM system generated. In the second larger group of 70 participants, 73% of participants experienced hypoglycemia (low blood glucose, defined as 70 mg/dl or lower) during the study period. Almost one-third of glucose-related alerts (such as warning about hypoglycemia) during the daytime went unanswered by participants, and CGM sensors became detached from the skin in 24% of participants.
“This is a whole area of health technology that needs study,” said study author Michael Weiner, MD, a professor of medicine at the Indiana University School of Medicine, in a news release on the study. “Knowing how the technology works in the real world and the impact of the technology on usability and ultimately on health outcomes is important.”
Weiner noted that many participants ignored CGM system alerts and other smartphone prompts because they didn’t carry their phones with them, and that many participants experienced difficulty using or filling electronic medication bottles. At the same time, the high proportion of participants who experienced hypoglycemia indicates a need for widespread real-time glucose monitoring — suggesting that health care providers may need to work with older people with diabetes to make better use of CGM systems.
Want to learn more about CGM? Read “CGM for Diabetes Management” and “How to Pick an Insulin Pump or CGM.”