November is National Diabetes Month. In the United States, more than 13.3 million people older than age 65 have diabetes. Furthermore, the incidence of diabetes increases as people age, with those ages 65 and older having higher rates of diagnosed diabetes compared to those ages 18–44.
These staggering statistics highlight the increasing importance of effective diabetes management as people age. Advancements in diabetes technology have made it possible for a person living with diabetes to see their blood glucose levels and trends any time of day through a continuous glucose monitor (CGM). The ability for patients and healthcare teams to receive such blood glucose information and track patterns may help to provide better outcomes for people with diabetes.
All patients with diabetes should have access to tools that can manage their disease more effectively. Monitoring of blood glucose is one tool used to achieve individual diabetes goals. New technology for glucose monitoring allows easier viewing of glucose information in real time without painful finger stick testing.
CGM consists of a flexible thin sensor inserted under the skin to measure glucose continuously and send readings to an external device (smartphone or specialized reader). Advantages include patients’ ability to view current blood glucose levels as well as see past glucose trends on a historical graph, with trend arrows indicating the direction blood glucose is headed. In addition, CGM can alert patients if blood glucose is too high or too low, depending upon individualized personal alarm settings. This feature is critical for some individuals with diabetes, especially those with a long history of the disease and older adults, who may be less likely to sense when their blood glucose is low. All of these advantages can lead to improved diabetes outcomes and better quality of life.
Continuous glucose monitoring provides information that can spur behavior change.
Despite known benefits, there are barriers to adoption of CGM such as insurance restrictions, misperceptions and some bias against patient ability to adopt technology (particularly for older patients). Yet evidence demonstrates older adults can effectively use CGM and show improvements in hemoglobin A1C levels (a test used to help monitor diabetes management) and preventing hypoglycemia (low blood glucose). One recent study documented those ages 65 and older who used CGM had a significant decrease in their hemoglobin A1C (from 8.9% to 7.5%) maintained over two years. Furthermore, participants older than age 75 had similar A1C reductions for the same period. These A1C reductions were achieved without any severe hypoglycemia.
According to the 2022 American Diabetes Association Standards of Medical Care in Diabetes, older adults who have diabetes are at a greater risk of hypoglycemia compared to younger people. Thus, it is recommended that during older adults’ routine diabetes care visits that healthcare providers screen for hypoglycemia. This can be accomplished by the healthcare team accessing CGM data. Also recommended is real time or intermittently scanned CGM data for improved management of older adults on insulin (whether Type 1 or Type 2 diabetes) to help reduce hypoglycemia.
In addition to helping improve blood glucose levels, CGM provides information that can help empower behavior change. Healthy eating and blood glucose monitoring are two of seven areas included in diabetes self-management education and support (DSME) curricula. Combining healthy eating education with CGM can result in a positive effect on behavioral outcomes.
One study accessing the Self-Evaluation of Unhealthy foods by Looking (SEOUL) at postprandial glucose algorithm was created and applied to guide education for patients to follow healthy eating behaviors depending upon the individualized after-meal glucose response. Using this lifestyle modification tool based on eating behavior with CGM led to a 0.5% reduction in A1C and improvements in the Summary of Diabetes Self-Care Activities (SDSCA) score. SDSCA is a brief self-report questionnaire of diabetes self-management assessing: general diet, specific diet, exercise, blood-glucose testing, foot care and smoking. This study highlighted the impact of personal CGM resulting in patient-driven behavioral change.
Use of CGM to manage diabetes in older populations can lead to better health outcomes, which may result in an improved quality of life. It is important for all people with diabetes regardless of age to be educated on CGM benefits and offered access to this important medical device.
Anniece Spencer, DNP, FNP-C, BC-ADM is medical science liaison for Abbott Diabetes Care in Alameda, California.