A Telehealth Program Using Continuous Glucose Monitoring and a Connected Insulin Pen Cap in Nursing Homes for Older Adults with Insulin-Treated Diabetes: The Trescasas Study

<b><i>Objective:</i></b> To assess the impact and feasibility of a telehealth program using continuous glucose monitoring (CGM) and a connected insulin pen cap (CIPC) in nursing homes for older adults with insulin-treated diabetes. <b><i>Research Methods:</i></b> This multicenter, prospective, sequential, single-arm study consisted of three phases: (1) baseline, blind CGM (<i>Freestyle Libre Pro®</i>); (2) intervention 1, CGM (<i>Freestyle Libre2®</i>) without alarms; and (3) intervention 2, CGM with alarms for hypo and hyperglycemia. Two telehealth visits from reference diabetes units were conducted to adjust antidiabetic treatments. Insulin treatment was tracked using the <i>Insulclock®</i> CIPC. The study's primary objective was to evaluate the reduction of hypoglycemia rate. <b><i>Results:</i></b> Of 82 eligible patients at seven nursing homes, 54 completed the study (age: 87.7 ± 7.1, 68-102 years, 56% women, duration of diabetes: 18.7 years, baseline glycated hemoglobin: 6.9% [52 mmol/mol]). The mean number of hypoglycemic events was significantly reduced from baseline (4.4) to intervention 1 (2.8; <i>P</i> = 0.060) and intervention 2 (2.1; <i>P</i> = 0.023). The time below range 70 mg/dL (3.9 mmol/L) significantly decreased from 3.7% at baseline to 1.4% at intervention 2 (<i>P</i> = 0.036). The number of insulin injections significantly decreased from baseline to intervention 1 (1.2 to 0.99; <i>P</i> = 0.027). Nursing home staff expressed a positive view of the program, greater convenience, and potential to reduce hypoglycemia with the <i>Freestyle Libre2®</i> CGM versus the glucometer. <b><i>Conclusions:</i></b> A telehealth program using CGM and a CIPC was associated with improved glycemic profiles among institutionalized older individuals with diabetes receiving insulin and was well perceived by professionals.