The Use of a Continuous Glucose Monitoring Device in Older People

Abstract Background The incidences of diabetes mellitus, dementia and frailty are individually increasing. Continuous glucose monitoring(CGM) is a wearable technology that measures interstitial glucose in real-time and avoids the need for finger pricks. CGM is associated with improved quality of life, improved glycemic control and reduced hypoglycaemia. Ageism in digital health can be a barrier for older people accessing valuable healthcare technology. Therefore, we aimed to audit CGM use and outcomes in older adults living with diabetes. Methods Patient demographics, glycated haemoglobin (HbA1c) and CGM metrics were gathered retrospectively on people over the age of 65 living with diabetes, using CGM and on insulin. Data was collected from electronic patient records between December 2020-2024. The clinical frailty scale was used to assess frailty where scores ≥4 were considered consistent with frailty. Baseline fortnightly glycaemic metrics were compared to recent follow-up. Results There were 123 people included. The mean age 73.3(±6.2, range 65-92) years, 52%(n=64) were male, 76(61.8%) had type 1 diabetes, 45 (36.6%) had type 2 diabetes, mean duration of diabetes was 31.3(±15.4) years. Eighty-five percent had microvascular or macrovascular complications from diabetes. The average Charlson Comorbidity Index score was 5.6 (±1.5, range: 3-12). The mean CFS score was 4.6 (±2.3). There were two nursing home residents. There was a statistically significant improvement in HbA1c from CGM commencement to follow up (67.4 mmol/mol [±13.7] versus 64.9 mmol/mol [±13.2], p=0.01). There was no significant change in time spent in hypoglycaemia demonstrated. Conclusion CGM is an effective tool in a real world older adult population. This study demonstrates that CGM use lowered HbA1c in older adults, in line with research conducted in younger cohorts, without increasing time spent in hypoglycaemia. Further research is needed into the impact of CGM on older adults and for those who care for them.