Continuous glucose monitoring in older adults with diabetes across care settings: A systematic review

BACKGROUND: Continuous glucose monitoring (CGM) use is increasing among older adults with diabetes, yet evidence across different care settings remains fragmented. OBJECTIVES: To describe how CGM has been used among older adults with diabetes in community, hospital, and nursinghome settings and to synthesize reported clinical, glycemic, and user-reported outcomes. METHODS: Quantitative studies involving adults aged ≥65 years using CGM and reporting clinical or user-related outcomes were included, while non-English articles, pediatric studies, reviews, and studies without CGM-related outcomes were excluded. MEDLINE, CINAHL, Embase, Scopus, Web of Science, and the Cochrane Library were searched from inception to January 2025. Study quality was assessed using NIH tools for randomized and observational studies. Due to heterogeneity across study designs and outcomes, a narrative synthesis was conducted. RESULTS: Thirty-two studies met the inclusion criteria, including 10 randomized trials, 17 cohort studies, and 5 cross-sectional studies. CGM improved glycemic outcomes by reducing HbA1c, increasing time in range, lowering glycemic variability, and identifying previously unrecognized hypoglycemia. Observational studies reported 34-62.9% reductions in hyperglycemia-related hospitalizations and high persistence of CGM use. Feasibility and acceptability were generally positive, although frail and cognitively impaired adults, as well as institutional settings, were underrepresented. DISCUSSION: Heterogeneity in designs and outcomes precluded meta-analysis; most studies were short-term, conducted in community settings, and lacked standardized measures. CGM improves key glycemic indicators and supports safer diabetes care for many older adults. However, wider evidence across hospitals and nursing homes and among frailer populations is needed. Others: No external funding was received. The review was registered in PROSPERO: CRD420250656434.