Professional Continuous Glucose Monitoring for Diabetes Management in Older Adults with Type 2 Diabetes on Insulin: An Underutilized Tool?

Abstract

Background: Professional CGM (proCGM) holds the potential to improve diabetes management in older adults with insulin-treated type 2 diabetes (T2D). However, information on proCGM use and the reasons for and barriers to prescribing it in clinical practice are limited.

Methods: At a tertiary diabetes-only clinic, we reviewed electronic medical records of older adults with T2D (≥ 65 years) on insulin that underwent proCGM. Additionally, we surveyed clinicians on the reasons for and barriers to prescribing proCGM.

Results: During a 3-year period, a total of 2,481 older adults with T2D(72±7 years, HbA1c 8.2±1.5% and diabetes duration 21±10 years) using insulin were seen in the clinic. One- hundred and sixty-nine older adults (7% of the total) underwent proCGM. In the 139 older adults (77±8 years, HbA1c 8.0±1.5%, duration of diabetes 21±12 years) with viable proCGM data, the mean duration of hypoglycemia was high(<70 mg/dL: 5.5±6.3%; ≤54 mg/dL: 2.2±3.5%) and 86% of the cohort had 1 episodes of hypoglycemia(≥15 min). A clinically significant discrepancy (≥0.5%) between HbA1c and glucose management indicator was observed in 65% of the cohort. More than 80% (20/25) of the clinicians reported the use of proCGM was helpful for pattern management and identification of hypoglycemia, however more than half of clinicians reported difficulty with clinical workflow and insurance coverage.

Conclusion: In older adults with T2D on insulin, proCGM identified a high burden of hypoglycemia, despite suboptimal HbA1c. The great majority of clinicians reported use of proCGM helpful for diabetes management, however infrastructures issues were a major barrier to using it.