Use of continuous glucose monitoring in insulin-treated older adults with type 2 diabetes

• Published in: Diabetology and metabolic syndrome Vol. 15; no. 1; p. 240
• Main Authors: Leite, Silmara A O, Silva, Michael P, Lavalle, Ana C R, Bertogy, Maria C V, Bastos, Murilo, Kuklik, Suelen C Vieira, Umpierrez, Guillermo
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23-11-2023; BioMed Central; BMC
• Subjects: Age; Aged; Blood sugar monitoring; Cardiovascular disease; Dextrose; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes therapy; Glucose; Glucose monitoring; Glycosylated hemoglobin; Hypoglycemia; Insulin; Older people; Patient monitoring equipment; Patients; Research centers; Sarcopenia; Sensors; Statistical analysis; Type 2 diabetes
• ISSN: 1758-5996; 1758-5996
• DOI: 10.1186/s13098-023-01225-4

Few studies have reported the adherence to and efficacy of continuous glucose monitoring (CGM) for improving diabetes management in insulin-treated older adults with type 2 diabetes mellitus (T2DM).
Prospective observational cohort study using FreeStyle Libre Flash CGM in insulin-treated adults > 65 years with T2DM and HbA1c between 7% and 9%. The participants wore the CGM during the 6-weeks study period. The primary outcome was time in range (TIR) between 70 and 180 mg/dL. Secondary outcomes included time below range (TBR), glycemic variability (GV), adherence, and use of glucose data for self-insulin adjustment. Linear regressions with random effects verified the changes in TBR, TIR, time above range (TAR), GV, and GMI across the three visits using CGM (baseline, 4 weeks and 6 weeks), controlled for sex, age, educational level, and health system (private or public).
A total of 66 participants completed the six weeks of CGM (age 72·8 ± 5·3 years; BMI 27·8 ± 3·6 kg/m2), HbA1c: 8·0 ± 0·6%, with an overall sensor utilization of 93·1 ± 6·0%. We observed a stability in TIR (baseline: 63.5 ± 18.9% vs. endpoint: 65.5 ± 18.8%; β = 1,0, p = 0.190). Despite the low TBR at the baseline, we observed statistically significant reduction over the study period (baseline: 5.8 ± 7.0% vs. endpoint: 3.8 ± 4.7%; (β=-1.00, p = 0.008). Glucose variability also reduced from the baseline (34.9 ± 7.2%) to the endpoint (33.0 ± 6.8%) (β=-0.99, p = < 0.001).
FreeStyle Libre Flash CGM is well accepted by older adults with T2DM and allows participants to make therapeutic decisions to reduce TBR and glycemic variability.