CGM devices may pose problems with use for adults aged 50 to 85 years with diabetes
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Researchers highlighted challenges with continuous glucose monitoring devices, including trouble interpreting results, device adhesion and smartphone access, among adults aged 50 to 85 years with type 1 or type 2 diabetes.
Findings were published in Applied Clinical Informatics.
“This is a whole area of health technology that needs study,” Michael Weiner, MD, MPH, research scientist at the Center for Health Services Research at the Regenstrief Institute and the department of medicine at Indiana University and the department of Veterans Affairs, Veteran Health Administration, Health Services Research and Development Service at the Center for Health Information and Communication, Indianapolis, said in a related press release. “There’s hardware involved, which is the device itself. There’s software involved, which is reading, organizing, interpreting and communicating the data from the device. Knowing how the technology works in the real world and the impact of the technology on usability and ultimately on health outcomes is important.”
In a small pilot study, researchers enrolled seven Black and three white adults with diabetes aged 50 to 85 years who were patients at a safety-net institution in central Indiana. Participants were helped to use a CGM, physical activity monitor, electronic medication bottles and smartphones facilitating prompts about medications, behaviors and symptoms for 10 to 14 days.
Next, researchers enrolled 70 adults with diabetes (mean age, 60 years; 59% women; 67% Black, 31% white and 1.4% other) for a similar study. At entry 23% reported never checking their blood glucose prior to the study period, about half reported no regular meal routine, 67% reported previous hypoglycemia. Almost all (97%) reported using a smartphone at least twice in the week before enrollment, but 19% reported never having used the internet. Participants wore CGM devices and activity monitors and used smartphones and smart medication bottles for 2 weeks. All participants provided feedback on the devices.
In the first pilot study, the 10 participants reported problems related to the failure of the CGM device adhesive and understanding graphs that required assistance to interpret.
In the second study with 70 participants, during the 2-week period, 73% of participants had hypoglycemia with a glucose level of 70 mg/dL or lower, and 42% had clinically significant hypoglycemia with a glucose level below 54 mg/dL. Hypoglycemia was also identified among eight participants by home-based blood glucose measurement. Almost 33% of daytime smartphone prompts went unanswered by participants due to many participants not carrying their smartphones as instructed, and 24% of participants reported that CGM devices became detached unintentionally.
In addition, worry or fear about low blood glucose was reported as worse during the study by 1.4% of participants, unchanged in 79% and better in 20%.
“We identified opportunities to decrease the frequency of [hypoglycemia], including shared monitoring results, tailored recommendations and automated prompts based on triggers from continuous monitoring, but successful prompting will require more attention to engineering the workflow of activity to promote adherence and ease of reporting,” the researchers wrote.
Reference:
- Blood sugar monitoring devices pose wearability and use problems for older adults with diabetes and caregivers. http://www.regenstrief.org/article/blood-sugar-monitoring-devices-pose-wearability-and-use-problems-for-older-adults-with-diabetes-and-caregivers/. Published Jan. 26, 2023. Accessed Jan. 27, 2023.
Perspective
Back to TopFrom my perspective, there are several unique challenges faced by the elderly when using CGM systems. The main challenge involves one's comfort level with technology — learning to use the system, alarm fatigue, interpreting and sharing the data, and so on. I have found that this can be handled with proper training, delivered at a pace and style that suits the user.
Older adults are less likely to own smartphones, forcing reliance on the manufacturer's handheld receiver. The receiver displays may be difficult for those with reduced vision to see clearly, and the programming of the receivers can be cumbersome — issues that the manufacturers need to address. Inserting the sensors can be difficult for some older users, as the insertion devices require a certain degree of hand strength and dexterity. Device manufacturers need to take this into greater consideration when designing future iterations of the products. Skin issues can present challenges too. Bruising/bleeding is common, particularly for those who take blood thinners. Removal of the sensors may be difficult for those with thin/dry skin, and oils and adhesive solvents can help in this regard. Finally, dehydration is a common issue in the elderly, and proper hydration is essential for CGM performance. Hydration education should be provided for all elderly patients.
Overall, the pros far outweigh the cons when it comes to CGM use for older adults. CGM is a great tool for avoiding dangerous hypoglycemia, particularly for those with hypoglycemia unawareness, which is very common in older patients, and for showing how one's daily behaviors influence glucose levels. The challenges facing the elderly when using CGM can typically be overcome with proper education and training.
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