February 01, 2023
2 min read

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.
Infographic content were derived from Weiner M, et al. Appl Clin Inform. 2023;doi:10.1055/a-1975-4136.

“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 homebased
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/bloodsugar-
monitoring-devices-pose-wearability-and-use-problems-for-olderadults-
with-diabetes-and-caregivers/. Published Jan. 26, 2023. Accessed
Jan. 27, 2023.

Perspective
From 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.

Gary Scheiner, MS, CDCES
Owner and Clinical Director
Integrated Diabetes Services

Disclosures: Scheiner reports no relevant financial disclosures.
Sources/Disclosures

Disclosures: Weiner reports stock ownership in AbbVie, Amgen, Boston
Scientific Corp., Bristol Myers Squibb, IBM, Integer Holdings Corp., Johnson
& Johnson, Mallinckrodt PLC, Mead Johnson & Co., Medtronic, Mylan N.V.,
Novo Nordisk, Perspecta, Pfizer, Roche, Senseonics, Stryker, Teva and
Walgreens Boots Alliance. Please see the study for all other authors’ relevant
financial disclosures.

To read full article, click here: https://www.healio.com/news/endocrinology/20230131/cgm-devices-may-pose-problems-with-use-for-adults-aged-50-to-85-years-with-diabetes