Lalita Prasad-Reddy Alvin Godina , Ashwin Chetty , Diana Isaacs

Abstract
Many new technologies have been developed over the past decade, and these have substantially changed the way diabetes is managed. Continuous glucose monitoring is now the standard of care for many people living with diabetes, and among its numerous benefits, it has been shown to improve glycaemic outcomes and enhance quality of life. Older adults carry a high burden of diabetes and have a high risk of hypo-glycaemia and hypo-glycaemic unawareness, and continuous glucose monitoring can help to improve glycaemic management in this vulnerable population. Unfortunately, only a few trials have evaluated the effectiveness of continuous glucose monitoring in older adults. Certainly, the implementation of continuous glucose monitoring in older adults can come with many challenges, including logistical, educational and reimbursement barriers. This article will discuss the benefits of continuous glucose monitoring in older adults with diabetes, the clinical studies that support its use and the barriers to its optimal implementation in this population.
Keywords: Diabetes, continuous glucose monitoring, diabetes technology, older adults, blood glucose monitoring, diabetes management

Recent advances in technology have changed the landscape for managing diabetes treatment. Thanks to innovations such as connected insulin pens, sensor-augmented pump systems, automated insulin delivery, integrated mobile applications and continuous glucose monitoring (CGM) systems, people with diabetes now have access to devices that are easier to use and far less invasive than those available previously. Although CGM is now a standard of care for people living with diabetes, its use – especially in older populations – is under-appreciated. The benefit of CGM in adults with diabetes has been repeatedly shown to improve glycaemic outcomes and quality of life.1–6 Unfortunately, many clinical trials included either small proportions of older adults or none at all. Thus, their results are difficult to extrapolate to this population subset. More recently, new data and guidelines have been published that specifically address the use of diabetes technology in older adults.
CGM systems measure glucose in the interstitial fluid every 1–5 minutes and record this information every 5–15 minutes, depending on the device. Many CGM devices offer alerts for customizable high or low glucose thresholds. Furthermore, many devices can predict when glucose will reach such a threshold and provide alerts, which can be beneficial in older adults. For some devices, the transmitter and sensor are connected (e.g. FreeStyle Libre [Abbott Laboratories, Chicago, IL, USA]), whereas others require an additional step to attach the transmitter (Dexcom G6 [Dexcom, San Diego, CA, USA], Eversense® [Ascensia, Basel, Switzerland], Guardian™ [Medtronic, Dublin, Ireland]). A reader, receiver or mobile application displays the glucose readings and trend arrows and indicates whether glucose is rising or falling. Many devices are approved by the US Food and Drug Administration (FDA) to replace blood glucose monitoring, also called a non-adjunctive indication. A key difference between systems is their ability to integrate with connected insulin pens and insulin pumps. Table 1 compares the CGM systems available in the USA…..

For the full published article from the source, click here: https://pmc.ncbi.nlm.nih.gov/articles/PMC9835808/