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

Background 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). Methods 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). Results A total of 66 participants completed the six weeks of CGM (age 72 center dot 8 +/- 5 center dot 3 years; BMI 27 center dot 8 +/- 3 center dot 6 kg/m2), HbA1c: 8 center dot 0 +/- 0 center dot 6%, with an overall sensor utilization of 93 center dot 1 +/- 6 center dot 0%. We observed a stability in TIR (baseline: 63.5 +/- 18.9% vs. endpoint: 65.5 +/- 18.8%; beta = 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%; (beta=-1.00, p = 0.008). Glucose variability also reduced from the baseline (34.9 +/- 7.2%) to the endpoint (33.0 +/- 6.8%) (beta=-0.99, p = < 0.001). Conclusion 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.