Personal real-time continuous glucose monitoring in patients 65 years and older

Little information is available on personal real-time continuous glucose monitoring (PCGM) in patients ≥65 years old. We report on PCGM use in insulin-requiring patients ≥65 years old in a community endocrine practice.

Patients ≥65 or older who had been prescribed PCGM were identified by retrospective review. Glycated hemoglobin (A1C) values from the year prior and subsequent to PCGM prescription, the most recent A1C value, continued PCGM usage, percentage reporting severe hypoglycemia (SH), and rate of SH were examined.

Thirty-eight patients were identified: 31 with type 1 diabetes, 21 females, mean age 70 years (range 65-78), and a mean diabetes duration of 31 years. Overall, 28 were on insulin pump therapy, 29 were using PCGM regularly, and 25 had both pre- and post-PCGM use A1C results. Regular PCGM use was associated with a decrease in mean (SD) A1C: 7.6 (0.9)% to 7.1 (0.9)%, (P<.0001) that was maintained until the most recent A1C value (7.2 [0.8]%, P = .0145, average 37 months), with fewer reporting SH (from 79% to 31%, P = .0002), and a lower rate of SH (0.37 to 0.12 per year, P = .0007). The group of 9 patients who did not continue PCGM (mean use 3 months) was too small to allow meaningful statistical evaluation. Lack of insurance coverage was the most common reason given for not using/continuing PCGM. Those continuing PCGM were more likely to have insurance coverage for PCGM (86%) than those not continuing PCGM (25%).

Patients ≥65 with insulin-requiring diabetes achieve improved glycemic control with regular PCGM use. The presence of PCGM insurance coverage favored continued PCGM use.