Clin-STAR Corner: Practice Changing Advances in Diabetes Care

Diabetes is common among older adults. While most cases are type 2, treatment advances and more adult-onset cases have led to more individuals living with type 1 diabetes. All older adults with diabetes are at an increased risk for hypoglycemia, yet this risk is especially high among those with type 1 diabetes due to the lifelong requirement for insulin. Advanced diabetes technologies-such as continuous glucose monitoring (CGM) and automated insulin delivery systems (AID)-can improve glycemic management, enhance safety, and reduce complications in insulin-requiring individuals.

We aimed to review randomized controlled trials that tested the feasibility and effectiveness of diabetes technology in older adult populations.

We conducted a searchfrom 08/15/2024-09/15/2024 that was updated 01/15/2025. We selected six studies testing CGM and AID use in adults ≥ 60 with diabetes, ≥ 3 months follow-up, ≥ 30 participants, and primary glycemic outcomes, prioritizing methodological rigor and clinical relevance.

The selected studies demonstrated that CGM reduces hypoglycemia and increases time spent in the target glucose range (70-180 mg/dL) compared to blood glucose monitoring in older adults, with benefits seen across insulin regimens and diabetes types. AID systems reduce both hypoglycemia and hyperglycemia in older adults with type 1 diabetes. Participant adherence and acceptability measures were consistantly high.

These trials suggest that diabetes technology is feasible to implement in older adult populations and can reduce hypoglycemia without increasing hyperglycemia.

Additional research testing these technologies among populations with age-related impairments is necessary, as are efforts to implement and ensure broad accessibility of these technologies across diverse care settings, including primary and geriatrics care.