Clin-STAR Corner: Practice Changing Advances in Diabetes Care

Area of Science:

• Gerontology
• Endocrinology
• Medical Technology

Background:

• Diabetes is prevalent in older adults, with increasing numbers of type 1 diabetes cases.
• Older adults with diabetes face a high risk of hypoglycemia, particularly those with type 1 diabetes requiring insulin.
• Advanced diabetes technologies offer potential benefits for glycemic management and safety in this population.

Purpose of the Study:

• To review randomized controlled trials on the feasibility and effectiveness of diabetes technology in older adults.
• To assess the impact of continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems in this demographic.

Main Methods:

• A systematic search of randomized controlled trials was conducted.
• Six studies involving adults aged 60 and above with diabetes, using CGM and/or AID systems, were selected.
• Studies focused on glycemic outcomes with a minimum follow-up of 3 months and 30 participants.

Main Results:

• Continuous glucose monitoring (CGM) significantly reduced hypoglycemia and increased time in the target glucose range (70-180 mg/dL) compared to traditional blood glucose monitoring.
• Automated insulin delivery (AID) systems effectively reduced both hypoglycemia and hyperglycemia in older adults with type 1 diabetes.
• High participant adherence and acceptability were consistently reported for both CGM and AID systems.

Conclusions:

• Diabetes technology, including CGM and AID, is feasible for older adults and effectively reduces hypoglycemia without increasing hyperglycemia.
• Further research is needed for populations with age-related impairments.
• Implementation and accessibility of these technologies across diverse healthcare settings are crucial.