Usability of Continuous Glucose Monitoring for Older Adults with Type 2 Diabetes: A Systematic Review

This systematic review aims to examine the use and usability of continuous glucose monitoring (CGM) among older adults with type 2 diabetes mellitus. The following databases, PubMed, Embase, and CINAHL, were searched for studies published between 2019 and 2024, and results were documented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Eligibility criteria included English-language studies that researched the use and usability of CGM in adults 60 years or older with a minimum wear time of 2 weeks. We extracted usability (efficiency, effectiveness, and satisfaction) outcomes. Study quality was assessed using the Critical Appraisal Skills Program Checklist. Of the 118 identified titles, 58 articles underwent a full-text review, with seven being included in the final analysis. Studies evaluated clinical management of type 2 diabetes with CGM, assessing the following differences: CGM versus usual care, CGM across device types, and CGM across care models. Clinical effectiveness, based on glycated hemoglobin and time-in-range, and satisfaction were higher across CGM types compared with usual care. Based on descriptive measures, satisfaction was higher with real-time CGM than professional-mode CGM. Efficiency findings were not reported in the included studies. There were no findings on the effectiveness, efficiency, and satisfaction of ambulatory glucose profile (AGP) metrics. Although the clinical effectiveness of CGM among adults 60 years or older was demonstrated in the reviewed studies, our usability assessment is inconclusive. There is a gap in evidence related to the essential components that comprise the context of CGM use, which prohibits a complete usability assessment. Future studies are warranted to investigate CGM usability, emphasizing AGP metrics, to inform improvements and personalization for older adults.