An aging population and better long-term diabetes treatment options mean more people with diabetes are living longer. The Centers for Medicare and Medicaid Services approved reimbursement for select continuous glucose monitoring (CGM) devices in 2017, but there are limited data on the use of CGM, insulin pumps, and other advanced diabetes technologies in older adults. Three clinical researchers will share their insights, experience, and trial results during Sunday’s Current Issues session Should Advanced Diabetes Technology Be Used in Older Adults? The one-hour session begins at 5:30 p.m. in N-Hall E (North, Exhibition Level).
What are the challenges of treating older adults with diabetes?
Richard E. Pratley, MD, Samuel E. Crockett Chair in Diabetes Research and Medical Director at AdventHealth Translational Research Institute for Diabetes and Metabolism: We see patients in their ’60s and ’70s in clinic with type 1 diabetes, oftentimes a 50-year duration. These people are very susceptible to hypoglycemia. In part, it’s that they’ve had diabetes so long they have hypoglycemic unawareness. But mostly it’s because they have managed their diabetes very tightly over a number of years and hypoglycemia is a consequence.
Medha Munshi, MD, Director of the Joslin Geriatric Diabetes Programs: If you want to treat diabetes in either older or younger people, you have to think about what else is going on in their lives. If you have younger patients, it’s what’s happening at home and in school. With older adults, it’s what other clinical issues they have and their psychosocial status. Thinking about diabetes in isolation will not be a success.
Grazia Aleppo, MD, Professor of Medicine and Medical Director of the Diabetes Education Program at Northwestern University: Healthy older adults can use technology and benefit from it. Vulnerable older adults with cognitive impairments, visual and hearing impairments, and dexterity problems may have significant challenges using diabetes technology. Technology is not yet simple enough for these patients. Managing diabetes with technology for some older adults means changing things they’ve done for a long time and learning new skills or behaviors can be more difficult with age.
What’s the evidence for using advanced technology in older adults?
Dr. Aleppo: Very little so far. Studies using online questionnaires report positive results with CGM use in older adults. However, the respondents are self-selected for success because they’re able to access online studies and can use computers and smartphones.
Dr. Pratley: We are using CGM in clinical practice, but we’re doing it without a lot of evidence. I will be discussing the results of the first CGM study in older patients with type 1 diabetes. More than 200 patients were randomized to CGM or self-monitored glucose for six months, then allowed to choose their own method for another six months of observation.
What’s the future of technology use in older populations?
Dr. Aleppo: We’re in a transition phase with older adults going from an analog population to a digital population. In 10 years, we won’t even be asking the question because most older adults will be using technology, including for diabetes.
Dr. Munshi: One guarantee is that we will all be seeing more older adults with diabetes in clinic and using more technology. We just need to use the technology that’s appropriate for the individual patient.
Dr. Pratley: There’s a bias that older adults are less able to use technology. There’s some truth to that assumption, but it’s changing as more people use more technology throughout their lives. The experience and the evidence are very compelling to use more technology in our older individuals with diabetes.