medwireNews: Findings from a UK feasibility study suggest that continuous glucose monitoring (CGM) is an acceptable approach for older people with diabetes and memory problems, but devices with automated transfer of glucose readings may be needed to improve completeness of data capture.
The research involved 12 hospitalized patients with an average age of 85 years who had type 1 (n=1) or type 2 (n=11) diabetes, and either a diagnosis of dementia (n=3) or an Abbreviated Mental Test score of 8 points or lower (n=9). After discharge from hospital, participants commenced GCM use with the FreeStyle Libre flash glucose monitoring device, consisting of a reader (or an app for people with certain smartphones) and a sensor.
Katharina Mattishent, from the University of East Anglia in Norwich, and team explain that although the FreeStyle Libre device measures glucose levels continuously, “data are not transmitted continuously from the sensor,” and “the user has to swipe the sensor with a reader […] at 8 hourly intervals in order to achieve complete capture of data throughout the 2-week life-span of a sensor.”
Thus, completeness of data capture by the CGM device “varied considerably,” they report in BMJ Open.
Over 2 weeks, data capture ranged from 3% to 92%, with half of the participants having less than 60% of glucose readings recorded. Of the nine insulin users in the study, 66% experienced hypoglycemic events, with an average duration of 106 to 437 minutes.
The investigators say that the poor data capture in some participants was “due to the need for users to conduct ≥3 scans per day” with the FreeStyle Libre device, and suggest that “devices with automated data transfer may be more suitable in older people with memory problems.”
Nonetheless, Mattishent et al found that “[p]articipants and carers overwhelmingly found using the device acceptable” over 2 weeks of use, with the majority saying that it was unobtrusive and did not interfere with daily activities.
None of the participants reported stress or anxiety related to CGM, while many said they were not aware of the device at night, and the most frequently described advantage was a reduced requirement for finger-prick tests.
The researchers note that their study had a number of limitations, including difficulties recruiting participants in the hospital setting and challenges in study retention, with five of the original 17 participants withdrawing from the study before recording CGM data because they or their carers felt it would be overwhelming.
The team concludes: “There is a clear need for a large-scale prospective study using CGM to assess its true potential impact in this vulnerable group.”
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