Use of Technology in Older Adults with Type 1 Diabetes: Clinical Characteristics and Glycemic Metrics

Abstract

Background: The use of diabetes-related technology, both for insulin administration and glucose monitoring, has shown benefits in older adults with type 1 diabetes (T1D). However, the characteristics of older adults with T1D and their use of technology in real-world situations are not well documented. Methods: Older adults (age ≥65 years) with T1D, using insulin pump or multiple daily injections (MDI) for insulin administration, and continuous glucose monitoring (CGM) or glucometer (blood glucose monitoring [BGM]) for glucose monitoring were evaluated. Participants wore CGM for 2 weeks, completed surveys, and underwent laboratory evaluation. Results: We evaluated 165 older adults with T1D; mean age 70 ± 10 years, diabetes duration 40 ± 17 years, and A1C 7.4% ± 0.9% (57 ± 10 mmol/mol). For insulin administration, 63 (38%) were using MDI, while 102 (62%) were using pump. Compared to MDI, pump users were less likely to have cognitive dysfunction (49% vs. 65%, P = 0.04) and had lower scores on the hypoglycemia fear survey (P = 0.03). For glucose monitoring, 95 (58%) used CGM, while 70 (42%) used BGM. Compared to BGM, CGM users were more likely to report impaired awareness of hypoglycemia (IAH) (P = 0.01), and had lower A1C (P = 0.02). Participants who used any technology (pump or CGM) had lower A1C (P = 0.04, 0.006), less hypoglycemia ≤54 mg/dL (P = 0.0006, <0.0001) and <70 mg/dL (P = 0.0002, 0.0001), and fewer glycemic excursions (coefficient of variation %) (P = 0.0001, <0.0001), while reporting more IAH (P = 0.04, P = 0.006) and diabetes distress (P = 0.02, 0.004). Conclusion: Older adults with T1D who use newer diabetes-related technology had better glycemic control, lower hypoglycemia risk, and fewer glycemic excursions. However, they were more likely to report IAH and diabetes-related distress. Clinical trials.gov NCT03078491.

Keywords: A1C test; Diabetes technology; Hypoglycemia; Older adults; Type 1 diabetes.

Conflict of interest statement

M.M.: Consultant for Sanofi and Lilly. C.S., D.D., A.M., K.S., R.D., and A.A.-C.: No conflicts of interest relevant to this article were reported. E.T.: Consultant for Medtronic.

Figures

FIG. 1.

Odds ratios for significant variables for all subgroups in the four categories of technology usage: (A) “Pump+CGM” (n = 67), (B) “Pump+BGM” (n = 35), and (C) “MDI+CGM” (n = 28), using “MDI+BGM” (n = 35) as the reference category. Odds ratios are plotted with their 95% confidence intervals and listed P-values. Boldface P-values were significant at α of 0.05. The x-axis is plotted on a logarithmic scale, with 1.0 and corresponding vertical line representing the null value of the odds ratio scale. BGM, blood glucose monitoring; CGM, continuous glucose monitoring; MDI, multiple daily injections.