Continuous glucose monitoring in elderly patients treated with insulin
Authors:
MUDr. Markéta Kubíčková
Authors‘ workplace:
III. interní gerontometabolická klinika FN Hradec Králové
Published in:
Geriatrie a Gerontologie 2020, 9, č. 2: 101-104
Category:
Review Article
Overview
Elderly patients with diabetes mellitus treated with insulin are at risk of hypoglycaemia. Hypoglycemia is associated with increased morbidity and mortality. Comorbidities, sensory and cognitive disorders, often present at old age, reduce the ability to maintain regularity in diet and motoric exercise. The result is greater fluctuations in glycaemia.
Without adequate self-monitoring, successful and safe treatment is not possible. But it is the ability and willingness to perform it in geriatric patients that is also declining. New technologies, such as Flash Glucose Monitoring (FGM) or some forms of Continuous Glucose Monitoring (CGM), expand glycemic self-monitoring capabilities, are simple, and increase the much needed safety of treatment.
Keywords:
hypoglycemia – diabetes mellitus – insulin – elderly patients – continuous glucose monitoring CGM – flash glucose monitoring
Sources
1. Pickup JC, Freeman SC, Sutton AJ. Glycaemic control in type 1 diabetes during real time continuous glucose monitoring compared with self monitoring of blood glucose: meta-analysis of randomised controlled trials using individual patient data. BMJ. 2011; 343: d3805.
2. Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care. 2011; 34(4): 795–800.
3. Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. Effectiveness of continuous glucose monitoring in a clinical care environment: evidence from the Juvenile Diabetes Research Foundation continuous glucose monitoring (JDRF-CGM) trial. Diabetes Care. 2010; 33(1): 17–22.
4. Weiss R, Garg SK, Bode BW, et al. Hypoglycemia reduction and changes in hemoglobin A1c in the ASPIRE In-Home Study. Diabetes Technol Ther. 2015; 17(8): 542–547.
5. Yeh HC, Brown TT, Maruthur N, et al. Comparative effectiveness and safety of methods of insulin delivery and glucose monitoring for diabetes mellitus: a systematic review and meta-analysis. Ann Intern Med. 2012; 157(5):336–347.
6. Garg SK, Voelmle MK, Beatson CR, et al. Use of continuous glucose monitoring in subjects with type 1 diabetes on multiple daily injections versus continuous subcutaneous insulin infusion therapy: a prospective 6-month study. Diabetes Care. 2011; 34(3): 574–579.
7. Hommel E, Olsen B, Battelino T, et al. Impact of continuous glucose monitoring on quality of life, treatment satisfaction, and use of medical care resources: analyses from the SWITCH study. Acta Diabetol. 2014; 51(5): 845–851.
8. Poolsup N, Suksomboon N, Kyaw AM. Systematic review and meta-analysis of the effectiveness of continuous glucose monitoring (CGM) on glucose control in diabetes. Diabetol Metab Syndr. 2013; 5: 39.
9. Ehrhardt NM, Chellappa M, Walker MS, Fonda SJ, Vigersky RA. The effect of real-time continuous glucose monitoring on glycemic control in patients with type 2 diabetes mellitus. J Diabetes Sci Technol. 2011;5(3): 668–675.
10. Pettus J, Edelman SV. Differences in use of glucose rate of change (ROC) arrows to adjust insulin therapy among individuals with type 1 and type 2 diabetes who use continuous glucose monitoring (CGM). J Diabetes Sci Technol. 2016;10(5): 1087–1093.
11. Cox DJ, Taylor AG, Moncrief M, et al. Continuous glucose monitoring in the self-management of type 2 diabetes: a paradigm shift. Diabetes Care. 2016;39(5): e71–73.
12. Meneilly GS, Cheung E, Tuokko H. Counterregulatory hormone responses to hypoglycemia in the elderly patient with diabetes. Diabetes. 1994; 43(3): 403–410.
13. Meneilly GS, Tessier D. Diabetes in the elderly. Diabet Med. 1995;12(11): 949–960.
14. Schutt M, Fach EM, Seufert J, et al. Multiple complications and frequent severe hypoglycaemia in “elderly” and “old” patients with type 1 diabetes. Diabet Med. 2012; 29(8): e176–179.
15. Weinstock RS, Xing D, Maahs DM, et al. Severe hypoglycemia and diabetic ketoacidosis in adults with type 1 diabetes: results from the T1D Exchange clinic registry. J Clin Endocrinol Metab. 2013;98(8): 3411–3419.
16. Weinstock RS, DuBose SN, Bergenstal RM, et al. Risk factors associated with severe hypoglycemia in older adults with type 1 diabetes. Diabetes Care. 2016;39(4): 603–610.
17. DuBose SN, Weinstock RS, Beck RW, et al. Hypoglycemia in older adults with type 1 diabetes. Diabetes Technol Ther. 2016;18(12):765–771.
18. Beck RW, Riddlesworth T, Ruedy K, et al. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND Randomized Clinical Trial. JAMA. 2017;317(4): 371–378.
19. Bergenstal R, Riddlesworth T, Ruedy K, Kollman C, Price D, Beck RW. Patients with type 2 diabetes using multiple daily insulin injections have high adherence and benefit from CGM: a prospective, randomized controlled trial. Paper presented at: 10th International Conference on Advanced Technology and Therapeutics (ATTD); February 15–18, 2017; Paris, France.
20. Argento NB, Nakamura K. Personal real-time continuous glucose monitoring in patients 65 years and older. Endocr Pract. 2014;20(12): 1297–1302.
21. Polonsky WH, Peters AL, Hessler D. The impact of real-time continuous glucose monitoring in patients 65 years and older. J Diabetes Sci Technol. 2016;10(4): 892-897.
22. Lipska KJ, Ross JS, Wang Y, et al. National trends in US hospital admissions for hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011. JAMA Intern Med. 2014;174: 1116-1124.
23. Bolinder J, Antuna R, Geelhoed-Duijvestijn P, Kröger J, Weitgasser R. Novel glucose-sensing technology and hypoglycaemia in type 1 diabetes: a multicentre, non-masked, randomised controlled trial. Lancet. 2016 Nov 5; 388(10057): 2254–2263.
24. Miller KM, Beck RW, Bergenstal RM, Goland RS, Haller MJ, McGill JB, Rodriguez H, Simmons JH, Hirsch IB. T1D Exchange Clinic Network. Evidence of a strong association between frequency of self-monitoring of blood glucose and hemoglobin A1c levels in T1D exchange clinic registry participants. Diabetes Care. 2013 Jul;36(7): 2009–2014.
25. JDRF Continuous Glucose Monitoring Study Group. Effectiveness of continuous glucose monitoring in a clinical care environment: evidence from the JDRF Continuous Glucose Monitoring trial. Diabetes Care 2010; 33: 17–22.
26. MacLeod KM, Hepburn DA, Frier BM. Frequency and morbidity of severe hypoglycaemia in insulin-treated diabetic patients. Diabet Med 1993; 10: 238–245.
27. Microvascular and acute complications in IDDM patiens: the EURODIAB IDDM Complications study. Diabetologia 1994; 37: 278–285.
28. Nordin C. The case for hypoglycaemia as a proarrhythmic event: basic and clinical evidence. Diabetologia 2010; 53: 1552–1561.
29. Brierley EJ, Broughton DL, James OF, Alberti KG. Reduced awareness of hypoglycaemia in the elderly despite an intact counterregulatory response. Q J Med 1995; 88: 439–445.
Labels
Geriatrics General practitioner for adults Orthopaedic prostheticsArticle was published in
Geriatrics and Gerontology
![Issue 2](https://www.prolekare.cz/media/cache/resolve/journal_issue/media/image_pdf/53e72890ce5311e7624237787e758eb1.jpeg)
2020 Issue 2
Most read in this issue
- Frail patients in long term care institutions
- Coronavirus infection within senior people – The immunologist’s view
- Influence of selected factors on evalution of dignity of older person
- Risks of treatment by dabigatran in seniors with chronic kidney desease