Use of Telecommunication and Diabetes-Related Technologies in Older Adults With Type 1 Diabetes During a Time of Sudden Isolation: Mixed Methods Study

Continuous Glucose Monitoring With Geriatric Principles in Older Adults With Type 1 Diabetes and Hypoglycemia: A Randomized Controlled Trial

OBJECTIVE

Continuous glucose monitoring (CGM) use in older adults with type 1 diabetes (T1D) has shown benefits. However, the impact of CGM use, coupled with simplified treatment regimens and personalized glycemic goals that are better suited for older patients with multiple comorbidities and hypoglycemia, is not known.

RESEARCH DESIGN AND METHODS

Older adults (≥65 years) with T1D with hypoglycemia (two or more episodes of hypoglycemia [blood glucose <70 mg/dL for ≥20 min over 2 weeks]) who were CGM naive or CGM users were randomized to intervention and control groups. The intervention consisted of the combined use of CGM with geriatric principles (i.e., adjusting goals based on overall health, and simplification of regimens based on CGM patterns and clinical characteristics) over 6 months. The control group received usual care by their endocrinologist. The primary end point was change in time when blood glucose was <70 mg/dL from baseline to 6 months. Cost-effectiveness was calculated using a health care sector perspective.

RESULTS

We randomized 131 participants (aged 71 ± 5 years; 21% ≥75 years old) to the intervention (n = 68; CGM users = 33) or the control (n = 63; CGM users = 40) group. The median change in hypoglycemia from baseline to 6 months was -2.6% in the intervention group and -0.3% in the control group (median difference, -2.3% [95% CI -3.7%, -1.3%]; P < 0.001). This improvement was seen in both CGM naive (-2.8%; 95% CI -5.6%, -0.8%) and CGM users (-1.2%; 95% CI -2.7%, -0.1%). The HbA1c did not differ between the groups (7.5% vs. 7.3%). The intervention was cost-effective (incremental cost-effectiveness ratio $71,623 per quality adjusted life-year).

CONCLUSIONS

In older adults with T1D and high risk of hypoglycemia, CGM use enhanced by geriatric principles can lower hypoglycemia without worsening glycemic control in a cost-effective fashion.

Patient and Clinician Perspectives on the Effectiveness of Current Telemedicine Approaches in Endocrinology Care for Type 2 Diabetes: Qualitative Study

BACKGROUND

Since the rapid widespread uptake in 2020, the use of telemedicine to deliver diabetes specialty care has persisted. However, evidence evaluating patient and clinician perspectives on benefits, shortcomings, and approaches to improve telemedicine care for type 2 diabetes is limited.

OBJECTIVE

This study aims to assess clinician and patient perspectives on specific benefits and limitations of current telemedicine care delivery for type 2 diabetes and views on approaches to enhance telemedicine effectiveness for patients who rely on it.

METHODS

We conducted semistructured qualitative interviews with diabetes specialty clinicians and adults with type 2 diabetes. We used a qualitative description approach to characterize participant perspectives on care delivery for type 2 diabetes via telemedicine.

RESULTS

Both clinicians (n=15) and patients (n=13) identify significant benefits of telemedicine in overcoming both physical (geographic and transportation) and scheduling (work commitments and wait times) barriers to specialty care for type 2 diabetes. In addition, telemedicine may enhance communication around diabetes care by improving information sharing between patients and clinicians. However, clinicians identify limited availability of home blood glucose data and vital signs as factors, which impair the optimal management of type 2 diabetes and related comorbid conditions via telemedicine. Previsit preparation, involvement of multidisciplinary providers, and frequent brief check-ins were identified by patients and clinicians as potential strategies to improve the quality of telemedicine care for adults with type 2 diabetes.

CONCLUSIONS

Patients and clinicians identify key strengths of telemedicine in enhancing access to diabetes specialty care for adults with type 2 diabetes and describe approaches to ensure that telemedicine delivers high-quality diabetes care to patients who rely on it.

Habit and Help-Experiences of Technology Use During the COVID-19 Pandemic: Interview Study Among Older Adults

BACKGROUND

The COVID-19 pandemic compelled older adults to engage with technology to a greater extent given emergent public health observance and home-sheltering restrictions in the United States. This study examined subjective experiences of technology use among older adults as a result of unforeseen and widespread public health guidance catalyzing their use of technology differently, more often, or in new ways.

OBJECTIVE

This study aimed to explore whether older adults scoring higher on the Unified Theory of Acceptance and Use of Technology questionnaire fared better in aspects of technology use, and reported better subjective experiences, in comparison with those scoring lower.

METHODS

A qualitative study using prevalence and thematic analyses of data from 18 older adults (mean age 79 years) in 2 groups: 9 scoring higher and 9 scoring lower on the Unified Theory of Acceptance and Use of Technology questionnaire.

RESULTS

Older adults were fairly competent technology users across both higher- and lower-scoring groups. The higher-scoring group noted greater use of technology in terms of telehealth and getting groceries and household items. Cognitive difficulty was described only among the lower-scoring group; they used technology less to get groceries and household items and to obtain health information. Qualitative themes depict the role of habit in technology use, enthusiasm about technology buttressed by the protective role of technology, challenges in technology use, and getting help regardless of technology mastery.

CONCLUSIONS

Whereas the pandemic compelled older adults to alter or increase technology use, it did not change their global outlook on technology use. Older adults' prepandemic habits of technology use and available help influenced the degree to which they made use of technology during the COVID-19 pandemic.

Patient experiences of continuous glucose monitoring and sensor-augmented insulin pump therapy for diabetes: A systematic review of qualitative studies

AIMS

Blood glucose control is central to the management of diabetes, and continuous glucose monitoring (CGM) improves glycemic control. We aimed to describe the perspectives of people with diabetes using CGM.

MATERIALS AND METHODS

We performed a systematic review of qualitative studies.

RESULTS

Fifty-four studies involving 1845 participants were included. Six themes were identified: gaining control and convenience (reducing pain and time, safeguarding against complications, achieving stricter glucose levels, and sharing responsibility with family); motivating self-management (fostering ownership, and increasing awareness of glycemic control); providing reassurance and freedom (attaining peace of mind, and restoring social participation); developing confidence (encouraged by the endorsement of others, gaining operational skills, customizing settings for ease of use, and trust in the device); burdened with device complexities (bewildered by unfamiliar technology, reluctant to rely on algorithms, overwhelmed by data, frustrated with malfunctioning and inaccuracy, distressed by alerts, and bulkiness of machines interfering with lifestyle); and excluded by barriers to access (constrained by cost, lack of suppliers).

CONCLUSIONS

CGM can improve self-management and confidence in patients managing diabetes. However, the technical issues, uncertainty in readings, and cost may limit the uptake. Education and training from the health professionals may help to reduce the practical and psychological burden for better patient outcomes.