Continuous glucose monitoring in older adults with diabetes: Data from the diabetes prospective follow-up (DPV) registry

AIMS

To analyse predictors for continuous glucose monitoring (CGM) use in people with diabetes aged ≥60 years using insulin therapy and to assess the rates of CGM use during recent years (2019-2021).

RESEARCH DESIGN AND METHODS

Prospective study including 6849 individuals with diabetes and insulin therapy (type 2 diabetes: n = 5320; type 1 diabetes: n = 1529) aged ≥60 years. Data from 129 treatment centres were retrieved from the Diabetes Prospective Follow-up Registry (DPV) in March 2023.

RESULTS

Sensor use in individuals aged ≥60 years has increased in type 1 (2019: 28%, 2020: 39%, 2021: 45%) and type 2 diabetes (2019: 10%, 2020: 16%, 2021: 18%). Predictors for sensor use in older individuals with type 1 diabetes are younger age and CSII use (p < 0.001). Predictors in older individuals with type 2 diabetes are younger age, longer diabetes duration, higher BMI and CSII use (p < 0.001).

CONCLUSIONS

CGM has become more common in older adults with diabetes and will presumably increase further. Age is a predictor for sensor use in older adults with diabetes. Age-related physical barriers and insufficient usability of devices, lack of interest in technologies, but possibly also effects of prejudice on the grounds of age may contribute to this finding.

More Frequent Use of Glucose Alarms Is Associated with Continuous Glucose Monitoring-Specific Diabetes Education: Findings from the Dia·Link Diabetes Panel

The associations of continuous glucose monitoring (CGM)-specific diabetes education with real-world utilization of glucose alerts and alarms were assessed in current CGM-users with type 1 or type 2 diabetes. A cross-sectional online survey was conducted in Germany assessing utilization (use and responses) of different alerts and alarms. Ordinal logistic regression analyses were conducted to analyze associations between utilization and participation in CGM-specific education. Data from 453 participants were analyzed (86.2% type 1 diabetes). Participants who received CGM-specific education were more likely to regularly use low-glucose alerts (odds ratio [OR] = 5.43, P < 0.001), low-glucose alarms (OR = 2.03, P = 0.027), and rate of change alerts (OR = 4.20, P = 0.009), and were more likely to immediately react to low-glucose alerts (OR = 5.23, P < 0.001) and rate of change alerts (OR = 3.75, P = 0.018). CGM-specific education has the potential to increase utilization of and response to alerts and alarms. This may help to implement more preventive elements regarding glucose management in everyday life.

Counting the Minutes: Perceived Diabetes Mental Load and its Associations With Technology Use and Mental Disorders

Little is known about mental load in people with diabetes and associations with demographic, clinical, and treatment characteristics, such as the use of diabetes technologies. To explore perceived mental load, 503 adults with diabetes answered the one-item survey "How much time (in minutes) would you spontaneously estimate that you spend each day thinking about your diabetes?" Mental load estimations varied widely within the sample and between subgroups. Perceived mental load was higher in type 1 diabetes than in type 2 diabetes, higher in women than in men and increased with treatment intensity (ie, insulin therapy, technology use) and the number of mental disorders. Further research may explore associations with diabetes-related distress and determine whether (perceived) mental load has relevance in technology use.

Cognitive reappraisal in mHealth interventions to foster mental health in adults: a systematic review and meta-analysis

Background

An increasing number of mHealth interventions aim to contribute to mental healthcare of which interventions that foster cognitive reappraisal may be particularly effective.

Objectives

To evaluate the efficacy of mHealth interventions enhancing cognitive reappraisal to improve mental health in adult populations.

Methods

The literature search (four databases) yielded 30 eligible randomized controlled trials (comprising 3,904 participants). We performed a multi-level meta-analysis to examine differences between intervention and comparator conditions at post-intervention assessment. Moderator analyses were conducted for potential moderator variables (e.g., type of comparators).

Results

Most interventions were CBT-based with other training components in addition to cognitive reappraisal. We found preliminary evidence for a small to medium effect favouring mHealth interventions to enhance cognitive reappraisal over comparators, M(SMD) = 0.34, p = .002. When analysing single symptoms, there was evidence for a small to medium effect of mHealth interventions on anxiety and depressive symptoms, but not for psychological distress and well-being. All analyses showed substantial heterogeneity. Moderator analyses revealed evidence for more favourable effects in studies with passive comparators. There was an overall high risk of bias in most of the studies.

Conclusions

We found preliminary evidence for a small to medium effect of mHealth interventions including a cognitive reappraisal component to improve mental health. However, most of the interventions were complex (i.e., reappraisal was provided alongside other components), which prevents us from examining reappraisal-specific effects beyond general mental health promotion in mHealth. Dismantling studies examining the effects of single intervention components are warranted to corroborate these promising results.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=142149, identifier [CRD42019142149].