Type 1 diabetes

Older age is not a barrier to diabetes technology

Dr Sybil McAuley

Clinicians are being encouraged not to make age-based assumptions about how older people with diabetes will embrace technology such as CGM.

Dr Sybil McAuley told the Australasian Diabetes Congress 2021 that older adults with diabetes can have additional clinical challenges to maintaining healthy glycaemic levels

These may relate to diverse factors such as medical comorbidities, diabetes related complications, sensory impairments, disorders of cognitive function, reduced dexterity and frailty.

“But what we do now know is that diabetes technology can help.”

She said the goals of therapy in older adults were to improve glucose management and lower the risk of hypoglycaemia.

“From my experience with this cohort there are many people who fall into the older age bracket who have the same level of desire and determination to have very tight control as younger adults with type 1 diabetes and keep complications at bay,” she said.

She said CGM can give older adults reassurance and help decrease the burden of living with diabetes.

“This is not only for the individual with diabetes themselves but also for their loved ones. Using technology to decrease this burden can be highly valuable.”

Dr McAuley, from St Vincent’s Hospital Melbourne, said diabetes technology could help improve quality of life including reducing diabetes distress and the fear of hypos.

She said the evidence was limited given many older adults had been excluded from trials of diabetes technology, however that was changing.

Dr McAuley said the WISDM study, a randomised trial of CGM versus standard blood glucose monitoring in adults 60+ years with type 1 diabetes had shown those using CGM spent less time in hypoglycaemia <3.9 mmol/L.

The Older Adult Closed Loop study, also presented at ADC 2021 had shown people could achieve the relatively conservative target of >50% time above range and benefit from less time in hypoglycaemia particularly overnight.

There were also clinical guidelines available, such as in the UK, with a focus on older adults.

She noted however that recommendations were still largely based on HbA1c targets rather than CGM targets such as time-in-range.

Dr McAuley said some of the barriers to older people using diabetes technology included cognitive function which could impact problem solving and trouble shooting.

Dexterity issues might impact CGM insertion and calibration or filling the reservoir while sensory impairments might make it hard to read the screens or hear the CGM alerts.

Social isolation and lack of support can also be barriers to older people needing help to change sensors or find new sites.

She concluded that older age was not a barrier to using diabetes technology and that technology advances should consider the needs of older people.

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