Richard E. Pratley, MD AdventHealth Samuel E. Crockett Chair in Diabetes Research Medical Director | AdventHealth Diabetes Institute Senior Investigator and Diabetes Program Lead AdventHealth Translational Research Institute

Type 1 Diabetes: Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults

MedicalResearch.com Interview with:

Richard E. Pratley, MD AdventHealth Samuel E. Crockett Chair in Diabetes Research Medical Director | AdventHealth Diabetes Institute Senior Investigator and Diabetes Program Lead AdventHealth Translational Research Institute

Dr. Pratley

Richard E. Pratley, MD
AdventHealth
Samuel E. Crockett Chair in Diabetes Research
Medical Director | AdventHealth Diabetes Institute
Senior Investigator and Diabetes Program Lead
AdventHealth Translational Research Institute 

MedicalResearch.com: What is the background for this study?

Response: Historically, older individuals with T1D have been underrepresented or excluded from clinical trials. Older individuals with T1D are at particularly high risk for hypoglycemia. Because of their long duration of diabetes, they often have impaired counterregulatory responses and hypoglycemia unawareness. Hypoglycemia in older individuals is particularly dangerous because it can lead to falls and fractures, cognitive impairment and cardiovascular events, including death. There has been the misperception that older individuals are less able to use technology to manage their diabetes.  This study dispelled that notion.  

MedicalResearch.com: What are the main findings?

Response: The key points from this study are:

  1. Older individuals were comfortable with continuous glucose monitoring and used the technology effectively. They had greater persistence on CGM at the end of the study than did youth in a parallel study that will also be reported in JAMA and they were using CGM to dose insulin
  2. CGM reduced all measures of hypoglycemia, including severe events (by 90%).
  3. The reductions in hypoglycemia did not come at the expense of worsening glycemic control. Although the group was well controlled at baseline, CGM improved time in range and reduced hyperglycemia and HbA1c.  

MedicalResearch.com: What should readers take away from your report?

Response: The newer Dexcom device is even easier to insert and doesn’t require calibration – I would predict that this would make it even more useful in clinical practice for my older individuals with T1D.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Future research should include longer term trials to assess the effect of reducing hypoglycemia on outcomes such as falls and fractures as well as cardiovascular events and cognitive performance.  There also need to be studies in patients who are frail, including those with impaired cognitive function.

In addition, there is a need to test other technologies such as advanced insulin delivery systems in older individuals with T1D.  Examples include pumps with predictive low glucose suspend and hybrid closed loop systems.

Citation: 

Pratley RE, Kanapka LG, Rickels MR, et al. Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA. 2020;323(23):2397–2406. doi:10.1001/jama.2020.6928

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Jun 17, 2020 @ 12:34 am

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