title: The Impact of Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older.
abstract: Older adults with type 1 diabetes (T1D) or insulin-using type 2 diabetes (iT2D) are at high risk for severe hypoglycemic episodes. Real-time continuous glucose monitoring (RT-CGM) in this population may reduce this risk, but when patients switch to Medicare at age 65, RT-CGM is no longer a covered benefit. We developed a survey to examine health and quality of life (QOL) benefits of RT-CGM in seniors (age ≥ 65).
  
  
  
  Two groups of seniors with T1D or iT2D-current RT-CGM users (n = 210) and RT-CGM "hopefuls" (patients who wanted but could not obtain RT-CGM due to lack of insurance coverage; n = 75)-completed an online survey. The survey examined history of hypoglycemic experiences as well as current quality of life (QOL), including generic and diabetes-specific measures.
  
  
  
  Current users reported fewer moderate (P < .01) and fewer severe hypoglycemic episodes (P < .01) over the past 6 months than "hopefuls" and greater reductions over time in hypoglycemic events requiring the assistance of another, ER visits, and paramedic visits to the home (in all cases, P < .01). Regarding QOL, current users reported significantly better well-being (P < .001), less hypoglycemic fear (P < .05), and less diabetes distress (P < .05) than "hopefuls."
  
  
  
  These data suggest that RT-CGM use in seniors is associated with reductions in episodes of severe hypoglycemia and improved QOL, suggesting that restrictive access to RT-CGM in the Medicare age population may have deleterious health, economic, and QOL consequences.
authors.affiliation: University of California, San Diego, CA, USA Behavioral Diabetes Institute, San Diego, CA, USA whp@behavioraldiabetes.org.
authors.forename: William H
authors.initials: WH
authors.lastname: Polonsky
authors.affiliation: University of Southern California, Los Angeles, CA, USA.
authors.forename: Anne L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Danielle
authors.initials: D
authors.lastname: Hessler
mesh_terms: D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000191:economics / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000209:etiology; D008297:Male; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: Medicare; continuous glucose monitoring; hypoglycemia; quality of life