Older adults with type1 diabetes (T1D) are at high risk for hypoglycemia and its devastating consequences. Several randomized controlled trials (RCTs) have demonstrated the benefits of continuous glucose monitoring (CGM) in reducing the risk for hypoglycemia in adults with T1D. However, many older adults have limited technological proficiency that could be a barrier to effective use of this technology. To address this need of older adults for additional support with the use of technology and greater caregiver involvement in their diabetes management, we have developed a tablet-based diabetes management platform (DMP) that: 1) automates data transfer from CGM and insulin delivery devices without need for patient intervention; 2) facilitates communication among patients and their circle of care givers, including family members; 3) provides on-demand diabetes education materials; and 4) incorporates a clinical decision support system (CDS) that provides dosing adjustment recommendations to the healthcare team.
In aim 1, we will perform a RCT to test the efficacy of this enhanced CGM (eCGM) in older adults with T1D. Subjects will be randomized to eCGM or attention control (usual care + self-blood glucose monitoring). Endpoint analysis (primary: biochemical hypoglycemia, measured by CGM [blinded in the control group]; secondary: A1c) will be at 6 months, followed by a 6-month ?continuation phase? with reduced study staff contact to assess sustainability of any benefit.
In aim 2, we will use a mixed methods approach, including semi-structured interviews of patients and their caregivers, to make an in-depth assessment of barriers and enablers to the use of diabetes technology in older adults.
In aim 3, we will assess the cost-effectiveness and cost-utility of eCGM, compared to usual care. This project brings together a multidisciplinary team of physician/researchers ? Dr. Howard Wolpert (an expert in the use of technology in the care of adults with T1D), Dr. Medha Munshi (an expert in geriatric diabetes), Dr. Garry Steil (an engineer and pioneering closed-loop researcher), and Dr. Jonathan Wald (a medical informatics specialist whose research focuses on the barriers to technology adoption) ? with the complementary expertise required to advance the use of technology in older adults with T1D.
In this proposal, we plan to study the effectiveness of enhanced CGM (CGM with a digital diabetes management platform) in older adults with T1D. eCGM incorporates best practices in geriatric diabetes care with a clinical decision support system(CDS) that provides dosing recommendations to the healthcare team.
