Analysis of glycemic trends in elderly patients with diabetes mellitus with continuous glucose monitoring
Abstract
Background: Glycemic control is critical in elderly diabetics, considering their increased vulnerability to hypo- and hyperglycemic events. Continuous Glucose Monitoring (CGM) offers real-time, 24-hour insights into glucose fluctuations by measuring interstitial glucose levels over 14 days. CGM summarizes glycemic variability using metrics such as time above range (TAR), time in range (TIR), and time below range (TBR), enabling better detection of patterns compared to isolated blood glucose measurements. This study aimed to investigate glycemic variability in elderly diabetics using CGM. Also, to evaluate CGM’s relevance in identifying hypo- and hyperglycemia, and provide evidence for the benefits of CGM in diabetes management. Methods: A six-month observational study at tertiary care hospital in Pune enrolled elderly diabetics on CGM. Data was transmitted by patients periodically. Insulin therapy was remotely titrated in real time as per patient requirement. Results: The study had a mean age of 70.72 years, with 76% males. Hypoglycemic episodes were reported in 8% of patients, 64.7% of which were asymptomatic and 35.3% symptomatic. In those experiencing early morning hyperglycemia, 48% patients showed Dawn’s and 32% Somogyi’s phenomenon. 76% of patients had fasting hyperglycemia, while 64% had postprandial hyperglycemia. Following remote insulin titration over 14 days, TAR decreased by 7.1% and TIR increased by 8.7%. Conclusions: CGM provides a comprehensive, dynamic assessment of glycemic patterns in elderly, surpassing traditional glucose monitoring. Study demonstrates that remote titration of insulin and OHAs based on CGM data significantly improves glycemic control while reducing the risk of hypo- and hyperglycemia. Findings underscore the clinical value of CGM in elderly diabetes care, enabling personalized therapeutic decisions and enhancing safety in a population highly susceptible to glucose fluctuations. Integrating CGM into standard management protocols can optimize outcomes and mitigate complications.