Project Description

There is a growing population of older adults (defined as adults who are 65 years of age or older) with type 1 diabetes (T1). As individuals age, both the risk for and the danger of low blood sugar (i.e. hypoglycemia) increases. Thus, much of diabetes care and management in older adulthood is focused around avoiding these dangerous episodes of hypoglycemia. 

Continuous glucose monitoring (CGM) is a new, technologic approach to glucose monitoring that transmits real-time or near real-time glucose readings from an on-body sensor to a small device. Compared to self-monitoring with intermittent finger sticks and a glucometer, CGM offers greater insight into current glucose levels and trends, in addition to notifications for out-of-range readings and alarms for low glucose levels. In a study of older adults, in which half of the participants were randomized to use CGM for six months, CGM reduced hypoglycemia. The findings of that study suggested that CGM may offer life-saving benefits for older adults. However, not all older adults use CGM right now. 

One challenge for widespread use of CGM in the population of older adults is that aging is complex, and older adults often have multiple medical conditions and changing social needs as they age. A further challenge is that each individual patient is unique: they live in different environments, have different lifestyles, and manage different physical and mental health conditions. They also may have had different historical experiences with T1D and technology, and they may carry different attitudes and preferences surrounding T1D management. Thus, individual older adults may need different combinations of resources, education, and support to initiate and use CGM over time, such that they can have a positive experience and reap the health benefit from use. To date, older adults’ experiences with CGM has not been well-studied or described in the medical literature. 

My overarching hypothesis is that delivering CGM to older adults with T1D demands new approaches that consider a breadth of different individual-level needs for patient-oriented “onboarding” and use in daily life. I aim to generate scientific evidence to tailor support and resources for effective CGM use in older adults with T1D. Over one year, I will complete three discrete studies to address my research questions:

1,. How and why do older adults with type 1 diabetes have different experiences initiating and using CGM over time?

Knowledge to be gained: We will incorporate stakeholder perspectives to discover the suboptimal response patterns to CGM (i.e., responses that signal an individual did not have the resources, support, education, accommodations, etc. that they needed for effective CGM use) and the complex, contributing factors.

2. What are the associated individual patient characteristics with suboptimal CGM response patterns?

Knowledge to be gained: We will learn how we can use individual-level data (i.e. sociodemographic characteristics, clinical features, psychosocial measures, etc.) to identify the patients who have or are estimated to experience a suboptimal response to CGM.

3. What are viable approaches and real-world needs to maximize the benefits of CGM use in older adults?

Knowledge to be gained: We will generate stakeholder-engaged actions and strategies to pre-empt and address suboptimal CGM responses. Informed by Aims 1 and 2, these interventions, and the approaches to best match them to the patients who need them, can be tested in a future pragmatic, precision health trial framework.

My long-term objective as a diabetes researcher is to work alongside stakeholders, including older adults with T1D, their caregivers, and members of their diabetes care team, to translate the findings from these studies into new, impactful strategies to “bolster” CGM use for older adults. In the future, by using statistical algorithms from the field of precision health, these interventions can be tailored to older adults based on their characteristics, health information, and preferences.  The intended impact for this work is to improve the experience of learning to use new diabetes technology across the lifespan and to enhance the equity of current and emerging diabetes treatment options by ensuring that critical resources are delivered efficiently to the patients who need them.

Click HERE to view Dr. Kahkoska’s video.