"Nothing is linear": Characterizing the determinants and dynamics of CGM use in older adults with type 1 diabetes

Anna R Kahkoska; Cambray Smith; Sirisha Thambuluru; Joshua Weinstein; John A Batsis; Richard Pratley; Ruth S Weinstock; Laura A Young; Kristen Hassmiller Lich

doi:10.1016/j.diabres.2022.110204

"Nothing is linear": Characterizing the determinants and dynamics of CGM use in older adults with type 1 diabetes

Diabetes Res Clin Pract. 2023 Feb:196:110204. doi: 10.1016/j.diabres.2022.110204. Epub 2022 Dec 9.

Authors

Anna R Kahkoska¹, Cambray Smith², Sirisha Thambuluru³, Joshua Weinstein⁴, John A Batsis⁵, Richard Pratley⁶, Ruth S Weinstock⁷, Laura A Young⁸, Kristen Hassmiller Lich⁹

Affiliations

¹ Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, NC, USA. Electronic address: anna_kahkoska@med.unc.edu.
² Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: cambray_smith@med.unc.edu.
³ Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: Sirisha.Thambuluru@unchealth.unc.edu.
⁴ Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: jmwein@live.unc.edu.
⁵ Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, NC, USA. Electronic address: john_batsis@med.unc.edu.
⁶ AdventHealth Translational Research Institute, Orlando, FL, USA. Electronic address: richard.pratley.md@adventhealth.com.
⁷ SUNY Upstate Medical University, Syracuse, NY, USA. Electronic address: WeinstoR@upstate.edu.
⁸ Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: laura_young@med.unc.edu.
⁹ Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. Electronic address: klich@unc.edu.

Abstract

Aims: Continuous glucose monitoring (CGM) can reduce hypoglycemia in older adults with type 1 diabetes (T1D). We aimed to characterize factors that influence effective use in this age group.

Methods: Older adults with type T1D (age ≥ 65) and their caregivers participated in one of a series of parallel group model building workshops, a participatory approach to system dynamics involving drawing and scripted group activities. Data were synthesized in a qualitative model of the hypothesized system of factors producing distinct patterns of CGM use in older adults. The model was validated through virtual follow-up interviews.

Results: Data were collected from 33 participants (four patient-caregiver dyads, mean age 73.8 ± 4.4 years [range 66-85 years]; 16 % non-CGM users, 79 % pump users). The system model delineates drivers of CGM uptake, drivers of ongoing CGM use, and feedback loops that either reinforce or counteract future CGM use. Participants emphasized the importance of different sets of feedback loops at different points in the duration of CGM use.

Conclusions: The holistic system model underscores that factors and feedback loops driving effective CGM use in older adults are both individualized and dynamic (e.g., changing over time), suggesting opportunities for staged and tailored age-specific education and support.

Keywords: Continuous glucose monitoring; Older adults; Participatory system dynamics; Systems science; Type 1 diabetes.

MeSH terms

Aged
Aged, 80 and over
Blood Glucose
Blood Glucose Self-Monitoring
Diabetes Mellitus, Type 1*
Glycated Hemoglobin
Humans
Hypoglycemia*
Hypoglycemic Agents

Substances

Blood Glucose
Glycated Hemoglobin
Hypoglycemic Agents

Abstract

MeSH terms

Substances

Grants and funding