Continuous Glucose Monitoring and Other Wearable Devices to Assess Hypoglycemia among Older Adult Outpatients with Diabetes Mellitus

Michael Weiner; Philip Adeoye; Margaret J. Boeh; Kunal Bodke; Jessica Broughton; Anietra R. Butler; Mackenzie L. Dafferner; Lindsay A. Dirlam; Denisha Ferguson; Amanda L. Keegan; NiCole R. Keith; Joy L. Lee; Corrina B. McCorkle; Daniel G. Pino; Mu Shan; Preethi Srinivas; Qing Tang; Evgenia Teal; Wanzhu Tu; April Savoy; Christopher M. Callahan; Daniel O. Clark

doi:10.1055/a-1975-4136

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2023; 14(01): 037-044
DOI: 10.1055/a-1975-4136

Research Article

Continuous Glucose Monitoring and Other Wearable Devices to Assess Hypoglycemia among Older Adult Outpatients with Diabetes Mellitus

Michael Weiner

¹Department of Medicine, Indiana University, Indianapolis, Indiana

²Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana

³Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13–416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana

,

Philip Adeoye

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

,

Margaret J. Boeh

⁵Senior Care, Eskenazi Health, Indianapolis, Indiana

,

Kunal Bodke

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

,

Jessica Broughton

⁵Senior Care, Eskenazi Health, Indianapolis, Indiana

,

Anietra R. Butler

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

,

Mackenzie L. Dafferner

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

,

Lindsay A. Dirlam

⁶Lifestyle Health and Wellness, Eskenazi Health, Indianapolis, Indiana

,

Denisha Ferguson

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

,

Amanda L. Keegan

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

,

NiCole R. Keith

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

⁷Department of Kinesiology, Indiana University, Indianapolis, Indiana

,

Joy L. Lee

¹Department of Medicine, Indiana University, Indianapolis, Indiana

²Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana

,

Corrina B. McCorkle

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

,

Daniel G. Pino

¹Department of Medicine, Indiana University, Indianapolis, Indiana

⁶Lifestyle Health and Wellness, Eskenazi Health, Indianapolis, Indiana

,

Mu Shan

⁸Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana

,

Preethi Srinivas

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

,

Qing Tang

⁸Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana

,

Evgenia Teal

⁹Data Services, Regenstrief Institute, Inc., Indianapolis, Indiana

,

Wanzhu Tu

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

⁸Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana

,

April Savoy

²Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana

³Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13–416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana

¹⁰Computer and Information Technology, Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indiana

,

Christopher M. Callahan

¹Department of Medicine, Indiana University, Indianapolis, Indiana

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

⁵Senior Care, Eskenazi Health, Indianapolis, Indiana

,

Daniel O. Clark

¹Department of Medicine, Indiana University, Indianapolis, Indiana

⁴Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana

› Author Affiliations

Abstract

Background Hypoglycemia (HG) causes symptoms that can be fatal, and confers risk of dementia. Wearable devices can improve measurement and feedback to patients and clinicians about HG events and risk.

Objectives The aim of the study is to determine whether vulnerable older adults could use wearables, and explore HG frequency over 2 weeks.

Methods First, 10 participants with diabetes mellitus piloted a continuous glucometer, physical activity monitor, electronic medication bottles, and smartphones facilitating prompts about medications, behaviors, and symptoms. They reviewed graphs of glucose values, and were asked about the monitoring experience. Next, a larger sample (N = 70) wore glucometers and activity monitors, and used the smartphone and bottles, for 2 weeks. Participants provided feedback about the devices. Descriptive statistics summarized demographics, baseline experiences, behaviors, and HG.

Results In the initial pilot, 10 patients aged 50 to 85 participated. Problems addressed included failure of the glucometer adhesive. Patients sought understanding of graphs, often requiring some assistance with interpretation. Among 70 patients in subsequent testing, 67% were African-American, 59% were women. Nearly one-fourth (23%) indicated that they never check their blood sugars. Previous HG was reported by 67%. In 2 weeks of monitoring, 73% had HG (glucose ≤70 mg/dL), and 42% had serious, clinically significant HG (glucose under 54 mg/dL). Eight patients with HG also had HG by home-based blood glucometry. Nearly a third of daytime prompts were unanswered. In 24% of participants, continuous glucometers became detached.

Conclusion Continuous glucometry occurred for 2 weeks in an older vulnerable population, but devices posed wearability challenges. Most patients experienced HG, often serious in magnitude. This suggests important opportunities to improve wearability and decrease HG frequency among this population.

Keywords

wearable devices - hypoglycemia - diabetes mellitus - glycemic control

Full Text

References

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