Maryland Endocrine, PA; Columbia, Maryland.
Dexcom, Inc., San Diego, California.
Endocr Pract. 2014 Dec;20(12):1297-302. doi: 10.4158/EP14017.OR.
Little information is available on personal real-time continuous glucose monitoring (PCGM) in patients ≥65 years old. We report on PCGM use in insulin-requiring patients ≥65 years old in a community endocrine practice.
Patients ≥65 or older who had been prescribed PCGM were identified by retrospective review. Glycated hemoglobin (A1C) values from the year prior and subsequent to PCGM prescription, the most recent A1C value, continued PCGM usage, percentage reporting severe hypoglycemia (SH), and rate of SH were examined.
Thirty-eight patients were identified: 31 with type 1 diabetes, 21 females, mean age 70 years (range 65-78), and a mean diabetes duration of 31 years. Overall, 28 were on insulin pump therapy, 29 were using PCGM regularly, and 25 had both pre- and post-PCGM use A1C results. Regular PCGM use was associated with a decrease in mean (SD) A1C: 7.6 (0.9)% to 7.1 (0.9)%, (P<.0001) that was maintained until the most recent A1C value (7.2 [0.8]%, P = .0145, average 37 months), with fewer reporting SH (from 79% to 31%, P = .0002), and a lower rate of SH (0.37 to 0.12 per year, P = .0007). The group of 9 patients who did not continue PCGM (mean use 3 months) was too small to allow meaningful statistical evaluation. Lack of insurance coverage was the most common reason given for not using/continuing PCGM. Those continuing PCGM were more likely to have insurance coverage for PCGM (86%) than those not continuing PCGM (25%).
Patients ≥65 with insulin-requiring diabetes achieve improved glycemic control with regular PCGM use. The presence of PCGM insurance coverage favored continued PCGM use.
关于≥65 岁的患者个人实时连续血糖监测（PCGM）的信息很少。我们报告了在社区内分泌实践中需要胰岛素的≥65 岁患者中使用 PCGM 的情况。
通过回顾性审查确定了≥65 岁且已被处方 PCGM 的患者。检查了 PCGM 处方前和后的糖化血红蛋白（A1C）值、最近的 A1C 值、持续使用 PCGM、报告严重低血糖（SH）的百分比和 SH 的发生率。
共确定了 38 例患者：31 例为 1 型糖尿病，21 例为女性，平均年龄 70 岁（范围 65-78），平均糖尿病病程 31 年。总体而言，28 例患者接受胰岛素泵治疗，29 例患者定期使用 PCGM，25 例患者有 PCGM 使用前后的 A1C 结果。定期使用 PCGM 与 A1C 平均值的降低相关：从 7.6（0.9）%降至 7.1（0.9）%（P<.0001），直至最近的 A1C 值（7.2[0.8]%，P=0.0145，平均 37 个月），报告 SH 的患者减少（从 79%降至 31%，P=0.0002），SH 发生率降低（从 0.37 至 0.12 年/人，P=0.0007）。9 例未继续使用 PCGM 的患者（平均使用时间 3 个月）的样本量太小，无法进行有意义的统计学评估。没有保险覆盖是不使用/不继续使用 PCGM 的最常见原因。继续使用 PCGM 的患者更有可能获得 PCGM 的保险覆盖（86%），而不继续使用 PCGM 的患者为 25%。
需要胰岛素的≥65 岁糖尿病患者使用常规 PCGM 可改善血糖控制。PCGM 保险覆盖的存在有利于继续使用 PCGM。
