Polonsky William H, Peters Anne L, Hessler Danielle
University of California, San Diego, CA, USA Behavioral Diabetes Institute, San Diego, CA, USA
University of Southern California, Los Angeles, CA, USA.
J Diabetes Sci Technol. 2016 Jun 28;10(4):892-7. doi: 10.1177/1932296816643542. Print 2016 Jul.
Older adults with type 1 diabetes (T1D) or insulin-using type 2 diabetes (iT2D) are at high risk for severe hypoglycemic episodes. Real-time continuous glucose monitoring (RT-CGM) in this population may reduce this risk, but when patients switch to Medicare at age 65, RT-CGM is no longer a covered benefit. We developed a survey to examine health and quality of life (QOL) benefits of RT-CGM in seniors (age ≥ 65).
Two groups of seniors with T1D or iT2D-current RT-CGM users (n = 210) and RT-CGM "hopefuls" (patients who wanted but could not obtain RT-CGM due to lack of insurance coverage; n = 75)-completed an online survey. The survey examined history of hypoglycemic experiences as well as current quality of life (QOL), including generic and diabetes-specific measures.
Current users reported fewer moderate (P < .01) and fewer severe hypoglycemic episodes (P < .01) over the past 6 months than "hopefuls" and greater reductions over time in hypoglycemic events requiring the assistance of another, ER visits, and paramedic visits to the home (in all cases, P < .01). Regarding QOL, current users reported significantly better well-being (P < .001), less hypoglycemic fear (P < .05), and less diabetes distress (P < .05) than "hopefuls."
These data suggest that RT-CGM use in seniors is associated with reductions in episodes of severe hypoglycemia and improved QOL, suggesting that restrictive access to RT-CGM in the Medicare age population may have deleterious health, economic, and QOL consequences.
1型糖尿病（T1D）或使用胰岛素的2型糖尿病（iT2D）老年患者发生严重低血糖事件的风险较高。该人群使用实时连续血糖监测（RT-CGM）可能会降低这种风险，但当患者65岁转为医疗保险时，RT-CGM不再是一项涵盖的福利。我们开展了一项调查，以研究RT-CGM对老年人（年龄≥65岁）健康和生活质量（QOL）的益处。
两组患有T1D或iT2D的老年人——当前的RT-CGM使用者（n = 210）和RT-CGM“渴望者”（因缺乏保险覆盖而想要但无法获得RT-CGM的患者；n = 75）——完成了一项在线调查。该调查考察了低血糖经历史以及当前的生活质量（QOL），包括一般和糖尿病特异性指标。
与“渴望者”相比，当前使用者在过去6个月中报告的中度低血糖事件（P < .01）和严重低血糖事件较少（P < .01），并且随着时间推移，在需要他人协助的低血糖事件、急诊就诊以及护理人员上门就诊方面的减少幅度更大（在所有情况下，P < .01）。关于生活质量，当前使用者报告的幸福感明显更好（P < .001），低血糖恐惧更少（P < .05），糖尿病困扰更少（P < .05）。
这些数据表明，老年人使用RT-CGM与严重低血糖事件发作减少和生活质量改善相关，这表明医疗保险年龄人群对RT-CGM的限制使用可能会对健康、经济和生活质量产生有害影响。
