A pair of case-based studies from the United Kingdom provides a glimpse of the potential value of continuous glucose monitors (CGMs) in the care of an aging population of people with diabetes. In both studies, the use of the Abbott Freestyle Libre, an intermittently scanned CGM, helped health care professionals uncover issues in blood sugar management among homebound patients with diabetes.
In a case study published in the Journal of Diabetes Nursing, two researchers with the Sussex Community NHS Foundation Trust attempted to determine whether patients with type 2 diabetes given twice-daily insulin injections by visiting nurses were at risk of hypoglycemia.
The project received support from Abbott, the maker of the CGM utilized for the study.
Before the study began, the nurses checked the blood sugar of the patients twice a day with a non-continuous meter during home visits. The researchers then fitted four patients who were on Tresiba insulin therapy with Freestyle Libre flash CGMs, and their blood sugar levels were monitored remotely. The researchers then followed the blood sugar management and results of the patients for a year.
Analyzing the CGM data, the researchers found all four patients were experiencing previously undiscovered periods of blood sugar levels below the optimal range set by the health care providers for frail, elderly patients. Because of this discovery, two of the patients had their insulin doses reduced, and health care providers discontinued insulin for the other two patients. Remote blood glucose monitoring also reduced nursing visits by 1460 over the year, and saved the U.K. health system £58,400 ($71,811) in nursing costs.
A second case study published in the British Journal of Community Nursing also utilized the Abbott CGM, but was instead focused on empowering healthcare assistants and associate practitioners to provide home-based diabetes care. This was done in an effort to stretch the overtaxed home-based nursing resources in East Kent.
That study received support from Sanofi, an insulin manufacturer.
In this ongoing case study, lead researcher Sarah-Jane Gregory, a senior diabetes specialist nurse with the East Kent Hospitals University Foundation, focused her research on the effects of providing additional diabetes training for these unlicensed care professionals, but the Libre CGM was also utilized to remotely monitor vulnerable patients in the study population. Again, the device’s use uncovered previously undiscovered blood glucose fluctuations. The use of the CGM “has highlighted the real risk of undetected hypoglycaemia (sic) and the potential for reducing some visits from the community nurse,” the researcher wrote.
While these two research efforts are case studies, and focus on patients with type 2 diabetes, such findings will likely prove important for a growing population of aging patients with type 1 diabetes, who will increasingly need long-term care. As resources for endocrinologists and other diabetes health care practitioners are stretched thin, it will be necessary for home health care workers to be better trained about insulin therapy; remote blood glucose monitoring may prove pivotal in the expansion of those services.
In addition, studies proving the effectiveness of CGMs in older patients with diabetes may help expand public and private insurance coverage for such devices.
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