964-P: CGM-Tele Monitoring in Older Adults with T1D: Results of a Pilot Study

Abstract

T1D management in older individuals can be difficult due to an increased risk for hypoglycemia and other co-morbidities. CGM can help lower rates of hypoglycemia; however, in practice, patient data is only reviewed at clinic visits, rather than in near real-time by the diabetes care team. This pilot study tested if patients could be remotely monitored daily through a CGM system (Dexcom G5/6) that communicated via smart phone to a Tidepool designed dashboard. Alerts were set for: ≥4 hours without CGM signal, ≥2 hours 54-70 mg/dl, and 15 mins <54 mg/dl. If alerts occurred, the CDE performed telemedicine outreach following a protocol. Ten individuals with T1D ≥65 years were enrolled. Patients were 72+5.3 years; duration of diabetes 39.1+16.5 years; 50% were on CSII. At baseline, the CGM was connected to the monitoring system, followed by 2 weeks of system checks. Remote monitoring was activated at week 2 continuing to week 14. Three patients didn’t complete the study. One had connection issues, one didn't want to wear the CGM; the third had spousal health issues. The CDE/system was capable of identifying the desired findings (Table). An A1C was measured at baseline and 14 weeks. The A1C didn’t change, 7.2% +0.95 vs. 7.3% +0.99. This trial proved it was possible to monitor well-controlled seniors with T1D using an automated system with daily alerts to identify episodes of hypoglycemia and time off CGM. Further research is needed to assess the alert system efficacy. Disclosure M.D. Harmel: Advisory Panel; Spouse/Partner; Abbott, Becton, Dickinson and Company, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., MannKind Corporation, Merck & Co., Inc., Novo Nordisk Inc., Omada Health, Inc., OptumRx, Inc., Sanofi, Zafgen, Inc. Consultant; Self; MannKind Corporation. Research Support; Spouse/Partner; AstraZeneca, Dexcom, Inc., MannKind Corporation. Speaker's Bureau; Spouse/Partner; Novo Nordisk Inc. V.F. Ruelas: None. E.T. Nykaza: None. A.L. Peters: Advisory Panel; Self; Abbott, Becton, Dickinson and Company, Bigfoot Biomedical, Eli Lilly and Company, Lexicon Pharmaceuticals, Inc., Livongo Health, MannKind Corporation, Medscape, Merck & Co., Inc., Omada Health, Inc., OptumRx, Inc., Sanofi US, Zafgen, Inc. Research Support; Self; AstraZeneca, Dexcom, Inc., Jaeb Center for Health Research, MannKind Corporation, National Institute of Diabetes and Digestive and Kidney Diseases. Speaker's Bureau; Self; Novo Nordisk Inc.