Abstract P156: Use of Continuous Glucose Monitoring for Risk-Stratification in Older Adults With Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Introduction: The American Diabetes Association (ADA) recommends individualizing treatment for older adults with diabetes based on their burden of comorbidities. However, implementing this recommendation in practice is challenging. Glucose excursions and variability may be markers of declining health that can identify high-risk older patients. Hypothesis: Glucose abnormalities are associated with comorbidities in older adults with diabetes. Methods: We conducted a cross-sectional analysis of 319 with type 2 diabetes (mean age 83 years) in the Atherosclerosis Risk in Communities Study (visit 9, 2021-2022). Participants wore continuous glucose monitoring (CGM) sensors for up to 14 days. We calculated four clinical measures from CGM data: mean glucose, standard deviation of glucose, % time with hypoglycemia (glucose <54 mg/dl), and % time with hyperglycemia (glucose>180 mg/dl). Based on ADA guidelines for older adults, we examined 6 comorbidities (defined using information from clinical examinations and medical records). We examined the association between CGM measures and comorbidities with logistic regression. Results: The prevalence of comorbidities ranged from 2% (dementia) to 66% (chronic kidney disease). Increased time with hypoglycemia was significantly associated with cardiovascular disease, chronic kidney disease, depression, and poor functional status (Table) . In contrast, comorbid conditions were not consistently related to mean glucose, standard deviation of glucose, or hyperglycemia. Conclusion: Hypoglycemia was common in those older adults with diabetes who had poor physical functioning and major comorbidities. CGM captures hypoglycemic episodes and may be a useful tool to supplement traditional risk assessment.