Background: Older adults with diabetes with cognitive or functional impairment are recommended to have higher A1C. However, impact of higher A1C on CGM metrics in impaired and unimpaired patients are not well studied.
Methods: A cross-sectional analysis of baseline data across three studies was performed in older adults (age ≥65 years) with diabetes on insulin. Demographic and clinical characteristics including cognitive and functional status, and continuous glucose monitoring (CGM) data were reviewed.
Results: Data on 209 participants stratified as unimpaired (MoCA ≥26 and no frailty) and impaired (MoCa <26 and/or frailty ≥1) were analyzed. Compared to the 66 patients with unimpaired status, the 143 patients with impaired status were more likely to live alone, had greater hypoglycemia fear, and high burden of comorbidities (Table 1). Although the impaired patients had higher HbA1c (7.9% ), both unimpaired and impaired patients had high burden of hypoglycemia (time spent <70 mg/dL)(4.4% and 3.2% respectively) and extreme hyperglycemia (time spent >250 mg/dL(13% and 19% respectively).
Conclusion: Liberal A1C goals based on cognitive and/or functional impairment may not protect against risk of hypoglycemia and extreme hyperglycemia in older adults. CGM should be considered for diabetes care decisions in the older population independent of health status.
C.D. Conery: None. C. Slyne: None. K. Loo Urbina: None. N. Krakoff: None. H. Brabant: None. M. Munshi: Consultant; Sanofi. E. Toschi: Consultant; Vertex Pharmaceuticals Incorporated, Sanofi.
The Leona M. and Harry B. Helmsley Charitable Trust
