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Cited by 73Diabetes Management and ResearchTechnology Use by Older AdultsDiabetes Management and Education

The Growing Role of Technology in the Care of Older Adults With Diabetes

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Huang, Elbert S., Sinclair, Alan, Conlin, Paul R., Cukierman-Yaffe, Tali, Hirsch, Irl B., Huisingh-Scheetz, Megan, Kahkoska, Anna R., Laffel, Lori +13 more·2023·Diabetes Care
DOI 10.2337/dci23-0021PMC PMC10369127
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Abstract

The integration of technologies such as continuous glucose monitors, insulin pumps, and smart pens into diabetes management has the potential to support the transformation of health care services that provide a higher quality of diabetes care, lower costs and administrative burdens, and greater empowerment for people with diabetes and their caregivers. Among people with diabetes, older adults are a distinct subpopulation in terms of their clinical heterogeneity, care priorities, and technology integration. The scientific evidence and clinical experience with these technologies among older adults are growing but are still modest. In this review, we describe the current knowledge regarding the impact of technology in older adults with diabetes, identify major barriers to the use of existing and emerging technologies, describe areas of care that could be optimized by technology, and identify areas for future research to fulfill the potential promise of evidence-based technology integrated into care for this important population.

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References 74 · Cited by 73

Research works printed but not linked: 54

  1. Laiteerapong N, Huang ES. Diabetes in older adults, 3rd edition. In Diabetes in America.
  2. Munshi MN, Florez H, Huang ES, et al. Management of diabetes in long-term care and skilled nursing facilities: a position statement of the American Diabetes Association. Diabetes Care 2016;39:308-318
  3. American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care 2018;41:917-928
  4. Huang ES, Laiteerapong N, Liu JY, John PM, Moffet HH, Karter AJ. Rates of complications and mortality in older patients with diabetes mellitus: the diabetes and aging study. JAMA Intern Med 2014;174:251-258
  5. Biessels GJ, Deary IJ, Ryan CM. Cognition and diabetes: a lifespan perspective. Lancet Neurol 2008;7:184-190
  6. Reijmer YD, van den BE, Ruis C, Kappelle LJ, Biessels GJ. Cognitive dysfunction in patients with type 2 diabetes. Diabetes Metab Res Rev 2010;26:507-519
  7. Exalto LG, Biessels GJ, Karter AJ, et al. Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study. Lancet Diabetes Endocrinol 2013;1:183-190
  8. Srikanth V, Sinclair AJ, Hill-Briggs F, Moran C, Biessels GJ. Type 2 diabetes and cognitive dysfunction-towards effective management of both comorbidities. Lancet Diabetes Endocrinol 2020;8:535-545
  9. Gregg EW, Mangione CM, Cauley JA, et al.; Study of Osteoporic Fractures Research Group. Diabetes and incidence of functional disability in older women. Diabetes Care 2002;25:61-67
  10. Wong E, Backholer K, Gearon E, et al. Diabetes and risk of physical disability in adults: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2013;1:106-114
  11. Park SW, Goodpaster BH, Strotmeyer ES, et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care 2007;30:1507-1512
  12. Park SW, Goodpaster BH, Strotmeyer ES, et al. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes 2006;55:1813-1818
  13. Sinclair A, Morley J. Frailty and diabetes. Lancet 2013;382:1386-1387
  14. Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults. Diabetes Care 2012;35:2650-2664
  15. Punthakee Z, Miller ME, Launer LJ, et al.; ACCORD Group of Investigators; ACCORD-MIND Investigators. Poor cognitive function and risk of severe hypoglycemia in type 2 diabetes: post hoc epidemiologic analysis of the ACCORD trial. Diabetes Care 2012;35:787-793
  16. Sinclair AJ, Girling AJ, Bayer AJ. Cognitive dysfunction in older subjects with diabetes mellitus: impact on diabetes self-management and use of care services. All Wales Research into Elderly (AWARE) Study. Diabetes Res Clin Pract 2000;50:203-212
  17. Kerr D, Axelrod C, Hoppe C, Klonoff DC. Diabetes and technology in 2030: a utopian or dystopian future? Diabet Med 2018;35:498-503
  18. Shivers JP, Mackowiak L, Anhalt H, Zisser H. "Turn it off!": diabetes device alarm fatigue considerations for the present and the future. J Diabetes Sci Technol 2013;7:789-794
  19. Kahkoska AR, Smith C, Thambuluru S, et al. "Nothing is linear": characterizing the determinants and dynamics of CGM use in older adults with type 1 diabetes. Diabetes Res Clin Pract 2023;196:110204
  20. Kramer DB, Matlock DD, Buxton AE, et al. Implantable cardioverter-defibrillator use in older adults: proceedings of a Hartford Change AGEnts Symposium. Circ Cardiovasc Qual Outcomes 2015; 8:437-446
  21. Huang ES, O'Grady M, Basu A, et al.; Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group. The cost-effectiveness of continuous glucose monitoring in type 1 diabetes. Diabetes Care 2010;33:1269-1274
  22. Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C; DIAMOND Study Group. Continuous glucose monitoring in older adults with type 1 and type 2 diabetes using multiple daily injections of insulin: results from the DIAMOND Trial. J Diabetes Sci Technol 2017;11:1138-1146
  23. Carlson AL, Kanapka LG, Miller KM, et al.; WISDM Study Group. Hypoglycemia and glycemic control in older adults with type 1 diabetes: baseline results from the WISDM Study. J Diabetes Sci Technol 2021;15:582-592
  24. Beck RW, Riddlesworth TD. Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections. Ann Intern Med 2018;168:526-527
  25. Yaron M, Roitman E, Aharon-Hananel G, et al. Effect of flash glucose monitoring technology on glycemic control and treatment satisfaction in patients with type 2 diabetes. Diabetes Care 2019;42:1178-1184
  26. Beck RW, Riddlesworth TD, Ruedy KJ, et al.; DIAMOND Study Group. Effect of initiating use of an insulin pump in adults with type 1 diabetes using multiple daily insulin injections and continuous glucose monitoring (DIAMOND): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2017;5:700-708
  27. Stone MP, Agrawal P, Chen X, et al. Retrospective analysis of 3-month real-world glucose data after the MiniMed 670G system commercial launch. Diabetes Technol Ther 2018; 20:689-692
  28. McAuley SA, Trawley S, Vogrin S, et al. Closed- loop insulin delivery versus sensor-augmented pump therapy in older adults with type 1 diabetes (ORACL): a randomized, crossover trial. Diabetes Care 2022;45:381-390
  29. Tung EL, Peek ME, Makelarski JA, Escamilla V, Lindau ST. Adult BMI and access to built environment resources in a high-poverty, urban geography. Am J Prev Med 2016;51:e119-e127
  30. Seligman HK, Bolger AF, Guzman D, L opez A, Bibbins-Domingo K. Exhaustion of food budgets at month's end and hospital admissions for hypoglycemia. Health Aff (Millwood) 2014;33: 116-123
  31. Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med 2009;32:20-47
  32. Faverio M. Share of those 65 and older who are tech users has grown in the past decade. 2022. Pew Research Center. Accessed 5 April 2023. Available from https://www.pewresearch .org/fact-tank/2022/01/13/share-of-those -65-and-older-who-are-tech-users-has-grown-in -the-past-decade/ 46. Pew Research Center. 2021. Internet/ Broadband Fact Sheet. Accessed 5 April 2023. Available from https://www.pewresearch.org/ internet/fact-sheet/internet-broadband/ 47. Mangla T, Paul U, Gupta A, Marwell NP, Feamster N. Internet inequity in Chicago: adoption, affordability, and availability. SSRN 2022. https:// ssrn.com/abstract=4182994.
  33. Yoon H, Jang Y, Vaughan PW, Garcia M. Older adults' internet use for health information: digital divide by race/ethnicity and socioeconomic status. J Appl Gerontol 2020;39:105-110
  34. Skinner B, Levy H, Burtch T. Digital redlining: the relevance of 20th century housing policy to 21st century broadband access and education. EdWorkingPapers. 2021. Accessed 5 April 2023. Available from https://doi.org/10.26300/q9av- 9c93 · DOI
  35. Barnett E, Casper M. A definition of "social environment". Am J Public Health 2001;91:465
  36. Steve SL, Tung EL, Schlichtman JJ, Peek ME. Social disorder in adults with type 2 diabetes: building on race, place, and poverty. Curr Diab Rep 2016;16:72
  37. Christine PJ, Auchincloss AH, Bertoni AG, et al. Longitudinal associations between neighborhood physical and social environments and incident type 2 diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis (MESA). JAMA Intern Med 2015;175:1311-1320
  38. Halbert CH, Bellamy S, Briggs V, et al. Collective efficacy and obesity-related health behaviors in a community sample of African Americans. J Community Health 2014;39:124-131
  39. Anderson M, Perrin A. Tech adoption climbs among older adults. Chapter 2. Barriers to adoption and attitudes towards technology. 2017. Pew Research Center. Accessed 16 September 2022. Available from https://www.pewresearch.org/ internet/2017/05/17/barriers-to-adoption-and -attitudes-towards-technology/ 55. Arighi A, Fumagalli GG, Carandini T, et al. Facing the digital divide into a dementia clinic during COVID-19 pandemic: caregiver age matters. Neurol Sci 2021;42:1247-1251
  40. Tong HL, Laranjo L. The use of social features in mobile health interventions to promote physical activity: a systematic review. NPJ Digit Med 2018;1:43
  41. Sinclair AJ, Abdelhafiz A, Dunning T, et al. An international position statement on the management of frailty in diabetes mellitus: summary of recommendations 2017. J Frailty Aging 2018;7:10-20 59. American Diabetes Association. 11. Older adults: Standards of Medical Care in Diabetes- 2018. Diabetes Care 2018;41(Suppl. 1):S119-S125
  42. Pahor M, Guralnik JM, Ambrosius WT, et al.; LIFE Study Investigators. Effect of structured physical activity on prevention of major mobility disability in older adults: the LIFE study randomized clinical trial. JAMA 2014;311:2387-2396
  43. Rodriguez-Mañas L, Laosa O, Vellas B, et al.; European MID-Frail Consortium. Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus. J Cachexia Sarcopenia Muscle 2019;10:721-733
  44. Pandya N, Hames E, Sandhu S. Challenges and strategies for managing diabetes in the elderly in long-term care settings. Diabetes Spectr 2020;33:236-245
  45. Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults. Diabetes Care 2012;35: 2650-2664
  46. Cheng AYY, Feig DS, Ho J; Diabetes Canada Clinical Practice Guidelines Expert Working Group; Diabetes Canada Clinical Practice Guidelines Steering Committee. Blood glucose monitoring in adults and children with diabetes: update 2021. Can J Diabetes 2021;45:580-587
  47. Griffith KN, Prentice JC, Mohr DC, Conlin PR. Predicting 5-and 10-year mortality risk in older adults with diabetes. Diabetes Care 2020;43: 1724-1731
  48. Conlin PR, Colburn J, Aron D, Pries RM, Tschanz MP, Pogach L. Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: management of type 2 diabetes mellitus. Ann Intern Med 2017;167:655-663
  49. Toschi E, Slyne C, Sifre K, et al. The relationship between CGM-derived metrics, A1C, and risk of hypoglycemia in older adults with type 1 diabetes. Diabetes Care 2020;43:2349-2354
  50. Perlman JE, Gooley TA, McNulty B, Meyers J, Hirsch IB. HbA1c and glucose management indicator discordance: a real-world analysis. Diabetes Technol Ther 2021;23:253-258
  51. Andreassen LM, Sandberg S, Kristensen GB, Sølvik UO, Kjome RL. Nursing home patients with diabetes: prevalence, drug treatment and glycemic control. Diabetes Res Clin Pract 2014;105:102-109
  52. Idrees T, Castro-Revoredo IA, Migdal AL, Moreno EM, Umpierrez GE. Update on the management of diabetes in long-term care facilities. BMJ Open Diabetes Res Care 2022;10:e002705 73. Bouillet B, Tscherter P, Vaillard L, et al. Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes. Age Ageing 2021;50:2088-2093
  53. Mattishent K, Lane K, Salter C, et al. Continuous glucose monitoring in older people with diabetes and memory problems: a mixed- methods feasibility study in the UK. BMJ Open 2019;9:e032037 75. Petrillo LA, Gan S, Jing B, Lang-Brown S, Boscardin WJ, Lee SJ. Hypoglycemia in hospice patients with type 2 diabetes in a national sample of nursing homes. JAMA Intern Med 2018;178:713- 715
  54. Fulmer T, Berman A, Lesiak B, Alshabasy S, Levy N. Age-friendly health systems. In The Age-Friendly Lens. Gardiner C, O'Brien Webb E, Eds. Oxfordshire, U.K., Routledge, 2022, p. 60-73

Authors
Huang, E. S., Sinclair, A., Conlin, P. R., Cukierman-Yaffe, T., Hirsch, I. B., Huisingh-Scheetz, M., Kahkoska, A. R., Laffel, L., Lee, A. K., Lee, S., Lipska, K., Meneilly, G., Pandya, N., Peek, M. E., Peters, A., Pratley, R. E., Sherifali, D., Toschi, E., Umpierrez, G., Weinstock, R. S., & Munshi, M.
Affiliations
  • University of Chicago (US)
  • King's College London (GB)
  • Harvard University (US)
  • 5Division of Endocrinology, Diabetes, and Metabolism, Ramat Gan, Israel
  • University of Washington (US)
  • University of North Carolina at Chapel Hill (US)
  • Joslin Diabetes Center (US)
  • University of California, San Francisco (US)
  • Yale University (US)
  • University of British Columbia (CA)
  • Nova Southeastern University (US)
  • University of Southern California (US)
  • AdventHealth Orlando (US)
  • McMaster University (CA)
  • Emory University (US)
  • SUNY Upstate Medical University (US)
Corresponding author
Huang, Elbert S.
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2023-07-20
Volume
46
Issue
8
Pages
1455-1463
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dci23-0021
PMC
PMC10369127
OpenAlex
W4384924871
Cited by
73
References
74
Citations by year
2026: 22 · 2025: 27 · 2024: 23 · 2023: 1
FWCI
2.62
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/journals/pages/license (vor)
Locations
  • Diabetes Care (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
  • NSUWorks (Nova Southeastern University) (submittedVersion)
Funders
  • U.S. Department of Veterans Affairs (I01 HX003527)
  • National Center for Advancing Translational Sciences (KL2TR002490, UL1 TR002541)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK113358, P30 DK092949, R01 DK114098, R01 DK122603, R01 DK127961, U01 DK127392, U01 DK135131)
  • National Institute on Aging (K24 AG069080, R01 AG060756, R01 AG063391)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Social Sciences › Demography › Technology Use by Older Adults
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
Keywords
diabetes management, older adults, continuous glucose monitoring, insulin pump, smart pen, diabetes technology, technology adoption barriers, caregiver empowerment, diabetes care quality, health care costs
MeSH terms
Aged, Blood Glucose, Costs and Cost Analysis, Diabetes Mellitus, Humans, Insulin Infusion Systems, Caregivers

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