Appl Clin Inform 2023; 14(01): 037-044
DOI: 10.1055/a-1975-4136
Research Article

Continuous Glucose Monitoring and Other Wearable Devices to Assess Hypoglycemia among Older Adult Outpatients with Diabetes Mellitus

Michael Weiner
1   Department of Medicine, Indiana University, Indianapolis, Indiana
2   Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
3   Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13–416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
,
Philip Adeoye
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
,
Margaret J. Boeh
5   Senior Care, Eskenazi Health, Indianapolis, Indiana
,
Kunal Bodke
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
,
Jessica Broughton
5   Senior Care, Eskenazi Health, Indianapolis, Indiana
,
Anietra R. Butler
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
,
Mackenzie L. Dafferner
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
,
Lindsay A. Dirlam
6   Lifestyle Health and Wellness, Eskenazi Health, Indianapolis, Indiana
,
Denisha Ferguson
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
,
Amanda L. Keegan
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
,
NiCole R. Keith
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
7   Department of Kinesiology, Indiana University, Indianapolis, Indiana
,
Joy L. Lee
1   Department of Medicine, Indiana University, Indianapolis, Indiana
2   Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
,
Corrina B. McCorkle
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
,
Daniel G. Pino
1   Department of Medicine, Indiana University, Indianapolis, Indiana
6   Lifestyle Health and Wellness, Eskenazi Health, Indianapolis, Indiana
,
Mu Shan
8   Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana
,
Preethi Srinivas
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
,
Qing Tang
8   Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana
,
Evgenia Teal
9   Data Services, Regenstrief Institute, Inc., Indianapolis, Indiana
,
Wanzhu Tu
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
8   Department of Biostatistics and Health Data Science, Indiana University, Indianapolis, Indiana
,
April Savoy
2   Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana
3   Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13–416, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
10   Computer and Information Technology, Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indiana
,
Christopher M. Callahan
1   Department of Medicine, Indiana University, Indianapolis, Indiana
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
5   Senior Care, Eskenazi Health, Indianapolis, Indiana
,
Daniel O. Clark
1   Department of Medicine, Indiana University, Indianapolis, Indiana
4   Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana
› Author Affiliations
Funding This study was supported by the Agency for Healthcare Research and Quality (grant no.: P30HS024384).

Abstract

Background Hypoglycemia (HG) causes symptoms that can be fatal, and confers risk of dementia. Wearable devices can improve measurement and feedback to patients and clinicians about HG events and risk.

Objectives The aim of the study is to determine whether vulnerable older adults could use wearables, and explore HG frequency over 2 weeks.

Methods First, 10 participants with diabetes mellitus piloted a continuous glucometer, physical activity monitor, electronic medication bottles, and smartphones facilitating prompts about medications, behaviors, and symptoms. They reviewed graphs of glucose values, and were asked about the monitoring experience. Next, a larger sample (N = 70) wore glucometers and activity monitors, and used the smartphone and bottles, for 2 weeks. Participants provided feedback about the devices. Descriptive statistics summarized demographics, baseline experiences, behaviors, and HG.

Results In the initial pilot, 10 patients aged 50 to 85 participated. Problems addressed included failure of the glucometer adhesive. Patients sought understanding of graphs, often requiring some assistance with interpretation. Among 70 patients in subsequent testing, 67% were African-American, 59% were women. Nearly one-fourth (23%) indicated that they never check their blood sugars. Previous HG was reported by 67%. In 2 weeks of monitoring, 73% had HG (glucose ≤70 mg/dL), and 42% had serious, clinically significant HG (glucose under 54 mg/dL). Eight patients with HG also had HG by home-based blood glucometry. Nearly a third of daytime prompts were unanswered. In 24% of participants, continuous glucometers became detached.

Conclusion Continuous glucometry occurred for 2 weeks in an older vulnerable population, but devices posed wearability challenges. Most patients experienced HG, often serious in magnitude. This suggests important opportunities to improve wearability and decrease HG frequency among this population.

Note

Aspects of this work were presented at Improving Primary Care through Industrial and Systems Engineering (i-PrACTISE), Boston, MA, June 3, 2019; and The Scottsdale Institute, February 27, 2020.


M.W. is Chief of Health Services Research and Development at the Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis, Indiana. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.




Publication History

Received: 08 May 2022

Accepted: 25 October 2022

Accepted Manuscript online:
09 November 2022

Article published online:
18 January 2023

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