OBJECTIVE Continuous glucose monitoring (CGM) use in older adults with type 1 diabetes (T1D) has shown benefits. However, the impact of CGM use, coupled with simplified treatment regimens and personalized glycemic goals that are better suited for older patients with multiple comorbidities and hypoglycemia, is not known. RESEARCH DESIGN AND METHODS Older adults (≥65 years) with T1D with hypoglycemia (two or more episodes of hypoglycemia [blood glucose <70 mg/dL for ≥20 min over 2 weeks]) who were CGM naïve or CGM users were randomized to intervention and control groups. The intervention consisted of the combined use of CGM with geriatric principles (i.e., adjusting goals based on overall health, and simplification of regimens based on CGM patterns and clinical characteristics) over 6 months. The control group received usual care by their endocrinologist. The primary end point was change in time when blood glucose was <70 mg/dL from baseline to 6 months. Cost-effectiveness was calculated using a health care sector perspective. RESULTS We randomized 131 participants (aged 71 ± 5 years; 21% ≥75 years old) to the intervention (n = 68; CGM users = 33) or the control (n = 63; CGM users = 40) group. The median change in hypoglycemia from baseline to 6 months was −2·6% in the intervention group and −0.3% in the control group (median difference, −2.3% [95% CI −3.7%, −1.3%]; P < 0.001). This improvement was seen in both CGM naïve (−2.8%; 95% CI −5.6%, −0.8%) and CGM users (−1.2%; 95% CI −2.7%, −0.1%). The HbA1c did not differ between the groups (7.5% vs 7.3%). The intervention was cost-effective (incremental cost-effectiveness ratio $71,623 per quality adjusted life-year). CONCLUSIONS In older adults with T1D and high risk of hypoglycemia, CGM use enhanced by geriatric principles can lower hypoglycemia without worsening glycemic control in a cost-effective fashion.

中文翻译：

---

根据老年学原理对患有 1 型糖尿病和低血糖的老年人进行连续血糖监测：一项随机对照试验


目的 对患有 1 型糖尿病 (T1D) 的老年人使用连续血糖监测 (CGM) 已显示出益处。然而，CGM 的使用以及更适合患有多种合并症和低血糖的老年患者的简化治疗方案和个性化血糖目标的影响尚不清楚。研究设计和方法 未接受过 CGM 或 CGM 用户的患有 T1D 并伴有低血糖（两次或多次低血糖发作 [血糖 <70 mg/dL，持续 ≥ 20 分钟，超过 2 周]）的老年人（≥65 岁）被随机接受干预和对照组。干预措施包括将 CGM 与老年学原则相结合（即根据整体健康状况调整目标，并根据 CGM 模式和临床特征简化治疗方案），为期 6 个月。对照组接受内分泌科医生的常规护理。主要终点是从基线到 6 个月血糖为 <70 mg/dL 时的时间变化。成本效益是从医疗保健部门的角度计算的。结果 我们将 131 名参与者（年龄 71 ± 5 岁；21% ≥75 岁）随机分为干预组（n = 68；CGM 用户 = 33）或对照组（n = 63；CGM 用户 = 40）。干预组中低血糖相对于基线至 6 个月的中位变化为 -2·6%，对照组为 -0.3%（中位差异，-2.3% [95% CI -3.7%, -1.3%]；P % 3C 0.001）。这种改善在未使用 CGM（-2.8%；95% CI -5.6%，-0.8%）和 CGM 用户（-1.2%；95% CI -2.7%，-0.1%）中均可见。各组之间的 HbA1c 没有差异（7.5% vs 7.3%）。该干预措施具有成本效益（每个质量调整生命年的增量成本效益比为 71,623 美元）。 结论 对于患有 T1D 和低血糖高风险的老年人，通过老年学原则加强 CGM 的使用可以以经济有效的方式降低低血糖，而不会使血糖控制恶化。