A Telehealth Program Using Continuous Glucose Monitoring and a Connected Insulin Pen Cap in Nursing Homes for Older Adults with Insulin-Treated Diabetes: The Trescasas Study.

Abstract

Objective: To assess the impact and feasibility of a telehealth program using continuous glucose monitoring (CGM) and a connected insulin pen cap (CIPC) in nursing homes for older adults with insulin-treated diabetes. Research Methods: This multicenter, prospective, sequential, single-arm study consisted of three phases: (1) baseline, blind CGM (Freestyle Libre Pro®); (2) intervention 1, CGM (Freestyle Libre2®) without alarms; and (3) intervention 2, CGM with alarms for hypo and hyperglycemia. Two telehealth visits from reference diabetes units were conducted to adjust antidiabetic treatments. Insulin treatment was tracked using the Insulclock® CIPC. The study's primary objective was to evaluate the reduction of hypoglycemia rate. Results: Of 82 eligible patients at seven nursing homes, 54 completed the study (age: 87.7 ± 7.1, 68-102 years, 56% women, duration of diabetes: 18.7 years, baseline glycated hemoglobin: 6.9% [52 mmol/mol]). The mean number of hypoglycemic events was significantly reduced from baseline (4.4) to intervention 1 (2.8; P = 0.060) and intervention 2 (2.1; P = 0.023). The time below range 70 mg/dL (3.9 mmol/L) significantly decreased from 3.7% at baseline to 1.4% at intervention 2 (P = 0.036). The number of insulin injections significantly decreased from baseline to intervention 1 (1.2 to 0.99; P = 0.027). Nursing home staff expressed a positive view of the program, greater convenience, and potential to reduce hypoglycemia with the Freestyle Libre2® CGM versus the glucometer. Conclusions: A telehealth program using CGM and a CIPC was associated with improved glycemic profiles among institutionalized older individuals with diabetes receiving insulin and was well perceived by professionals.