Detection of asymptomatic drug-induced hypoglycemia using continuous glucose monitoring in older people – Systematic review

Aim: We conducted a systematic review of the use of continuous glucose monitoring (CGM) in older patients, in order to consolidate the growing evidence base in this area.

Methods: Our protocol was registered on PROSPERO (CRD42017068523).

We searched SCI Web of Science, Ovid SP MEDLINE and EMBASE from January 2010 to June 2017 for observational studies and randomized controlled trial of CGM in older patients (mean age 65 or older) with diabetes. We excluded studies that involved only hospitalized patients. Two reviewers independently extracted data blood sugar values (in particular, hypoglycemic episodes) captured with the use of CGM. We also assessed adverse events and acceptability of CGM.

Results: After screening 901 abstracts, we included nine studies with a total of 989 older patients with diabetes.

The CGM studies reveal that hypoglycemic episodes were occurring in a sizeable proportion (28–65%) of participants. Most (80–100%) of these episodes were asymptomatic, with some patients spending nearly two hours per day in the hypoglycemic range. Older people with diabetes found CGM acceptable and experienced improved health-related well-being.

Conclusion: CGM frequently picks up asymptomatic hypoglycemic episodes in older patients with diabetes. Users of CGM report improved well-being, and reduction of diabetes-related stress.