Excessive Burden of Hyperglycemia Along With Hypoglycemia in Long-Term Care Facilities Identified by Continuous Glucose Monitoring.

OBJECTIVES

Recommendations for diabetes care in long-term care facilities (LTC) focus on the avoidance of hypoglycemia and symptomatic hyperglycemia. Using continuous glucose monitoring (CGM), we evaluated the current state of glycemia in LTC residents with multiple comorbidities.

DESIGN

Cross-sectional prospective observational study.

SETTINGS AND

PARTICIPANTS

Participants with diabetes on 1 or more glucose-lowering medications residing in 1 of 8 LTC facilities in Ohio and Michigan.

METHODS

A masked Dexcom G6 pro CGM was placed for 10 days on LTC residents. Clinical and demographic information was collected from medical records.

RESULTS

Sixty-five residents [median age 68 years (range 44-84 years), 51% female, 100% with type 2 diabetes] completed the study. Overall, 68% of the cohort used insulin and 64% were on non-insulin agents (11% on sulfonylurea). The mean A1c of the cohort was 7.2% ± 1.5%. CGM data showed 26% of the cohort with ≥1% time spent in hypoglycemia (time <70 mg/dL). A larger burden of severe hyperglycemia (sensor glucose >250 mg/dL) was seen, with 52% of the cohort spending >10% time, 37% spending >25%, and 18% spending >50% time in severe hyperglycemia. The cohort had a median of 13 comorbid conditions, taking 19 medications daily, with 86% having functional disabilities and 63% reporting a recent fall. Fifty-four percent of the cohort had a body mass index (BMI) >30 kg/m2 and 22% had a BMI >40 kg/m2.

CONCLUSIONS AND IMPLICATIONS: In this multimorbid cohort of residents with diabetes living in LTC facilities, we identified a high burden of both hypoglycemia and severe hyperglycemia, despite optimal control of A1c. More consistent use of CGM may help to identify glycemic excursions and actionable glucose patterns to improve therapeutic decision-making by clinicians.