Continuous Glucose Monitoring in Older-Old With Type 2 Diabetes Mellitus: A Narrative Review of Evidence and Recommendations.

The global rise in Type 2 diabetes mellitus (T2DM) is increasingly driven by population aging; nearly one in four adults with diabetes is now aged 65 years or older. Older adults with T2DM, particularly, those on insulin, face heightened risks of hypoglycaemia, glycaemic variability and diabetes-related complications, contributing to functional decline, impaired quality of life and increased mortality. Conventional glycaemic assessment with glycated haemoglobin (HbA1c) inadequately captures clinically relevant glucose fluctuations, especially asymptomatic and nocturnal hypoglycaemia, which are common yet frequently unrecognised in this population. Continuous glucose monitoring (CGM) has emerged as a major advance in diabetes care, enabling real-time assessment of glucose trends and providing detailed metrics, such as time in range, that offer a more comprehensive picture of glycaemic control. Growing evidence links CGM use in older adults with T2DM to reductions in hypoglycaemia, improved glycaemic metrics and enhanced treatment satisfaction and quality of life. These benefits are, particularly, relevant in vulnerable subgroups, including adults aged ≥ 75 years, individuals with cognitive impairment or frailty and long-term care residents, where unrecognised hypoglycaemia and therapeutic inertia are especially prevalent. Despite growing guideline support, CGM adoption in routine care remains limited due to clinical, logistical, age-related and socioeconomic barriers. This narrative review summarises current evidence and clinical recommendations for CGM use in older adults with T2DM, focusing primarily on those aged ≥ 75 years and discusses implementation challenges and strategies to optimise its integration into individualised diabetes care.