195-OR: Efficacy and Feasibility of a Telemedicine Program for Institutionalized Elderly People with Insulin-Treated Diabetes Using Continuous Glucose Monitoring and a Connected Insulin Pen Cap-The Trescasas Study

• Published in: Diabetes (New York, N.Y.) Vol. 73; p. 1
• Main Authors: Gomez-Peralta, Fernando, Abreu, Cristina, Mazo, Estefania S
• Format: Journal Article
• Language: English
• Published: New York American Diabetes Association 01.06.2024
• Subjects: Caregivers; Diabetes; Diabetes mellitus; Feasibility studies; Glucose; Glucose monitoring; Hyperglycemia; Hypoglycemia; Institutionalization; Insulin; Older people; Telemedicine
• ISSN: 0012-1797; 1939-327X
• DOI: 10.2337/db24-195-OR

Introduction & Objective: Investigate the feasibility and efficacy of a telemedicine program in institutionalized elderly people with insulin-treated diabetes. Methods: This multicenter, prospective study comprised of three two-week phases: Phase 1 (baseline): blind CGM (Freestyle Libre Pro®); Phase 2a: CGM (Freestyle Libre2®) without alarms; Phase 2b: CGM with alarms for hypo and hyperglycemia. Two telemedicine visits from the reference diabetes units to adjust the treatment before phases 2a and 2b. The insulin treatment was tracked using the Insulclock® connected insulin pen cap. The caregivers' opinion about the program was measured. Feasibility criteria included the number of eligible patients, recruitment, attrition and the capture of glucose readings. The insulin or antidiabetic drugs changes were recorded. Results: From 82 eligible residents (87.7 +7.1, 68-102 y, 56% women, baseline HbA1c 6.9 +1.6) at 7 nursing homes, 54 completed all the procedures. The caregivers expressed an overall positive view of the program (3.8 out of 4 points); greater convenience (4.5 out of 5 points) and potential to reduce hypoglycemia (3.7 out of 5 points) by using Freestyle Libre2® over glucometer. The rate of glucose events <70 mg/dl in every phase (mean +SD) decreased: 4.9 +6.2, 3 +3.8, and 2.1 +3.1 (p 0.036). GMI and TIR 70-180 increased: 7.1 +1.2, 7.2 +1.4, 7.5 +1.7 (p 0.01); 65.6 +24.8, 65.1 +25.2, 60.4 +26.4 (p 0.02), respectively. The number of insulin injections (mean +SD): (1.2 +0.9 to 0.9 +0.8; p 0.02), and basal insulin dose (median) (16 to 14 IU; p 0.0003) decreased. The number of rapid insulin doses increased: 1.6 +3.8 to 2.9 +4.3 (p 0.02). Conclusion: A telemedicine program using CGM is well-perceived by caregivers and achieves a safer and more adequate glycemic profile in the challenging population of institutionalized older people with diabetes treated with insulin.