Insulin pump use was not required for eligibility. Eligibility criteria for people with diabetes were 1) age ≥60 years, 2) diagnosis of type 1 diabetes, 3) naive to use of personal real-time CGM system with the Dexcom Follow App, 4) A1C of 6.0–12% measured within the previous 6 months, 5) ability to read and write English, 6) possession of a smartphone compatible with the Dexcom G6 RT-CGM, and 6) care partner willing to participate. Participant dyads ( n = 10) were recruited from an academic endocrinology specialty clinic and through social media posts. To date, there has been a lack of research specifically addressing the use of telehealth services for older adults with type 1 diabetes and their care partners. Despite the potential benefits of telehealth-delivered interventions, research has shown mixed results for the effectiveness of telehealth in people with type 2 diabetes, including modest reductions in A1C compared with usual care ( 21) and greater improvements in A1C with telehealth with real-time feedback compared with telemonitoring alone ( 22), and no improvement in outcomes for people with type 1 diabetes ( 23). CGM technology is well suited to a telehealth approach because it allows diabetes care teams the opportunity to monitor the glucose levels of people with diabetes remotely, using internet-based platforms or apps ( 20). Certified diabetes care and education specialists (CDCESs) can provide education and behavioral interventions to people with diabetes and their care partners around these issues. Telehealth has the potential to both augment the effectiveness of CGM and aid in engaging care partners through the use of data-sharing apps ( 17). Health care providers and other diabetes care team members are well poised to recognize the difficulties older adults with diabetes and their care partners may be experiencing with CGM, but they may not know how to effectively engage care partners in assisting with diabetes management or have time or capacity in the clinic setting to provide the instruction they would need to do so effectively. In addition, the ADA has published guidelines supporting CGM for older adults with diabetes ( 6) and Medicare coverage has made CGM more accessible ( 14). However, there is growing evidence that continuous glucose monitoring (CGM) in older adults may be effective at decreasing both hypo- and hyperglycemia ( 12, 13). Both hyper- and hypoglycemia increase the risk of complications such as myocardial infarction, cerebrovascular accidents, dementia, and sudden death ( 10, 11). Yet, higher A1C targets do not prevent hypoglycemia ( 7) and predispose older adults to the negative effects of hyperglycemia ( 8, 9). The American Diabetes Association (ADA) recommends relaxed glycemic targets for older adults with multiple comorbidities to limit the incidence of hypoglycemia ( 6). As people with diabetes grow older, they experience age-related diabetes changes that may impede self-management ( 5), including increased hypoglycemia unawareness and changes in fine motor skills, visual acuity, dexterity, and cognitive function. Although life expectancy generally remains shorter among people with than among those without diabetes ( 2), the life expectancy of people with type 1 diabetes has increased up to an additional 15 years, resulting in a higher incidence of older adults living with the disease ( 3, 4). Type 1 diabetes is on the rise, currently affecting an estimated 1.59 million individuals in the United States ( 1).
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