Assistant Professor University of Florida University of Florida Gainesville, United States
Background: Cognitive impairment is associated with a higher risk of hypoglycemia and, hypoglycemia is associated with worsening of cognition. Over the coming decades, 13%–20% of older people with dementia are expected to have coexisting diabetes, continuous glucose monitoring (CGM) offers important benefits in terms of detecting hypoglycemia, and helping the physician make personalized insulin dose adjustments.
Objectives: We aimed to (1) assess the association between CGM use and all-cause mortality among diabetes patients with cognitive impairment and dementia, and (2) determine disparities in the use of CGM in this population.
Methods: We used 2016-2020 electronic health records data from the University of Florida Health System and identified patients who (1) had diagnoses of both diabetes and cognitive impairment (i.e., mild cognitive impairment or Alzheimer's disease and related dementias) and (2) were insulin users. We examined CGM use by race/ethnicity and insurance status; and applied multiple logistic regression to examine the association of CGM use with all-cause mortality.
Results: Of 1995 eligible patients (mean age 70.5±9.9 years, 56.9% non-Hispanic White (NHW), 37.5% non-Hispanic Black (NHB), and 5.6% others), 51 (2.6%) were CGM users and 566 (28.9%) died in a median follow up of 697 days. Black patients were less likely to use CGM compared to White patients (29.4% vs. 37.7% were Black among CGM users vs. non-users, respectively). Medicaid/uninsured patients were less likely to use CGM compared to Medicare/private insurance patients (1.9% vs. 11% were Medicaid/uninsured patients among CGM users vs. non-users, respectively). After adjusting for demographic and clinical characteristics in insulin users, CGM users were associated with a significantly lower risk of all-cause mortality compared to non-CGM users (adjusted OR (95% CI):0.2 (0.1-0.6)).
Conclusions: The use of CGM was associated with improved survival among diabetes patients who were insulin users and had cognitive impairment. However, racial and socioeconomic disparities in the use of CGM were observed, which may exacerbate existing inequities in diabetes care and outcomes.
