Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults with Type 1 Diabetes: A Randomized Clinical Trial

The Wireless Innovation for Seniors with Diabetes Mellitus (WISDM) study, published in the Journal of American Medical Association in 2020,¹ was one of the first randomized control continuous glucose monitor Clinical trials to assess whether Dexcom CGM use was more effective than the self-monitoring of blood glucose (SMBG) in reducing hypoglycemia in older adults with type 1 diabetes (n=203, >60 years of age). Compared with the SMBG control group, here are the results of the efficacy of CGM on hypoglycemia in T1D older adults:

• Median percent time <70 mg/dL decreased from 5.1% (73 minutes per day) at baseline to 2.7% (39 minutes per day) at the 6-month follow-up for the CGM group. By contrast, hypoglycemia exposure remained relatively unchanged for the SMBG group—from 4.7% (68 minutes per day) at baseline to 4.9% (70 minutes per day) during follow-up—for an adjusted treatment group difference of −1.9% (95% CI, −2.8% to −1.1%; P <0.001).

  • This Dexcom clinical trial result corresponds to a significant reduction in hypoglycemia of 27 minutes per day (P <.001).

• Reduction in hypoglycemia in older adults observed in the CGM group was independent of baseline characteristics, including age (<70 vs ≥70 years), socioeconomic status, presence of cognitive impairment, or A1C.

• Mean time spent in the target range of 70 to 180 mg/dL was 8.8 percentage points (2.1 hours per day) higher in the CGM group compared with the SMBG group (P <0.001). 

• Baseline A1C was relatively low. However, the study on the CGM group of older adults with Type 1 diabetes observed a small but statistically significant decrease in mean A1C (adjusted group difference, −0.3%; P <0.001).

• Adherence to CGM was high; 83% of users wore their Dexcom CGM >6 days per week.  

Percent of time spent of T1D older adults in hypoglycemia (<70mg/dL) by study visit

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^{1 Pratley RE, Kanapka LG, Rickels MR, et al. Effect of Continuous Glucose Monitoring on Hypoglycemia in Older Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA. 2020;323(23):2397–2406.}