Systematic review of disparities in continuous glucose monitoring prescribing in older adults living with diabetes

Introduction

Continuous glucose monitoring (CGM) is transforming diabetes care and its access should not depend on age, ethnicity, or socioeconomic status.

Updated NICE guidance in 2022 expanded NHS funding to include people with type 2 diabetes mellitus on insulin who meet certain criteria.

Emerging evidence indicates that older adults are significantly less likely to be offered CGM. We aimed to systematically review prescribing of CGM in older age groups compared to younger ones.

Methods

PROSPERO registration: CRD420251104079

Databases: PubMed, Web of Science

Inclusion criteria: studies that compared the extent of CGM prescribing in older adults against that of younger age groups.

Data Collection: Two independent reviewers screening and extracting data

Data Synthesis: Primary outcome of interest was the disparities or inequalities in CGM prescribing related to older age. Random effects meta-analysis was used to pool odds ratios (ORs).

Results

We included eight publications reporting on 9 datasets. The majority of the articles were from the United States, with one from Korea and one from the UK.

We had a total of 980,000 participants, of which 150,000 were prescribed CGM and 830,000 were not prescribed CGM.

 A random effects meta analysis of four datasets yielded a pooled OR 0.52 (95% Confidence Interval 0.37 - 0.73) for the likelihood of CGM prescription in the oldest age category compared to the least old category. On average, older people were 48% less likely to be prescribed CGM compared to the youngest age category.

Two studies reported that the mean age of those who had been prescribed CGM was significantly lower than that of the mean age of the ones who had not been prescribed CGM.

Conclusion

Older people are significantly less likely to be prescribed CGM raising concerns surrounding serious disparities in delivering the benefits of CGM to older people living with diabetes.