Experience with Continuous Glucose Monitoring in Reducing Diabetes Management Burden for Older Chinese Americans with Cognitive Impairment

Objective We aimed to study the experience of using continuous glucose monitoring (CGM) among older Chinese Americans with cognitive impairment (CI) and their care partners. We also explored physicians’ perspectives on using CGM in older adults with cognitive decline. Background CI can heighten the challenges of managing type 2 diabetes (T2D), particularly among older Chinese Americans due to the interplays of cultural, financial, and health-related burdens and older adults with cognitive decline that add additional challenges of diabetes management. The application of CGM in such populations remains understudied. Method Older Chinese American adults with CI and T2D and their care partners were recruited from the New York City (NYC) community. Clinicians who had clinical experience of the application of CGM in individuals with diabetes and cognitive decline were recruited nationally. After brief education, patients used CGM for 10 days and shared the data with their care partners. In-depth interviews were conducted among older Chinese Americans with both T2D and CI (n=11), care partners (n=11), and clinicians (n=8), transcribed, and then thematically analyzed using ATLAS.ti software. Results Older Chinese Americans with both T2D and CI had a mean age of 74.5 ± 5.2 years, and 63.6% were women. They reported CGM helped them assess the influence of various foods on glucose levels in order to choose appropriate foods (n=10) and portion sizes (n=5), gain insight on the role and impact of exercise (n=5), enhance care partner involvement (n=5) and communication (n=4), and promote a positive mindset by improving management confidence or disease understanding (n=9) in diabetes self-management. Care partners echoed similar sentiments but added that the device enhanced diabetes management as it was more persuasive in motivating behavioral changes (n=5), and increased care partner involvement by allowing them to check in more often (n=6) and review data with the patient at anytime and anywhere (n=4). Clinicians emphasized that CGM provided real-time, shareable continuous data, in contrast with occasional A1C results (n=5), improving safety, supporting individualized treatment decisions (n=5), highlighting the importance of strong care partner support systems (n=8), and noting that newer models with automatic data transmission (Dexcom G6/G7) are especially valuable (n=5). Conclusion Our findings indicate that CGM was feasible in easing management burden for older Chinese Americans with CI and T2D, while also enhancing care partner involvement and supporting clinicians in individualized treatment decisions. Application Potential applications of this research include the adaptation of the CGM in older Chinese Americans with CI and T2D to better accommodate their cultural needs in diabetes management.