Continuous Glucose Monitoring in Comorbid Dementia and Diabetes: The Evidence So Far

Abstract

Background: Type 2 diabetes mellitus (T2DM) and dementia are two of the leading chronic diseases in aging and are known to influence each other's disease progression. There is well-established evidence that T2DM increases the risk for cognitive decline and dementia. At the same time, people with cognitive changes or dementia can find it difficult to manage their diabetes, resulting in hyper- or hypoglycemic events which can exacerbate the dementia disease progression further. Monitoring of glucose variability is, therefore, of critical importance during aging and when people with T2DM develop dementia. The advent of continuous glucose monitoring (CGM) has allowed the monitoring of glucose variability in T2DM more closely. The CGM seems to be highly feasible and acceptable to use in older people with T2DM and has been shown to significantly reduce their hypoglycemic events, often resulting in falls. Less is known as to whether CGM can have a similar beneficial effect on people with T2DM who have cognitive impairment or dementia in community or hospital settings.

Aims: The current perspective will explore how CGM has made an impact on T2DM management in older people and those with comorbid cognitive impairment or dementia. We will further explore opportunities and challenges of using CGM in comorbid T2DM and dementia in community and hospital settings.

Keywords: Alzheimer’s diseases; CGM device; continuous glucose monitoring; dementia; type 2 diabetes mellitus.

Figure 1.

The blood glucose fluctuations with the time both captured by finger pricks and for CGM alarms/alerts. Diagram illustrating differences in glucose fluctuations via finger prick measurements or CGM. The red shaded area shows the dysglycemia. The red “x” refers the finger prick measurements., TIR = time in range, time spent in targeted blood glucose (70-180 mg/dL). The blue-shaded area shows the time that CGM receiver or smartphone sends alarms/alerts when it detects the interstitial glucose is upgoing/descending trend in a short time. The CGM can send notifications when the interstitial glucose of the user is increasing or decreasing rapidly (it also provides the speed with two modes) even if they are in euglycemia.