Rethinking diabetes technology to detect hypoglycemia in older adults with diabetes and Alzheimer’s disease

April Savoy, PhD, a researcher at the Regenstrief Institute, a human factors engineer and health services researcher, develops and tests user-friendly health information tools and technologies designed to improve accessibility and value for older adults with diabetes and Alzheimer’s disease and their caregivers. Without many fingers, these tools and technology will be designed to provide patients, caregivers and clinicians with the glucose readings needed to diagnose hypoglycemia and identify treatment options.

Older people with Alzheimer’s disease and type 1 or type 2 diabetes are at high risk of low blood sugar, known as low blood sugar, which often goes undetected. Hypoglycemia can cause dizziness, confusion, mood swings, hospitalization, and even death. Diagnosing and treating hypoglycemia can prevent complications.

“Alzheimer’s disease is a progressive disease, and hypoglycemic events can accelerate cognitive decline. That’s why we’re focused on detecting hypoglycemia in these older adults who have both Alzheimer’s disease and diabetes,” said Dr. Savoy, assistant professor in the Purdue School of Engineering and Technology at IUPUI.

Dementia impairs the ability of patients and relatives to manage their blood sugar, which can lead to hypoglycemic events and other cognitive losses. Repeated finger pricks to test blood sugar, following a prescribed diet and exercise can be difficult for patients with Alzheimer’s disease. Using traditional blood glucose meters can be problematic for people with Alzheimer’s disease as well as caregivers.

The study, “Improving shared decision-making to stimulate and guide individualized care for people with Alzheimer’s disease and diabetes,” will recruit 75 pairs of older adults with both Alzheimer’s disease and diabetes and diabetes, and their family caregivers. Twenty clinicians who see patients with both conditions will also participate.

Other studies have investigated how poor management of diabetes increases the risk of dementia. But this new research, which implements a human factors engineering approach, targets older people who have already been diagnosed with both Alzheimer’s disease and diabetes. Dr. Savoy and his colleagues will study the unique dynamics of the population, including how much data on glucose levels is needed, how to obtain it, and what works to enable shared decision-making for all involved—patients, caregivers, and clinicians.

“We hope to raise awareness and empower patients and caregivers to make individualized, patient-centered decisions about effective treatment options. Our goal is to prevent hypoglycemia in the growing population of older adults with Alzheimer’s disease and diabetes,” said Dr. Savoy.

In collaboration with Dr. Savoy on this work, which is supported by a new five-year grant from the National Institute on Aging of the National Institutes of Health, are Regenstrief Institute researchers and Indiana University School of Medicine faculty member Michael Weiner, MD , MPH, who has researched hypoglycemia and dementia, and Greg Sachs, MD, a geriatrician specializing in the aging brain; Richard Holden, PhD, faculty member of the Regenstrief Institute and Indiana University Bloomington School of Public Health, a human factors engineer developing technology for people with AD Alzheimer’s with their caregivers; and Indiana University School of Medicine faculty member Mary DeGroot, PhD, who studies and treats patients with diabetes.

Dr. Savoy and his colleagues recently wrote a commentary in the peer-reviewed journal Journal of Diabetes Science and Technology, on the importance of applying the human-centered design process for continuous glucose monitoring and investigating design solutions and interventions to integrate continuous glucose monitoring into the health care of patients with dementia and diabetes. Through the use of human-centered design, the authors indicate that they will be able to identify and inform continuous glucose monitoring designs for people with dementia and diabetes by expanding access to continuous glucose monitoring with what they believe is the achievable goal of increasing detection and treatment of the silent threat posed by hypoglycaemia.

The authors of “Improving Care for People Living with Dementia and Diabetes: Applying the Human-Centered Design Process to Continuous Glucose Monitoring,” in addition to Drs. Savoy and New Grant collaborators (mentioned above) are Daniel O. Clark, PhD, of the Regenstrief Institute and Indiana University School of Medicine, and David Klonoff, MD, University of California, San Francisco.

This research was supported by the National Institute on Aging of the National Institutes of Health under award number K01AG076971-01.

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